Non-Union and Reoperation after Ulna Shortening Osteotomy
Svenna HWL Verhiel, MD1; Sezai Özkan, MD1; Kyle R Eberlin, MD1; Neal C Chen, MD2
1Massachusetts General Hospital / Harvard University, Boston, MA, 2Massachusetts General Hospital, Boston, MA
Introduction The most common complications resulting from ulna shortening osteotomy are tendon irritation due to plate positioning and ulna non-union. Hardware irritation occurs in up to 55% of cases and non-union occurs in up to 18% of cases. Prior series suggest that tendon irritation may be associated with plate position and type. Known risk factors for non-union include higher age, poor nutrition, alcohol abuse, tobacco smoking, and diabetes. We studied the null hypothesis that there are no factors associated with reoperation after ulna shortening osteotomy. Our secondary aims were to determine the rate and type of reoperation procedures, and to report on persistent symptoms.
Materials & Methods In this retrospective study, we included all patients older than 18 years of age who underwent an ulna shortening osteotomy between January 2003 and December 2015. Medical records of patients were assessed for our explanatory variables, unplanned reoperations and reporting of symptoms. We used bivariate (Student t-test and Fisher's exact test) and multivariable analyses to identify factors associated with unplanned reoperation after ulna shortening osteotomy.
Results Among 94 patients who underwent 98 ulna shortening osteotomies, there were 34 unplanned reoperations (35%). Nineteen patients underwent removal of hardware (19%), 6 had a non-union (6.1%) and 9 patients (9.2%) underwent additional surgeries (Table 1).
Surgery on their dominant limb, trauma and prior surgery to the ipsilateral wrist were associated with unplanned reoperation. In multivariable analysis, factors independently associated with unplanned reoperation were the dominant side being affected (odds ratio 3.9; 95% CI 1.36-11) and traumatic origin (odds ratio 3.4; 95% CI 1.1-11).
Bivariate analysis identified younger age and prior surgery of the affected wrist as factors associated with unplanned hardware removal. More operations for refixation due to non-union of the osteotomy were performed in patients with a transverse osteotomy compared to patients with an oblique osteotomy (Table 2). At final follow-up, 21 out of 94 patients (22%) reported persistent ulnar-sided wrist pain.
Conclusions One in three patients will undergo an unplanned reoperation after ulna shortening osteotomy, most often due to hardware irritation or non-union of the osteotomy. Persistent ulnar sided wrist pain occurs in about 1 in 5 of patients, regardless of reoperation. Awareness of these factors may be helpful for pre-operative discussions and surgical decision-making.
Level of Evidence: level II – prognostic.
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