Step-Cut Ulnar Shortening Osteotomy for Ulnar Impaction Syndrome.

[Introduction][1] The step-cut ulnar shortening osteotomy for the treatment of ulnar impaction syndrome is a safe, reliable, and less expensive technique that uses a 7-hole 3.5-mm standard neutralization plate and a lag screw for fixation, thus avoiding the need for the special instrumentation that other ulnar shortening techniques require. [Indications & Contraindications][2] [Step 1: Preoperative Planning][3] Perform a physical examination and obtain imaging studies to identify all associated abnormalities. [Step 2: Wrist Arthroscopy][4] ([Video 1][5]) Verify the diagnosis of ulnar impaction syndrome and treat concurrent intra-articular abnormalities. [Step 3: Incision for the Ulnar Shortening Osteotomy][6] ([Video 2][7]) Make a longitudinal skin incision along the distal third of the ulna. [Step 4: Design the Step-Cut Ulnar Shortening Osteotomy][8] ([Video 2][7]) Design the step-cut ulnar shortening osteotomy. [Step 5: Perform the Step-Cut Ulnar Shortening Osteotomy][9] ([Video 2][7]) Create the step-cut ulnar shortening osteotomy using an oscillating saw. [Step 6: Fixation of the Osteotomy][10] ([Video 3][11]) Fix the osteotomy with a lag screw and volar plate. [Step 7: Wound Closure][12] Meticulously close the wound in layers. [Step 8: Postoperative Care][13] Protect the affected arm for the first 6 weeks. [Results][14] In our original study, 164 patients with symptomatic ulnar impaction syndrome were treated with a step-cut ulnar shortening osteotomy using a volar 3.5-mm standard neutralization plate and a lag screw[14][15]. [Pitfalls & Challenges][16] [Introduction][1] The step-cut ulnar shortening osteotomy for the treatment of ulnar impaction syndrome is a safe, reliable, and less expensive technique that uses a 7-hole 3.5-mm standard neutralization plate and a lag screw for fixation, thus avoiding the need for the special instrumentation that other ulnar shortening techniques require. [Indications & Contraindications][2] [Step 1: Preoperative Planning][3] Perform a physical examination and obtain imaging studies to identify all associated abnormalities. [Step 2: Wrist Arthroscopy][4] ([Video 1][5]) Verify the diagnosis of ulnar impaction syndrome and treat concurrent intra-articular abnormalities. [Step 3: Incision for the Ulnar Shortening Osteotomy][6] ([Video 2][7]) Make a longitudinal skin incision along the distal third of the ulna. [Step 4: Design the Step-Cut Ulnar Shortening Osteotomy][8] ([Video 2][7]) Design the step-cut ulnar shortening osteotomy. [Step 5: Perform the Step-Cut Ulnar Shortening Osteotomy][9] ([Video 2][7]) Create the step-cut ulnar shortening osteotomy using an oscillating saw. [Step 6: Fixation of the Osteotomy][10] ([Video 3][11]) Fix the osteotomy with a lag screw and volar plate. [Step 7: Wound Closure][12] Meticulously close the wound in layers. [Step 8: Postoperative Care][13] Protect the affected arm for the first 6 weeks. [Results][14] In our original study, 164 patients with symptomatic ulnar impaction syndrome were treated with a step-cut ulnar shortening osteotomy using a volar 3.5-mm standard neutralization plate and a lag screw[14][15]. [Pitfalls & Challenges][16] [1]: #sec-14 [2]: #sec-15 [3]: #sec-18 [4]: #sec-19 [5]: #media-1 [6]: #sec-20 [7]: #media-2 [8]: #sec-21 [9]: #sec-22 [10]: #sec-23 [11]: #media-3 [12]: #sec-24 [13]: #sec-25 [14]: #sec-26 [15]: #ref-14 [16]: #sec-27