Outcomes and complications of ulnar shortening osteotomy: an institutional review.
BACKGROUND
Ulnar impaction syndrome (UIS) is a common cause of ulnar wrist pain. Patients may be candidates for surgical intervention if nonoperative options are ineffective. At our institution, ulnar shortening osteotomy is the preferred procedure to manage this disorder. The purpose of this study was to present patient reported outcomes and complication rates of ulnar shortening osteotomy (USO) at mid-term follow-up.


METHODS
A retrospective chart review of 72 patients (75 wrists) obtained from our institutional database was performed. At a mean 32 months postoperatively, telephone interviews (n = 53) were performed for all patients who were available for follow-up. The patient-rated wrist evaluation (PRWE), a validated outcome tool, was completed and complications were reviewed.


RESULTS
Patient-rated outcomes were favorable; however, complications were frequent and included: delayed union (10/75, 13.3 %), nonunion (6/75, 8 %), and complex regional pain syndrome (5/75, 6.7 %). Ten patients (13.3 %) required revision surgery. Thirty-four patients (45.3 %) required hardware removal with 4/30 (11.4 %) of these patients experiencing refracture. Smokers (mean PRWE 67.1) and patients with workers' compensation claims (mean PRWE 64.9) reported higher residual pain and disability than their counterparts (mean PRWE 28.0; 25.2).


CONCLUSIONS
General outcome measures were favorable. Smokers and patients with workers' compensation claims experienced significantly poorer outcomes. However, the incidence of nonunion and delayed union was higher than most reports in the literature. Furthermore, we demonstrated a high refracture rate (11.4 %) following removal of hardware.
Division of Orthopaedic Surgery, Western University, 339 Windermere Road, London, ON N6G 2V4 Canada.
Raghav
R
Rajgopal
Division of Orthopaedic Surgery, Western University, 339 Windermere Road, London, ON N6G 2V4 Canada ; The Roth | MacFarlane Hand and Upper Limb Centre, St. Joseph's Health Centre, Suite D0-217, 268 Grosvenor Street, London, ON N6A 4L6 Canada.
James
J
Roth
Division of Orthopaedic Surgery, Western University, 339 Windermere Road, London, ON N6G 2V4 Canada ; The Roth | MacFarlane Hand and Upper Limb Centre, St. Joseph's Health Centre, Suite D0-217, 268 Grosvenor Street, London, ON N6A 4L6 Canada.
Graham
G
King
Division of Orthopaedic Surgery, Western University, 339 Windermere Road, London, ON N6G 2V4 Canada ; The Roth | MacFarlane Hand and Upper Limb Centre, St. Joseph's Health Centre, Suite D0-217, 268 Grosvenor Street, London, ON N6A 4L6 Canada.
Ken
K
Faber
Division of Orthopaedic Surgery, Western University, 339 Windermere Road, London, ON N6G 2V4 Canada ; The Roth | MacFarlane Hand and Upper Limb Centre, St. Joseph's Health Centre, Suite D0-217, 268 Grosvenor Street, London, ON N6A 4L6 Canada.
Ruby
R
Grewal
Nonunion; PRWE; Smoking; Ulnar shortening osteotomy; Workers compensation