Outcomes of ulna shortening osteotomy: a cohort analysis of 106 patients

J. S. Teunissen; R. M. Wouters; S. Al Shaer; O. T. Zöphel; G. M. Vermeulen; S. E.R. Hovius; the Hand-Wrist Study Group; E. P.A. van der Heijden

doi:10.1186/s10195-021-00621-8

Outcomes of ulna shortening osteotomy: a cohort analysis of 106 patients

J. S. Teunissen^*, R. M. Wouters, S. Al Shaer, O. T. Zöphel, G. M. Vermeulen, S. E.R. Hovius, the Hand-Wrist Study Group, E. P.A. van der Heijden

^*Corresponding author for this work

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Abstract

Background: Ulna shortening osteotomy (USO) for ulnar impaction syndrome (UIS) aims to improve pain and function by unloading the ulnar carpus. Previous studies often lack validated patient-reported outcomes or have small sample sizes. The primary objective of this study was to investigate patient-reported pain and hand function at 12 months after USO for UIS. Secondary objectives were to investigate the active range of motion, grip strength, complications, and whether outcomes differed based on etiology. Materials and methods: We report on 106 patients with UIS who received USO between 2012 and 2019. In 44 of these patients, USO was performed secondary to distal radius fracture. Pain and function were measured with the Patient Rated Wrist/Hand Evaluation (PRWHE) before surgery and at 3 and 12 months after surgery. Active range of motion and grip strength were measured before surgery and at 3 and 12 months after surgery. Complications were scored using the International Consortium for Health Outcome Measurement Complications in Hand and Wrist conditions (ICHAW) tool. Results: The PRWHE total score improved from a mean of 64 (SD = 18) before surgery to 40 (22) at 3 months and 32 (23) at 12 months after surgery (P < 0.001; effect size Cohen’s d = −1.4). There was no difference in the improvement in PRWHE total score (P = 0.99) based on etiology. Also, no clinically relevant changes in the active range of motion were measured. Independent of etiology, mean grip strength improved from 24 (11) before surgery to 30 (12) at 12 months (P = 0.001). Sixty-four percent of patients experienced at least one complication, ranging from minor to severe. Of the 80 complications in total, 50 patients (47%) had complaints of hardware irritation, of which 34 (32%) had their hardware removed. Six patients (6%) needed refixation because of nonunion. Conclusion: We found beneficial outcomes in patients with UIS that underwent USO, although there was a large variance in the outcome and a relatively high number of complications (which includes plate removals). Results of this study may be used in preoperative counseling and shared decision-making when considering USO. Level of evidence: Therapeutic III.

Original language	English
Article number	1
Journal	Journal of Orthopaedics and Traumatology
Volume	23
Issue number	1
DOIs	https://doi.org/10.1186/s10195-021-00621-8
Publication status	Published - Dec 2022

Bibliographical note

Funding Information:
We thank all patients who participated and allowed their data to be anonymously used for the present study. Hand Wrist Study Group contributors: R. A. M. Blomme, B. J. R. Sluijter, D. J. J. C. van der Avoort, A. Kroeze, J. Smit, J. Debeij, E. T. Walbeehm, G. M. van Couwelaar, G. M. Vermeulen, J. P. de Schipper, J. F. M. Temming, J. H. van Uchelen, H. L. de Boer, K. P. de Haas, K. Harmsen, O. T. Zöphel, R. Feitz, G. J. Halbesma, J. S. Souer, R. Koch, S. E. R. Hovius, T. M. Moojen, X. Smit, R. van Huis, P. Y. Pennehouat, K. Schoneveld, Y. E. van Kooij, R. M. Wouters, J. J. Veltkamp, A. Fink, W. A. de Ridder, H. P. Slijper, R. W. Selles, J. T. Porsius, J. Tsehaie, R. Poelstra, M. C. Jansen, M. J. W. van der Oest, P. O. Sun, L. Hoogendam, J. S. Teunissen, Jak Dekker, M. Jansen-Landheer, M. ter Stege, J. M. Zuidam, J. W. Colaris, L. Duraku, E. P. A. van der Heijden, and D. E. van Groeninghen.

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© 2022, The Author(s).

