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Long-term Outcome of Step-Cut Distal Ulnar-Shortening Osteotomy for Ulnar Impaction Syndrome
Loukia Papatheodorou, MD; Dean G. Sotereanos, MD; Robert Weiser, MPAs, PA-C; Mark E. Baratz, MD;
Allegheny General Hospital


Extra-articular ulnar shortening osteotomy is a common procedure for the surgical treatment of ulnar impaction syndrome. In recent years, several techniques for this osteotomy have been developed to avoid the morbidity associated with traditional techniques. The purpose of this study was to evaluate the outcome of step-cut distal ulnar-shortening osteotomy for ulnar impaction syndrome.

Materials & Methods

A retrospective review was performed of 164 consecutive patients who underwent step-cut distal ulnar-shortening osteotomy between 2000 and 2010. Eighty-eight patients were female and seventy-six were male with a mean age of 36.8 years (range, 14-59y). The step-cut osteotomy had its long arm oriented in the coronal plane parallel to the long axis of the ulna. The short arms of the osteotomy were perpendicular to the long axis in the axial plane. Fixation was performed with a palmar 3.5mm neutralization plate and a lag screw. The goal of osteotomy was to reduce ulnar variance. All patients were evaluated radiographically and clinically. Ulnar variance was assessed radiographically with the pronated grip view in all patients. The preoperative ulnar variance ranged from +1mm to +6 mm.


All patients were followed for at least 12 months. The mean follow-up was 62 months (range, 12 -144 months). Union of osteotomy was achieved with a mean time of 8.2 weeks (range, 5-18 weeks). The union rate was 98.78% (162/164 cases). There were two cases of nonunion, which required additional surgery. All patients returned to daily activities in a mean period of 4 months. The mean postoperative ulnar variance was +0.2 mm (range, -1mm to +1.5mm) after a mean overall shortening of 2.5mm. Hardware removals were performed in twelve patients due to persistent plate-related symptoms (7.3%). No other complications were encountered.


The step-cut osteotomy provides ample bone-to-bone contact and easier control of rotation. Stable internal fixation in combination with rapid healing allows early return to functional activities. Palmar placement of the plate diminishes the need for plate removal caused by irritation. This is a simple and effective technique for ulnar shortening without the use of special instrumentation in patients with ulnar impaction syndrome.

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