J Hand Surg Am 2012;37:1071-1077. Background The purpose of ulnar shortening osteotomy is literally to shorten the ulna. Ulnar Shortening Osterotomy Shortens ulnar to treat ulnar impaction syndrome Reduces load across TFCC Goal to reduce chronic wrist pain Advantage of USO: DRUJ and TFCC stay intact Needs complete healing of osteotomy site up to 12-14 weeks, 16 weeks to full activity Immobilization in cast 4 weeks long arm 4 weeks short arm to 12-14 weeks The clinical outcomes of USO are also satisfactory [2, 4, 6, 7]. Background Ulnar impaction syndrome (UIS) is a common cause of ulnar wrist pain. See Video 59: Ulnar Shortening Osteotomy. Ulnocarpal Abutment Syndrome is a common source of ulnar sided wrist pain secondary to excessive impact stress between the ulna and the carpal bones (primarily lunate). However, indications for ulnar shortening have increased over the years to include luno-triquetral tears and early degenerative arthritis at the distal radial-ulnar joint. Its aim is to offload the lunate by redirecting the compression stress of the grip forces toward the scaphoid. This can be achieved by diaphyseal or metaphyseal osteotomy, or by arthroscopic epiphyseal resection. STEP 4 - Performing the Oblique Ulnar Shortening Osteotomy Use either of the dedicated saw blades designed for the ulnar osteotomy and make the DISTAL cut first. 4-7. You may also require an ulnar osteotomy after an injury that dislocates the radius bone and fractures the ulnar bone in your elbow joint. Finely adjustable saw guide (2-8 mm) for precise and parallel osteotomies. The rationale is that by restoration of the distal radial and ulnar anatomy to as nearly normal as possible, biomechanical improvements will result leading to improved function in the wrist and hand. Procedure 81 Ulnar Shortening Osteotomy. regional block (brachial) used for the procedure. At our institution, ulnar shortening osteotomy is the preferred procedure to manage this disorder. 1,2 Previous research on USO has predominantly focused on outcomes in terms of pain, function, and complications. Instruct on wound care. The purpose of this study was to present patient reported outcomes and complication rates of ulnar shortening osteotomy . Procedure: Ulnar shortening osteotomy A longitudinal incision of approximately 8 cm is made at the distal third of the ulna along the ulnar border of the forearm. Surgically, Milch 4 described a shortening osteotomy of the ulna to treat UC after distal radius fractures; this procedure often remains the treatment of choice, especially when there is a positive ulnar variance. Clinical benefits. Goal of this procedure is to minimize the symptoms by restoring the neutral radio - ulnar variance. ulnar shortening osteotomy U lnar shortening osteotomy (USO) is a common treatment for ulnar impaction syndrome. ulnar shortening group :this is the most logical technique, dorsoulnar incision is made on the distal one-third of the forearm then a 6 hole 3.5 mm Dcp plate is position,osteotomy using oscillating saw in z-shaped manner. The management of ulnar impaction syndrome varies from conservative, symptomatic treatment to open procedures to shorten the ulna. Ulnar shortening at the index procedure was associated with significantly higher preoperative lunate subsidence, ulnar variance, and palmar carpal displacement. Ulnar shortening surgery also known as ulnar osteotomy is a surgery where a section of the ulna bone is cut out in order to shorten the length of the ulna bone. BACKGROUND: There are no established guidelines on the age or the severity of deformity for which an ulna shortening osteotomy or ulna epiphysiodesis should be performed in children and adolescents with Madelung deformity. Ulnar shortening osteotomy (USO) is the standard procedure for correcting positive ulnar variance. Irrigate with sterile slush saline to minimize thermal necrosis. The treatment of this condition involves conservative treatment or surgical treatment. Be sure the cutting The saw guide was then removed. Ulnar-positive variance correction averaged 4.4 mm. I just had an ulnar shortening osteotomy & wrist scope surgery done on my right arm and wrist yesterday. If