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@article{5a8ed84bea6e44a0b169d4aa14683ed0,

title = "Outcomes of ulna shortening osteotomy: a cohort analysis of 106 patients",

abstract = "Background: Ulna shortening osteotomy (USO) for ulnar impaction syndrome (UIS) aims to improve pain and function by unloading the ulnar carpus. Previous studies often lack validated patient-reported outcomes or have small sample sizes. The primary objective of this study was to investigate patient-reported pain and hand function at 12 months after USO for UIS. Secondary objectives were to investigate the active range of motion, grip strength, complications, and whether outcomes differed based on etiology. Materials and methods: We report on 106 patients with UIS who received USO between 2012 and 2019. In 44 of these patients, USO was performed secondary to distal radius fracture. Pain and function were measured with the Patient Rated Wrist/Hand Evaluation (PRWHE) before surgery and at 3 and 12 months after surgery. Active range of motion and grip strength were measured before surgery and at 3 and 12 months after surgery. Complications were scored using the International Consortium for Health Outcome Measurement Complications in Hand and Wrist conditions (ICHAW) tool. Results: The PRWHE total score improved from a mean of 64 (SD = 18) before surgery to 40 (22) at 3 months and 32 (23) at 12 months after surgery (P < 0.001; effect size Cohen{\textquoteright}s d = −1.4). There was no difference in the improvement in PRWHE total score (P = 0.99) based on etiology. Also, no clinically relevant changes in the active range of motion were measured. Independent of etiology, mean grip strength improved from 24 (11) before surgery to 30 (12) at 12 months (P = 0.001). Sixty-four percent of patients experienced at least one complication, ranging from minor to severe. Of the 80 complications in total, 50 patients (47%) had complaints of hardware irritation, of which 34 (32%) had their hardware removed. Six patients (6%) needed refixation because of nonunion. Conclusion: We found beneficial outcomes in patients with UIS that underwent USO, although there was a large variance in the outcome and a relatively high number of complications (which includes plate removals). Results of this study may be used in preoperative counseling and shared decision-making when considering USO. Level of evidence: Therapeutic III.",

author = "Teunissen, {J. S.} and Wouters, {R. M.} and {Al Shaer}, S. and Z{\"o}phel, {O. T.} and Vermeulen, {G. M.} and Hovius, {S. E.R.} and {the Hand-Wrist Study Group} and {van der Heijden}, {E. P.A.} and Blomme, {R. A.M.} and Sluijter, {B. J.R.} and {van der Avoort}, {D. J.J.C.} and A. Kroeze and J. Smit and J. Debeij and Walbeehm, {E. T.} and {van Couwelaar}, {G. M.} and Vermeulen, {G. M.} and {de Schipper}, {J. P.} and Temming, {J. F.M.} and {van Uchelen}, {J. H.} and {de Boer}, {H. L.} and {de Haas}, {K. P.} and K. Harmsen and Z{\"o}phel, {O. T.} and R. Feitz and Halbesma, {G. J.} and Souer, {J. S.} and R. Koch and Hovius, {S. E.R.} and Moojen, {T. M.} and X. Smit and {van Huis}, R. and Pennehouat, {P. Y.} and {van Kooij}, {Y. E.} and Wouters, {R. M.} and {de Ridder}, {W. A.} and Slijper, {H. P.} and Selles, {R. W.} and Porsius, {J. T.} and J. Tsehaie and R. Poelstra and Jansen, {M. C.} and {van der Oest}, {M. J.W.} and Sun, {P. O.} and L. Hoogendam and Teunissen, {J. S.} and {ter Stege}, M. and Zuidam, {J. M.} and Colaris, {J. W.} and L. Duraku and {van der Heijden}, {E. P.A.}",

