Optimized step-cut ulnar shortening osteotomy: A less invasive technique with a dedicated guide and plate.

PURPOSE: Ulnar shortening osteotomy (USO) is a standard treatment for ulnar impaction syndrome and triangular fibrocartilage complex (TFCC) injuries. However, complications such as delayed union, nonunion, and refracture after implant removal remain controversial issues. This study aimed to evaluate the clinical outcomes of modified step-cut USO using an osteotomy guide and a specialized ulnar shortening plate designed to maximize bone contact, enhance fixation stability, and reduce the invasiveness of the procedure.

METHODS

A retrospective case series involving 23 consecutive patients (23 wrists) who underwent step-cut USO using a dedicated osteotomy guide and plate (Nagoya, Japan) between 2021 and 2024 was conducted. The indications for surgery included ulnar impaction syndrome (n = 14) and TFCC tears (n = 9). The outcomes assessed included wrist range of motion, grip strength, pain using Visual analogue Scale (VAS), Disabilities of the Arm, Shoulder, and Hand score (DASH), radiographic union, and complications.

RESULTS

At a mean follow-up of 15.3 months, significant improvements were observed in the VAS and DASH scores, while the range of motion and grip strength were preserved. All patients achieved bone union, with a mean union time of 13 weeks and complete consolidation at 8 months. One patient with osteoporosis showed delayed union but achieved final healing. No cases of nonunion, implant-related complications, or fractures were observed. Mild plate irritation occurred in six cases but did not interfere with the patients' daily activities.

CONCLUSION

Step-cut USO using a dedicated ulnar shortening device is characterized by high bone union rates and minimal complications, providing a reliable low-profile fixation method and potentially reducing complications associated with conventional techniques.

LEVEL OF EVIDENCE: IV (Therapeutic case series).