Outcomes of ulna shortening osteotomy: a cohort analysis of 106 patients
Authors: Teunissen J. S. , Wouters R. M. , Al Shaer S. , Zöphel O. T. , Vermeulen G. M. , Hovius S. E. R. , Van der Heijden E. P. A. ,   The Hand-Wrist Study Group, Blomme R. A. M. , Sluijter B. J. R. , van der Avoort D. J. J. C. , Kroeze A. , Smit J. , Debeij J. , Walbeehm E. T. , van Couwelaar G. M. , Vermeulen G. M. , de Schipper J. P. , Temming J. F. M. , van Uchelen J. H. , de Boer H. L. , de Haas K. P. , Harmsen K , Zöphel O. T. , Feitz R. , Halbesma G. J. , Souer J. S. , Koch R. , Hovius S. E. R. , Moojen T. M. , Smit X. , van Huis R. , Pennehouat P. Y. , Schoneveld K. , van Kooij Y. E. , Wouters R. M. , Veltkamp J. J. , Fink A. , de Ridder W. A. , Slijper H. P. , Selles R. W. , Porsius J. T. , Tsehaie J. , Poelstra R. , Jansen M. C. , van der Oest M. J. W. , Sun P. O. , Hoogendam L. , Teunissen J. S. , Dekker Jak , Jansen-Landheer M. , ter Stege M. , Zuidam J. M. , Colaris J. W. , Duraku L. , van der Heijden E. P. A. , van Groeninghen D. E. 
Published: January 2022

Abstract
Background
Ulna shortening osteotomy (USO) for ulnar impaction syndrome (UIS) aims to improve pain and function by unloading the ulnar carpus. Previous studies often lack validated patient-reported outcomes or have small sample sizes. The primary objective of this study was to investigate patient-reported pain and hand function at 12 months after USO for UIS. Secondary objectives were to investigate the active range of motion, grip strength, complications, and whether outcomes differed based on etiology.

Materials and methods
We report on 106 patients with UIS who received USO between 2012 and 2019. In 44 of these patients, USO was performed secondary to distal radius fracture. Pain and function were measured with the Patient Rated Wrist/Hand Evaluation (PRWHE) before surgery and at 3 and 12 months after surgery. Active range of motion and grip strength were measured before surgery and at 3 and 12 months after surgery. Complications were scored using the International Consortium for Health Outcome Measurement Complications in Hand and Wrist conditions (ICHAW) tool.

Results
The PRWHE total score improved from a mean of 64 (SD = 18) before surgery to 40 (22) at 3 months and 32 (23) at 12 months after surgery (P  < 0.001; effect size Cohen’s d = −1.4). There was no difference in the improvement in PRWHE total score (P = 0.99) based on etiology. Also, no clinically relevant changes in the active range of motion were measured. Independent of etiology, mean grip strength improved from 24 (11) before surgery to 30 (12) at 12 months (P  = 0.001). Sixty-four percent of patients experienced at least one complication, ranging from minor to severe. Of the 80 complications in total, 50 patients (47%) had complaints of hardware irritation, of which 34 (32%) had their hardware removed. Six patients (6%) needed refixation because of nonunion.

Conclusion
We found beneficial outcomes in patients with UIS that underwent USO, although there was a large variance in the outcome and a relatively high number of complications (which includes plate removals). Results of this study may be used in preoperative counseling and shared decision-making when considering USO.

Level of evidence
Therapeutic III.