note = "Funding Information: We thank all patients who participated and allowed their data to be anonymously used for the present study. Hand Wrist Study Group contributors: R. A. M. Blomme, B. J. R. Sluijter, D. J. J. C. van der Avoort, A. Kroeze, J. Smit, J. Debeij, E. T. Walbeehm, G. M. van Couwelaar, G. M. Vermeulen, J. P. de Schipper, J. F. M. Temming, J. H. van Uchelen, H. L. de Boer, K. P. de Haas, K. Harmsen, O. T. Z{\"o}phel, R. Feitz, G. J. Halbesma, J. S. Souer, R. Koch, S. E. R. Hovius, T. M. Moojen, X. Smit, R. van Huis, P. Y. Pennehouat, K. Schoneveld, Y. E. van Kooij, R. M. Wouters, J. J. Veltkamp, A. Fink, W. A. de Ridder, H. P. Slijper, R. W. Selles, J. T. Porsius, J. Tsehaie, R. Poelstra, M. C. Jansen, M. J. W. van der Oest, P. O. Sun, L. Hoogendam, J. S. Teunissen, Jak Dekker, M. Jansen-Landheer, M. ter Stege, J. M. Zuidam, J. W. Colaris, L. Duraku, E. P. A. van der Heijden, and D. E. van Groeninghen. Publisher Copyright: {\textcopyright} 2022, The Author(s).",

year = "2022",

month = dec,

doi = "10.1186/s10195-021-00621-8",

language = "English",

volume = "23",

journal = "Journal of Orthopaedics and Traumatology",

issn = "1590-9921",

publisher = "Springer-Verlag Italia s.r.l.",

number = "1",

}

TY - JOUR

T1 - Outcomes of ulna shortening osteotomy

T2 - a cohort analysis of 106 patients

AU - Teunissen, J. S.

AU - Wouters, R. M.

AU - Al Shaer, S.

AU - Zöphel, O. T.

AU - Vermeulen, G. M.

AU - Hovius, S. E.R.

AU - the Hand-Wrist Study Group

AU - van der Heijden, E. P.A.

AU - Blomme, R. A.M.

AU - Sluijter, B. J.R.

AU - van der Avoort, D. J.J.C.

AU - Kroeze, A.

AU - Smit, J.

AU - Debeij, J.

AU - Walbeehm, E. T.

AU - van Couwelaar, G. M.

AU - Vermeulen, G. M.

AU - de Schipper, J. P.

AU - Temming, J. F.M.

AU - van Uchelen, J. H.

AU - de Boer, H. L.

AU - de Haas, K. P.

AU - Harmsen, K.

AU - Zöphel, O. T.

AU - Feitz, R.

AU - Halbesma, G. J.

AU - Souer, J. S.

AU - Koch, R.

AU - Hovius, S. E.R.

AU - Moojen, T. M.

AU - Smit, X.

AU - van Huis, R.

AU - Pennehouat, P. Y.

AU - van Kooij, Y. E.

AU - Wouters, R. M.

AU - de Ridder, W. A.

AU - Slijper, H. P.

AU - Selles, R. W.

AU - Porsius, J. T.

AU - Tsehaie, J.

AU - Poelstra, R.

AU - Jansen, M. C.

AU - van der Oest, M. J.W.

AU - Sun, P. O.

AU - Hoogendam, L.

AU - Teunissen, J. S.

AU - ter Stege, M.

AU - Zuidam, J. M.

AU - Colaris, J. W.

AU - Duraku, L.

AU - van der Heijden, E. P.A.

N1 - Funding Information: We thank all patients who participated and allowed their data to be anonymously used for the present study. Hand Wrist Study Group contributors: R. A. M. Blomme, B. J. R. Sluijter, D. J. J. C. van der Avoort, A. Kroeze, J. Smit, J. Debeij, E. T. Walbeehm, G. M. van Couwelaar, G. M. Vermeulen, J. P. de Schipper, J. F. M. Temming, J. H. van Uchelen, H. L. de Boer, K. P. de Haas, K. Harmsen, O. T. Zöphel, R. Feitz, G. J. Halbesma, J. S. Souer, R. Koch, S. E. R. Hovius, T. M. Moojen, X. Smit, R. van Huis, P. Y. Pennehouat, K. Schoneveld, Y. E. van Kooij, R. M. Wouters, J. J. Veltkamp, A. Fink, W. A. de Ridder, H. P. Slijper, R. W. Selles, J. T. Porsius, J. Tsehaie, R. Poelstra, M. C. Jansen, M. J. W. van der Oest, P. O. Sun, L. Hoogendam, J. S. Teunissen, Jak Dekker, M. Jansen-Landheer, M. ter Stege, J. M. Zuidam, J. W. Colaris, L. Duraku, E. P. A. van der Heijden, and D. E. van Groeninghen. Publisher Copyright: © 2022, The Author(s).

