Failed Distal Ulnar Epiphyseodesis is a Risk Factor for Revision Surgery Following Ulnar Shortening Osteotomy in Pediatric Patients
Jennifer Marks, MS1, Catherine C May, BS2, Joshua M Abzug, MD3 and Kevin J. Little, MD4, (1)Cincinnati Children's Hospital Medical Center, Ciincinnatii, OH, (2)University of Maryland School of Medicine, Timonium, MD, (3)University of Maryland School of Medicine, Baltimore, MD, (4)Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
Introduction: Ulnar shortening osteotomy (USO) is a common surgical procedure used to treat ulnar sided wrist pain. In pediatric patients, the most common indications for USO are distal radius growth arrest leading to ulnar impaction syndrome, gymnastâ€™s wrist, or TFCC injury. However, there are limited results of outcomes and healing following USO in pediatric patients, and no data regarding complications, nonunion rate, and reoperation rate have been reported for this population.
Materials & Methods: A retrospective review was conducted at two tertiary-care pediatric hospitals from 2006-2021 for patients <18 years old who underwent USO and had 6 months of clinical follow-up. Demographic and surgical data was collected and analyzed using t-tests, ANOVAâ€™s, and Chi Squared tests with p<0.05 considered significant.
Results: 39 patients (69% F) were identified and underwent USO at a mean age 14.2+1.4 years for physeal arrest (n=13, 33.3%), gymnast wrist (n=6, 15.3%), TFCC tear (n=3, 7.7%), or other diagnoses (n=17, 43.7%). The mean shortening was 5.5+3.5 mm. 16 (41%) had concomitant distal ulnar epiphyseodesis (DUE). 34 patients (87%) had no prior surgery to the wrist, while 18 (46%) presented to orthopaedics with ulnar positive variance and ulnar sided wrist pain. Mean time from initial injury or onset of symptoms to surgery was 247.1+325.1 days. There were no nonunions or delayed unions within the cohort. Three patients experienced complications (8%) requiring revision surgery and an additional eight (21%) underwent reoperation for hardware irritation at a mean of 528.6+389.8 days, resulting in a total reoperation rate of 28%. Two of sixteen DUE (13%) failed to arrest longitudinal growth of the ulna, leading to recurrent and symptomatic ulnar positive variance requiring revision USO and revision epiphyseodesis. There was no relationship between patient age, the type or orientation of the plate (volar vs dorsal), type of osteotomy (oblique vs transverse) or shortening amount with complications or the need for reoperation, and no correlation between prior surgery or patient age with complications or reoperation.
Conclusions: Outcomes of USOs were favorable with no nonunions or delayed unions, and a 28% reoperation rate, mostly due to hardware irritation. Concomitant DUE had a 13% failure rate. There was no difference in the complication rate for patients due to type of osteotomy, plate placement, amount of shortening or patient age. Ulnar shortening osteotomies were a suitable technique to resolve ulnar variance, with the caveat that concomitant DUE had a 13% failure rate necessitating revision surgery.
Back to 2024 Abstracts