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Demographic Aspects of Pediatric Patients who have Undergone Ulnar Shortening Osteotomy
Abdo Bachoura, MD1; Joshua Abzug, MD2; Sidney M. Jacoby1; Dan Zlotolow, MD3; Scott Kozin, MD3; Randall W. Culp4; (1)Philadelphia Hand Center, (2)University of Maryland, (3)Shriners Hospital for Children Philadelphia, (4)Thomas Jefferson University Hospital
The Philadelphia Hand Center, Philadelphia, PA, USA

Introduction: Ulnar Shortening Osteotomy (USO) is an effective treatment for ulnar impaction syndrome (UIS) in adults. In pediatric patients however, the outcomes and demographics of this procedure have been sparsely described. The purpose of this study was to document the demographic aspects of pediatric patients who have undergone an USO.

Materials & Methods: A retrospective chart review of all patients under the age of 18 who had undergone an USO procedure between 1/1/2000 - 9/1/2011 was performed. Data collected included age, sex, the mechanism of ulnar impaction, time from injury to surgery, complications and ulnar variance (both pre and post-op).

Results: 58 procedures in 55 patients were identified. There were 17 males and 38 females with a mean age of 15.1 years (range 11-17). The mechanism of UIS was related to late effects of traumatic wrist fractures and injuries in 25 (45.5%), competitive gymnastics in 10 (18.2%), intensive racquet sport playing/training 7 (12.7%), Madelung's deformity 4 (7.3%), no identifiable cause 2 (5.5%) and other causes in 7 patients (12.7%) (1 osteogensis imperfecta, 1 brachial plexus birth injury, 1 radial hypoplasia, 1 in utero radial growth arrest, 1 joint pain following acute Lyme disease, 2 other unspecified congenital forearm deformities). The mean time from injury to surgery was 21.4 months. Complications occurred in 10 patients (18.2 %). These included: recurring deformity in 4, cubital tunnel syndrome in 2, 2nd compartment extensor tendonitis in 2, medial and lateral epicondylitis in 1, delayed union in 1 patient taking chemotherapy, nail bed ischemia in 1 and nonunion in 1 patient. Hardware removal procedures were performed in 7 patients (12.7%). Mean ulnar variance was +4.1 mm (range -1 to +10) preoperatively and -0.5 mm (Range -4 to +6) post-operative.

Conclusion: USO in pediatric patients is typically performed months to years after attempted conservative or prior surgical treatment measures have failed. Female involvement was 2.2 times that of males. Intense sports activities that chronically load the wrist contributed to a large proportion of UIS requiring USO (31%). Traumatic wrist fracture is a leading cause of UIS requiring USO, but UIS in highly competitive children such as gymnasts and tennis players may be a preventable injury. Complications of USO are varied and rates are relatively high.

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