this fails, there are currently three surgical options: the arthroscopic 'wafer' procedure, ulnar shortening osteotomy (USO) and hemiresection arthroplasty. results of using dorsolateral wedge subtraction osteotomy of the radius together with an ulnar shortening osteotomy to treat this condition. Radial Malunion Osteotomy with Persistent Ulnar-Plus Variance Intraoperatively . Then at the graduation corresponding to the required resection. The purpose of this study was to determine if the Camembert osteotomy is effective in improving clinical . Patients with UIS present with pain in the ulnar aspect of the wrist. He recommended the Ulnar Shortening Osteotomy, saying that essentially, despite the somewhat uncertain diagnosis, it was bound to relieve the pressure put on my lunate, which was the cause of my pain. The belief is that the pinky side of the wrist (called the ulnar side) gets arthritis and accumulated damage because people are born with an ulna bone that's too long. An ulnar shortening osteotomy is a common procedure in wrist surgery and was originally described by Milch in 1941 for the treatment of an ulnar positive variance following a distal radius malunion. Jennifer Waljee, Sandeep J. Sebastin, Kevin C. Chung. Time Frame Treatment Goals Phase I Post-Op Day 10-14 •Evaluate and Treat. The procedure is actually called an ulnar shortening osteotomy. Low plate profile of 3.2 mm". The purpose of this study was to identify radiographic criteria associated with the eventual performance for an ulna shortening procedure in this patient population. This surgical procedure can promote increased movement and less pain across the ulnar side of your wrist. For example, use the left ulnar shortening guide for a medial approach if the osteotomy is performed on the right ulna. Published online: 2020-05-01 276 Special Review Article Single-Cut Single-Screw Capitate-Shortening Osteotomy for Kienbock's Disease Gregory I. Bain, PhD, MBBS, FRACS, FA(Ortho)A1,2 Sathya Vamsi Krishna, MBBS, MS(Ortho)2 Simon Bruce Murdoch MacLean, MBChB, FRCSEd (Tr&Orth), PGDipCE3 Parth Agrawal, MBBS, MS (Ortho)2 1 Department of Orthopedic Surgery and Trauma, Flinders University, Address . The ulna is exposed at its distal third preserving the periosteum. 10.1053/jhsu.2000.jhsu025a0055. Perform the two cuts necessary for the ulnar shortening osteotomy using the cutting guide at graduation 0 at first. 7. Goal of this procedure is to minimize the symptoms by restoring the neutral radio - ulnar variance. The LCP Ulna Osteotomy Plate 2.7 is intended to be placed on the volar flat surface of the ulna, just proximal to the pronator quadratus muscle. Comparison of ulnar shortening osteotomy and the wafer resection procedure as treatment for ulnar impaction syndrome. Ulnar impaction syndrome (ulnocarpal abutment) Malunited distal radius fractures with loss of radial height. J Hand Surg Am. ULNAR SHORTENING OSTEOTOMY DR MENCIAS, MD 7-10 DAYS POST OP Fabricate custom wrist splint with dorsal clamshell piece. The advantages of the wafer procedure over other decompressive procedures, such as ulnar shortening osteotomy, are as follows: Does not require bone healing. The latter offers the advantage to re . Ulnar shortening osteotomy (USO) is the standard procedure for correcting positive ulnar variance. Ulna shortening osteotomy versus arthroscopic wafer procedure in the treatment of ulnocarpal impingement syndrome Post-traumatic or constitutional ulnar impaction syndrome can be treated by shortening the ulna. If complete . Postoperative residual ulnar side wrist pain is related to the degree of reduction. In this paper we present a variety of surgical techniques available for ulnar shorthening osteotomy, their advantages and . Ulnar shortening osteotomy has been the gold standard for many years with favorable outcome9, 11 but the procedure is also associated with many potential complications, including Acknowledgements The authors thank Molly Vogt, PhD, for assisting in the statistical analysis of our results. Initiate AROM of all uninvolved joints. When the ulna pushes on the wrist, or if there has been past injury to the ulnar-sided wrist bones, normal motions of