Simplified Ulnar Shortening Osteotomy Using Interosseous Wire Fixation: A Reproducible Freehand Approach

Background: Ulnar shortening osteotomy (USO) is a common surgical treatment for ulnar impaction syndrome (UIS). Various fixation methods and specialised instruments have been developed to promote bone union; however, these approaches can increase both cost and technical complexity. The study aimed to describe a simplified technique combining freehand transverse osteotomy, interosseous wire fixation and locking compression plate fixation and to evaluate its clinical outcomes. Methods: Twenty-five wrists from 23 patients (median age: 45 years) who underwent USO for UIS between January 2014 and July 2023 were retrospectively reviewed. All procedures were performed without specialised jigs or cutting guides. The primary outcome was time to radiographic union. Operative time, complications, implant-related events and patient-reported outcomes were evaluated using the Numerical Rating Scale (NRS), Hand10, Patient-Rated Wrist Evaluation (PRWE) and EuroQol 5-Dimension 5-Level (EQ-5D-5L) questionnaires. Results: Radiographic and clinical union was achieved in all patients in a median of 10 weeks (interquartile range [IQR]: 7-13), with no delayed unions or non-unions. The median operative time was 68 minutes. NRS pain scores during activity improved from 5 (IQR: 4-7) preoperatively to 2 (IQR: 2-3) at the final follow-up. Amongst the 11 patients who completed patient-reported outcome measures, Hand10 and PRWE scores improved significantly (p < 0.001). The EQ-5D-5L score showed a trend towards improvement (p = 0.053). No postoperative infections, nerve injuries or refractures occurred after plate removal. Conclusions: This simplified freehand USO technique demonstrated consistent bone healing and functional improvement in this cohort, without the need for specialised instrumentation. It may offer a practical option for the surgical management of UIS. Level of Evidence: Level IV (Therapeutic).