Ulnar shortening osteotomy for ulnar carpal instability and ulnar carpal impaction

We report the results of a retrospective review of 47 ulnar shortening osteotomies carried out for ulnar carpal impaction and/or ulnar carpal instability. The average follow-up was 18 months. Wrist function was graded preoperatively and postoperatively using an assessment system modified from Chun and Palmer (1993). The results show that distal ulnar shortening osteotomy successfully reduces pain and improves wrist function both for ulnar carpal instability (UCI) and ulnar impaction syndrome (UIS) and is equally effective for those patients with combined UIS and UCI. Grip strength and wrist stability were significantly improved and range of wrist and forearm motion was little affected by the procedure. Oblique osteotomies were found to heal faster and to have a lower non-union rate than transverse osteotomies. Although radiographs did show adaptive changes of the distal radioulnar joint in a significant number of patients, there is no evidence (as yet) to suggest that this leads to the development of secondary osteoarthritis.