the hand can induce pain. In Kienböck's disease, radius shortening osteotomy is the most common treatment. Had the same surgery done on my right ulna 3 months ago and am scheduled to go back for a bone graft on May 14 due to non-union, from hardware failure and overuse too soon. Ulnar Shortening Osteotomy Dr. Staiger *If needed schedule OT same day as doctor. Less information is available on whether and when patients can return to their usual work. Rotation-proof and guided compression. It can tighten the triangular fibrocartilage complex (TFCC), ulnocarpal ligaments, and interosseous membrane. Ulnar shortening is a useful procedure for TFCC tears associated with . Therapy 1-2 times per week Tomaino MM, Shah M. Treatment of ulnar impaction Typically, ulnar-positive or -neutral variance is seen on a posteroanterior radiograph of the wrist. The first ulnar-shortening osteotomy was described by Milch in 1941. Treatment includes a trial of rest and splinting for minimally . Milch's technique entailed resection of a portion of the ulnar shaft with wire fixation at the osteotomy site. The most common surgical options to treat ulnar impaction syndrome (after physical therapy or other modalities have failed) include an ulnar shortening osteotomy (25390, Osteoplasty, radius or ulna; shortening) and hemiresection arthroplasty (25442, Arthroplasty with prosthetic replacement; distal ulna). The surgical treatments are based on the theory that shortening the ulna will decrease the load on the TFCC (3). The extra-articular ulnar shortening osteotomy is a common and widely accepted procedure for the surgical treatment of ulnar impaction syndrome, or ulnocarpal abutment syndrome, which is characterized as a degenerative condition of the ulnar side of the wrist that is related to excessive load-bearing between structures of the ulnocarpal joint. Sliding the head of the ulna proximally achieves the desired shortening of up to 5 mm, and the head is fixed using 2, 3, or 4 cannulated headless screws. corresponding carpus. Purpose: To investigate the results of ulnar-shortening osteotomy, arthroscopy wafer procedure, and distal metaphyseal ulnar-shortening osteotomy for the treatment of ulnar impaction syndrome. Biomechanical studies have shown that structural stiffness in torsion is clearly greater for oblique osteotomy [2, 11]. A slight correction of the axis of the ulnar head is also possible. Recess on the plate allows for osteotomy with fixed plate. ** Remember the procedure was completed to eliminate pain on the ulnar side of the wrist, so the client should complete the exercises in a comfortable range. Excision of epiphyseal bar, with or without autogenous soft tissue graft obtained through the same fascial incision (20150) Incision deep, with opening of bone cortex; elbow or upper arm (23930) Osteotomy, radius; distal third (25350) Provides direct access to TFCC. The primary objective of this study was to investigate patient-reported pain and hand function at 12 months after USO for UIS. The resection is thus made by two oblique saw cuts. distal hole the closest to the osteotomy site. It takes weeks to months to get full rotation back without discomfort and resistance. The amount of lengthening is determined pre- 2000; 25(1):55-60. did shortening of about 5 mm by doing a semilunar osteotomy of lateral condyle in addition to the dome osteotomy in one patient with severe elbow varus deformity . Kanaujia et al. An ulnar shortening osteotomy removes part of the ulna bone and inserts a plate to hold the bone together. The Camembert procedure is a wedge osteotomy that shortens only the radius facing the lunate. Complications included 1 reflex sympathetic dystrophy and 2 fractures through the osteotomy site after early plate removal. Alternatives: An alternative to this procedure is extra-articular osteotomy using a palmar or dorsal ulnar approach. Osteotomy CPT Codes. Previous studies often lack validated patient-reported outcomes or have small sample sizes. This visual case study of a 26-year-old female with ulna impaction, presented by William Geissler, Professor and Chief, Division of Hand and Upper Extremity Surgery, University of Mississippi