Osteochondral Shortening Osteotomy for the Treatment of Ulnar Impaction Syndrome

Abstract

A new technique for ulna shortening is described. It is a modification of the open-wafer procedure that preserves the distal ulna's articular surface. A 4- to 5-mm chondral-cortical bone block is removed at the distal ulna articular-metaphysis junction. Closing the bone gap results in the osteotomy site proximal to the sigmoid notch. The distal ulna chondral-cortical fragment is secured with 1 or 2 headless compression screws, which permit early motion and results in solid healing. Similar to Feldon's previously described open-wafer procedure, this new technique reduces the ulna carpal load by reducing the distal ulna carpal length at the distal radioulnar joint. This new technique eliminates the exposure of the radiocarpal joint to continuous bleeding from the distal ulna's trabecular bone as seen in Feldon's open-wafer procedure and avoids all the inherent problems associated with plating the ulna for a typical distal ulna osteotomy, such as delayed union and painful hardware.