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Ulnar Shortening Osteotomy Utilizing a TriMed Ulnar Osteotomy System

Pouliot, Michael MD; Yao, Jeffrey MD

Techniques in Hand & Upper Extremity Surgery: June 2014 - Volume 18 - Issue 2 - p 72–76
doi: 10.1097/BTH.0000000000000039
Techniques

Ulnar impaction syndrome (UIS) is a degenerative condition of the ulnar wrist typically seen in patients with static or dynamic ulnar-positive variance. Impaction of the distal ulna on the proximal lunate and triquetrum leads to degeneration of the triangular fibrocartilage complex and/or the chondral surfaces of the lunate and triquetrum. Patients with UIS present with pain in the ulnar aspect of the wrist. In cases of UIS refractory to nonoperative treatment, several surgical techniques have been described, including arthroscopic triangular fibrocartilage complex debridement, arthroscopic wafer procedure, and ulnar shortening osteotomy (USO). USO has gained favor as a reliable technique to offload the forces seen at the ulnar wrist extra-articularly while preserving the distal radioulnar joint stabilizing structures. We describe a technique utilizing a jig-facilitated, oblique, diaphyseal USO and fixed with a TriMed ulnar osteotomy compression plate. This system allows for precise measured ulnar shortening and reliable compression across the osteotomy site, and has been shown to decrease operative times and achieve to high union rates. Plate prominence is minimized by utilizing the volar surface of the ulna, although plate prominence and subsequent need for hardware removal remain a relatively common complication.

Stanford University Medical Center, Redwood City, CA

Conflicts of Interest and Source of Funding: J.Y. served on the speaker's bureau for TriMed but has not received royalties. The authors report no conflicts of interest.

Address correspondence and reprint requests to Jeffrey Yao, MD, Stanford University Medical Center, 450 Broadway Street, Suite C442, Redwood City, CA 94063. E-mail: jyao@stanford.edu.

© 2014 by Lippincott Williams & Wilkins