gms | German Medical Science

Objectives/Interrogation: Positive ulnar variance is one of the problems that cause ulnar sided wrist pain. Ulnar shortening osteotomy may be recommend to decompress the ulnar carpus and TFCC.

A novel technique of ulnar shortening osteotomy using the AO axial compression principle in a reversed compression direction used to achieve fracture simultaneous compression and shortening.

Methods: A prospect case series study was conducted on 19 patient with positive ulnar variance, 8 of them had post traumatic radial shortening. The average age was 35.6 years, the dominant hand involved in 10 patients.

The osteotomy was performed using power saw with 2 mm thick blade, 7-8 cm proximal to the DRUJ. If the desired amount of shortening is less than 3mm, a single cut was performed started at the medial border of the ulna and directed proximal and lateral.The distal fragment was fixed first with a small LC-DCP plate, then the plate was fixed tho the proximal fragment in eccentric position of the hole. The direction of the osteotomy and the axial compression of the fracture in a reversed way allow proximal slide of the distal fragment and fracture compression.

Results and Conclusions: After a mean follow up of 3.2 years, ulnar sided wrist pain improved on VAS from 6.3 to 1.9. The mean Mayo wrist score improved from 46 to 77 points and the Q-DASH score improve from 52 to 15. Non of our patient developed DRUJ instability or impingement.

The technique used in this study is simple and effective in treatment of ulnar impaction syndrome specially when special instrument and expensive implant for ulnar shortening are unavailable.