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Outcomes of Ulnar-Shortening Osteotomy in Children and Adolescents
Martha Kebeh, AB, Sayaka Mori, BA, Monika Thothadri, PharmD MPH, Joseph L. Yellin, MD; Apurva S. Shah, MD, MBA
Children's Hospital of Philadelphia, Philadelphia, PA
Introduction: Ulnar-shortening osteotomy (USO) is a surgical procedure that corrects positive ulnar variance and offloads the ulnocarpal joint. USO indications and outcomes are not well-reported in children.
Materials & Methods: Patients <25 years old undergoing USO at a single children's hospital between 2012-2024 were identified using Current Procedural Terminology codes. Patient demographics and clinical data were collected from medical records. Patients were contacted by telephone for patient-reported outcome (PRO) collection. Data were analyzed using R and SAS statistical programming.
Results: Sixty-four USOs were performed for 58 patients (45 female) with mean age of 14.7 ± 2.9 years. The most common indication was distal radius physeal arrest (36, 56.3%), including sequelae of distal radius fractures (16, 45.7%) and gymnast wrist (16, 45.7%), followed by Madelung deformity (13, 20.3%) and idiopathic ulnar impaction syndrome (11, 17.2%). Sixteen of 52 athletes (30.8%) were current or former gymnasts. Median pre- and postoperative ulnar variance was 4.6 and -0.47 millimeters respectively, with median shortening of 4.4 millimeters. Concurrent wrist arthroscopy and distal ulnar epiphysiodesis were performed in 30 (46.9%) and 17 (26.6%) cases, respectively. All cases achieved radiographic union at a median 73.5 days postoperatively. Plate length differed between commercial systems and small/mini-fragment hardware (84.0 vs. 61.0 millimeters, p<0.001), but plate type was not significantly associated with shortening length, hardware removal, pain resolution, or procedure length. Eight (38.1%) forearms underwent hardware removal. Twenty (34.5%) patients provided PROs at a mean of 5.0 ± 2.9 years after USO. Among athletes, 78.6% fully returned to sports. PROMIS Upper Extremity and QuickDash Sports/Music Module scores were within normal ranges. The median appearance score of the operated arm was 90.0/100.0 (100=normal), and the median Wong-Baker/FACES Pain Score was 1.0/10.0 (0="No Hurt"). Patients with a TFCC tear were more likely to report pain at latest follow-up or PRO collection (p=0.02). Residual ulnar positive or neutral variance was associated with higher residual pain compared to residual ulnar negative variance (p=0.004).
Conclusion: In children undergoing USO, union rates are higher and complication rates are lower compared to the adult population. Most children and adolescents undergoing USO experience pain relief and are able to return to sports at their preoperative level of competition. Concomitant TFCC injury and residual ulnar positive variance may contribute to persistent or residual pain.
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