Review Question - QID 219759

Ulnar shortening osteotomy is associated with increased complication and reoperation rates when compared to arthroscopic wafer procedure in the treatment of ulnocarpal abutment syndrome (Answer 1).

The patient has ulnar-sided wrist pain and radiographic findings of ulnar positivity, consistent with ulnocarpal abutment syndrome. Two of the available surgical management options for ulnar abutment syndrome include arthroscopic wafer procedure and ulnar shortening osteotomy. Ulnar shortening osteotomy has been demonstrated to have equivalent 1-year postoperative clinical outcome scores, grip strength, range of motion, and pain scores compared with the arthroscopic wafer procedure; however, ulnar shortening osteotomy is associated with increased reoperation rates (often symptomatic hardware requiring removal) and longer return to work times.

Afifi et al. performed a prospective randomized control trial comparing the arthroscopic wafer procedure and ulnar shortening osteotomy to treat ulnocarpal abutment syndrome. They concluded that the arthroscopic wafer procedure allows for an earlier return to work and lower complication rates but equivalent grip strength, range of motion, and DASH scores. 37% of patients with ulnar shortening osteotomy required reoperation for hardware irritation.

Constantine et al. performed a retrospective review of 22 patients who underwent either open ulnar wafer procedure or ulnar shortening osteotomy. They found no statistically significant differences in grip strength or range of motion at the final follow-up. 5 of 11 patients who underwent ulnar shortening osteotomy required hardware removal for extensor carpi ulnaris tendon irritation.

Oh et al. performed a retrospective review of 19 patients after the arthroscopic wafer procedure and 23 patients after ulnar shortening osteotomy. They found similar clinical and radiologic outcomes at 2 years after surgery. However, the arthroscopic wafer procedure showed lower overall complication rates and better grip strength and DASH scores 3 months after surgery.

Figure A is the AP radiograph of a wrist with ulnar positive variance.

Incorrect Answers:
Answers 2-3: Patients undergoing arthroscopic wafer procedure have an equivalent range of motion and grip strength at 1-year postoperative follow-up compared with ulnar shortening osteotomy.
Answer 4: Patients who undergo the arthroscopic wafer procedure return to work sooner on average than those who undergo ulnar shortening osteotomy.
Answer 5: Arthroscopic wafer procedure and ulnar shortening osteotomy result in similar clinical outcome scores at 1-year postoperative follow-up.