What are the long-term outcomes of ulnar shortening osteotomy?

What are the long-term outcomes of ulnar shortening osteotomy?

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Ulnar shortening osteotomy is the established treatment for patients with ulnar impingement syndrome. Previous studies have shown good results based on radiographs and clinical examinations, but few have assessed outcomes based on patient responses to satisfaction and quality of life questionnaires.

Also read: Fixation of 1 or 2 forearm bones in pediatric radial and ulnar diaphysis fractures?

a job follow up The 6-month PRWHE questionnaire showed good functional and pain outcomes (Patient-Assessed Wrist and Hand Assessment) were answered by 106 patients with ulnar shortening osteotomies, however, data on these long-term outcomes are sparser.Published in the magazine last month Bone joint opening A study whose primary purpose was to investigate such outcomes follow up larger. Secondary goals were to assess satisfaction with surgery, complications, and need for further surgery.

What are the long-term outcomes of ulna shortening osteotomy?

Research

A prospective cohort study of 106 patients in some Dutch hospitals operating between 2011 and 2017 was conducted. All osteotomies are oblique, performed at the level of the distal diaphysis, and are performed either manually or using an external cutting device, depending on the surgeon’s preference. Ulnar impact as an indicator. The mean shortening was 4 mm, based on preoperative ulnar changes. The ulna is fixed with compression plates and screws, or with a specific system for the ulna.

Age, sex, job type, symptom duration, treatment regimen, hand dominance, and smoking at the time of surgery were routinely recorded. Charts were reviewed to collect data on initial injury treatment, surgical variables, complication occurrence, and subsequent care. The patients also underwent the Dutch version of PRWHE to assess surgical outcomes.

After a mean late follow-up of six years (SD=1), 66 patients (74%) had long-term outcomes. The mean total PRWHE score improved from 63 points before surgery to 19 points later in follow-up (mean difference (Δ) 44; 95% confidence interval (CI) 39 to 50; p = < 0.001). The PRWHE total score also improved at 12 months and subsequent follow-up (Δ 12; 95% CI 6 to 18; p = < 0.001).

understand more: In situ maintenance or advancement of the ulnar nerve in surgical treatment of distal 1/3 bimonthly fractures of the humerus?

At subsequent follow-up, 14/66 patients (21%) reported a PRWHE total score of zero, compared with 3/51 patients (6%) at 12 months (p = 0.039). In total, 58/66 patients (88%) would be repeated with the same treatment under similar circumstances. Subsequent treatment for complications or recurrent symptoms was performed in 50/66 patients (76%) (total n = 66; surgery n = 57). The most common type of reoperation was hardware removal in 42/66 (64%) and pseudoarthrosis in 8/66 (12%).

in practice

Ulnar shortening osteotomy improves patient-reported pain and function even in the long term. While satisfaction is generally high, re-operations such as hardware removal are common. In addition, it is also important to remember that for cases with ulna plus less than 4 mm, arthroscopic disc surgery is also a good option for these patients with good results and a low complication rate.

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# Teunissen JS, van der Oest MJW, Selles RW, Ulrich DJO, Hovius SER, van der Heijden B; Contributors to the Wrist Research Group. Long-term outcomes after ulnar shortening osteotomy: a mean follow-up of six years. Bone Jt open. 2022 May;3(5):375-382. doi: 10.1302/2633-1462.35.BJO-2022-0031.R1.

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