Step-Cut Ulnar Shortening Osteotomy for Ulnar Impaction Syndrome.

Introduction: The step-cut ulnar shortening osteotomy for the treatment of ulnar impaction syndrome is a safe, reliable, and less expensive technique that uses a 7-hole 3.5-mm standard neutralization plate and a lag screw for fixation, thus avoiding the need for the special instrumentation that other ulnar shortening techniques require.

Step 1 Preoperative Planning: Perform a physical examination and obtain imaging studies to identify all associated abnormalities.

Step 2 Wrist Arthroscopy Video 1: Verify the diagnosis of ulnar impaction syndrome and treat concurrent intra-articular abnormalities.

Step 3 Incision For The Ulnar Shortening Osteotomy Video 2: Make a longitudinal skin incision along the distal third of the ulna.

Step 4 Design The Step-cut Ulnar Shortening Osteotomy Video 2: Design the step-cut ulnar shortening osteotomy.

Step 5 Perform The Step-cut Ulnar Shortening Osteotomy Video 2: Create the step-cut ulnar shortening osteotomy using an oscillating saw.

Step 6 Fixation Of The Osteotomy Video 3: Fix the osteotomy with a lag screw and volar plate.

Step 7 Wound Closure: Meticulously close the wound in layers.

Step 8 Postoperative Care: Protect the affected arm for the first 6 weeks.

Results: In our original study, 164 patients with symptomatic ulnar impaction syndrome were treated with a step-cut ulnar shortening osteotomy using a volar 3.5-mm standard neutralization plate and a lag screw.