Step-cut distal ular-shortening osteotomy

Purpose: Several techniques for ulnar-shortening osteotomies have been described in recent years, reflecting the difficulties that sometimes are encountered in what seems to be a relatively simple procedure. We describe the use of a simple step-cut ulnar-shortening osteotomy stabilized with a lag screw and a palmarly placed 3.5-mm neutralization plate. Methods: Twenty-nine patients had the surgery. The indication was ulnar-impaction syndrome in 23 patients and symptomatic ulnar-plus variance secondary to trauma in 6 patients (4 with previous distal radius fractures, 2 with Essex-Lopresti injuries). The preoperative ulnar variance ranged from +1 mm to +6 mm. Results: The mean follow-up period was 34 months. All osteotomies healed uneventfully. The mean postoperative ulnar variance was +0.2 mm (range, -1 mm to +1.5 mm). Three patients had hardware removal. Conclusions: The step-cut osteotomy resulted in solid union in all patients. It provides ample bone-to-bone contact and easier control of rotation, and no special instrumentation is necessary. Stable fixation permitted early mobilization of the wrist and palmar placement of the plate minimized the need for plate removal. This is a simple and effective technique for ulnar shortening.