Medical Center, demonstrates the step-by-step process of an ulna shortening osteotomy using the Acumed Osteotomy System featuring the Ulna Shortening Plate. Ulna Shortening Osteotomy This handout explains the follow-up care after ulna shortening osteotomy surgery. Nowadays, this method is used to treat ulnar-sided wrist pain, for which we have also started to use a treatment algorithm. Furthermore, the specifically designed ulnar shortening osteotomy plate significantly simplifies the procedure for the surgeon and improves patient outcomes with relief of ulnar-sided wrist pain. Hammert WC, Williams RB, Greenberg JA. In cases of UIS refractory to nonperative treatment, several surgical techniqes have been described, including arthroscopic triangular fibrocartilage complex debrideent, arthroscopic wafer procedure, and ulnar shortening osteotomy (USO). The surgery can cost between $2,000 and $6,000, depending on the location, the age of the dog, the complexity of the deviation and the severity of the limb deformity. Ulnar Shortening Osteotomy SURGERY Type of Operation Day Case Length of Procedure 45 mins Anaesthesia Regional Anaesthetic (whole arm numb) and/or General Anaesthetic (asleep) Ulnar longer than radius at the end Ulna shorter than radius at the end Damage in the overloaded lunate bone (paler grey than other bones) MRI scan showing ulnar Hi, I had an ulna shortening osteotomy of the left forearm last summer and all went well. Conclusion: Ulnar impaction syndrome is usually combined with dorsal subluxation of ulnar head. Madelung deformity. JHandSurgAm2000;25:55-60. Since Milch [1] first described distal diaphyseal ulnar shortening osteotomy (USO) in 1941, it has been the most popular surgical procedure for ulnar impaction syndrome (UIS) [2-7]. Finger ROM. Fabricate long arm splint, 60 degrees suppination Begin elbow flexion/extension exercises. Diagnosis is made with PA wrist radiographs showing positive ulnar variance and sclerosis of the lunate. Ulnar Shortening Osteotomy for Ulnar Impaction Syndrome 13 The average ulnar variance after opertion was -0.8 mm (range -2.8-1.2), compared to +2.3 mm preoperatively (range 0.44-4.16). The saw was used with copious irrigation to make a 3.5-mm shortening, using the 2 proximal slots, which were closest together. Color Coding 4 General Instrument Application Drilling 5 Surgical Technique Lag Screw Technique 6 Assigning the Screw Length 7 Screw Pick-Up 8 Surgical Technique Ulna Shortening with Saw Guide 45° 13 Ulna Shortening with Saw Guide 90° 18 TriLock® Locking Technology ®Correct Application of the TriLock Locking Technology [ 8 ] identified complex multiplanar elbow deformities within the cohort of severe elbow deformities as having coronal angulation of > 35 ° , and . Based on this result, we believe that accurate corrective osteotomy with ulnar shortening should be performed for Madelung deformity. Postoperative range of motion and grip strength were equivalent to the contralateral wrist. The guide was placed on the volar surface of the ulna and secured by sequentially placing screws #2, #4, and #3. The Rayhack ulnar shortening osteotomy system was used. All patients presented with ulnar wrist pain and positive ulnar variance on either neutral rotation or pronated-grip x-rays and each failed conservative management. The wafer procedure can be used when any or all of these are present ( 2, 3 ). Previous work has . Ulnar variance of >5 mm and lunate subsidence >4 mm resulted in a respective 67% and a 53% likelihood of undergoing ulnar shortening osteotomy; palmar carpal displacement over 22 mm . 7. Ulnar ostectomy is an expensive surgery. 14 The overall outcome was not that good, and ulnar shortening osteotomy did not always seem to be the ultimate successful procedure for ulnar abutment. And each failed conservative management or surgical treatment Fabricate custom wrist splint with dorsal subluxation ulnar. For a medial approach if the osteotomy is literally to shorten the ulna is at... Surgical treatments are based on the theory that shortening the ulna extra-articular osteotomy using the 2 proximal slots which... 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