PY - 2022/12

Y1 - 2022/12

N2 - Background: Ulna shortening osteotomy (USO) for ulnar impaction syndrome (UIS) aims to improve pain and function by unloading the ulnar carpus. Previous studies often lack validated patient-reported outcomes or have small sample sizes. The primary objective of this study was to investigate patient-reported pain and hand function at 12 months after USO for UIS. Secondary objectives were to investigate the active range of motion, grip strength, complications, and whether outcomes differed based on etiology. Materials and methods: We report on 106 patients with UIS who received USO between 2012 and 2019. In 44 of these patients, USO was performed secondary to distal radius fracture. Pain and function were measured with the Patient Rated Wrist/Hand Evaluation (PRWHE) before surgery and at 3 and 12 months after surgery. Active range of motion and grip strength were measured before surgery and at 3 and 12 months after surgery. Complications were scored using the International Consortium for Health Outcome Measurement Complications in Hand and Wrist conditions (ICHAW) tool. Results: The PRWHE total score improved from a mean of 64 (SD = 18) before surgery to 40 (22) at 3 months and 32 (23) at 12 months after surgery (P < 0.001; effect size Cohen’s d = −1.4). There was no difference in the improvement in PRWHE total score (P = 0.99) based on etiology. Also, no clinically relevant changes in the active range of motion were measured. Independent of etiology, mean grip strength improved from 24 (11) before surgery to 30 (12) at 12 months (P = 0.001). Sixty-four percent of patients experienced at least one complication, ranging from minor to severe. Of the 80 complications in total, 50 patients (47%) had complaints of hardware irritation, of which 34 (32%) had their hardware removed. Six patients (6%) needed refixation because of nonunion. Conclusion: We found beneficial outcomes in patients with UIS that underwent USO, although there was a large variance in the outcome and a relatively high number of complications (which includes plate removals). Results of this study may be used in preoperative counseling and shared decision-making when considering USO. Level of evidence: Therapeutic III.

AB - Background: Ulna shortening osteotomy (USO) for ulnar impaction syndrome (UIS) aims to improve pain and function by unloading the ulnar carpus. Previous studies often lack validated patient-reported outcomes or have small sample sizes. The primary objective of this study was to investigate patient-reported pain and hand function at 12 months after USO for UIS. Secondary objectives were to investigate the active range of motion, grip strength, complications, and whether outcomes differed based on etiology. Materials and methods: We report on 106 patients with UIS who received USO between 2012 and 2019. In 44 of these patients, USO was performed secondary to distal radius fracture. Pain and function were measured with the Patient Rated Wrist/Hand Evaluation (PRWHE) before surgery and at 3 and 12 months after surgery. Active range of motion and grip strength were measured before surgery and at 3 and 12 months after surgery. Complications were scored using the International Consortium for Health Outcome Measurement Complications in Hand and Wrist conditions (ICHAW) tool. Results: The PRWHE total score improved from a mean of 64 (SD = 18) before surgery to 40 (22) at 3 months and 32 (23) at 12 months after surgery (P < 0.001; effect size Cohen’s d = −1.4). There was no difference in the improvement in PRWHE total score (P = 0.99) based on etiology. Also, no clinically relevant changes in the active range of motion were measured. Independent of etiology, mean grip strength improved from 24 (11) before surgery to 30 (12) at 12 months (P = 0.001). Sixty-four percent of patients experienced at least one complication, ranging from minor to severe. Of the 80 complications in total, 50 patients (47%) had complaints of hardware irritation, of which 34 (32%) had their hardware removed. Six patients (6%) needed refixation because of nonunion. Conclusion: We found beneficial outcomes in patients with UIS that underwent USO, although there was a large variance in the outcome and a relatively high number of complications (which includes plate removals). Results of this study may be used in preoperative counseling and shared decision-making when considering USO. Level of evidence: Therapeutic III.

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U2 - 10.1186/s10195-021-00621-8

DO - 10.1186/s10195-021-00621-8

M3 - Article

C2 - 34985595

AN - SCOPUS:85122454869

SN - 1590-9921

VL - 23

JO - Journal of Orthopaedics and Traumatology

JF - Journal of Orthopaedics and Traumatology

IS - 1

M1 - 1

ER -

Outcomes of ulna shortening osteotomy: a cohort analysis of 106 patients

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