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INTRODUCTION

Ulnar shortening osteotomy is a reconstructive procedure for the wrist for patients experiencing pain and dysfunction from ulnocarpal impingement related to ulnar positive variance. Systems that use standardized cutting jigs for this procedure aim to improve consistency and reproducibility of surgical outcomes. This study examined patient characteristics and long term results of ulnar shortening osteotomy using the Trimed Dynamic Compression Plate over a four year span at a single institution.

METHODS

Medical charts were reviewed for 28 osteotomies between 2008 and 2011. Average patient age at time of surgery was 33 years. Mean duration of follow up was 24 months. Twenty-one (75%) wrists had chronic degenerative ulnar abutment, and eight (25%) had a posttraumatic etiology. Radiographic evidence of bony union was the primary study outcome. For a subset of 12 patients, range-of-motion, strength, radiographic alignment and patient outcomes scores for the Disabilities of Arm, Shoulder, and Hand score (Quick DASH), Patient Rated Wrist Evaluation score (PRWE), and visual analog pain scale (VAS) were obtained. Effect of patient-based risk factors that could deleteriously impact union rate or outcome scores were analyzed using T-Tests and Chi-square Tests using 0.05 for threshold for significance.

RESULTS

At time of follow up average grip strength as a percentage of control contralateral side was 79.4%. Average pinch strength was 88% of contralateral. Range of motion was uniformly greater than 90% of contralateral. Average Quick DASH score was 34.3 ± 22.47, average PRWE score was 41.1 ± 20.68, and average VAS score was 3.3 ± 2.8. Radiographically, average ulnar shortening was 3.9 (+/-1.8)mm. Bony union was obtained within 18 months after primary procedure in 86% of procedures. Patient-based risk factors did not significantly affect radiographic union, although workers compensation decreased the union rate by 25% (p=.105). However Workers Compensation exerted a significant negative effect on Quick DASH and PRWE scores, resulting in two-fold increases (p≤0.037).

CONCLUSIONS

Ulnar shortening osteotomy using the Trimed Dynamic Compression Plate is a reliable treatment for pain and dysfunction secondary to pathologic conditions that produce positive ulnar variance. Workers Compensation may negatively impact outcomes, suggested by a trend toward lower rate of bony healing and significant exacerbation of patient-based outcome scores. Limitations include small study sample, retrospective data collection, and potential selection bias in patients completing more extensive follow-up. Randomized control trials are needed to best determine the merit of this system.