This study aimed to evaluate the clinical outcomes and changes in distal radioulnar joint (DRUJ) stability in patients with ulnar impaction syndrome (UIS) combined with DRUJ instability, treated with ulnar shortening osteotomy (USO) without concomitant triangular fibrocartilage complex (TFCC) repair. Between November 2017 and December 2024, a total of 16 patients (7 males, 9 females; mean age, 40 ± 12 years) underwent USO combined with wrist arthroscopy, followed by structured rehabilitation and regular follow-up. Clinical outcomes were assessed using ulnar variance, the Ballottement test, visual analog scale (VAS) for pain, Disabilities of the Arm, Shoulder, and Hand (DASH) score, modified Mayo wrist score, Patient-Rated Wrist Evaluation (PRWE), grip strength, and wrist range of motion. Preoperatively, all patients had positive Ballottement tests, and TFCC injuries were confirmed by arthroscopy. At the final follow-up (mean, 31 months), ulnar variance was significantly reduced, and VAS, DASH, modified Mayo wrist score, PRWE, and grip strength all showed marked improvement. DRUJ stability was restored in all patients, with the Ballottement test converting to negative. These findings suggest that isolated USO effectively treats UIS with concurrent DRUJ instability and achieves satisfactory clinical outcomes without the need for simultaneous TFCC repair. Therapeutic, Level IV.

Acute compartment syndrome (ACS) is a rare but limb-threatening emergency in children, usually associated with displaced fractures, crush injuries, or high-energy trauma. Prompt recognition and fasciotomy are essential to prevent permanent disability. An unusual case of ACS after non-displaced fractures is presented, challenging traditional risk factors. A healthy 4-year-old girl presented 12 h after a 2-m fall with severe forearm pain, swelling, an absent radial pulse, delayed capillary refill (3 - 4 s), and cold digits. Radiographs showed non-displaced proximal ulna and distal radius fractures. Emergency fasciotomy was performed based on clinical findings of ACS. ACS can occur in children after non-displaced fractures, even without conventional risk factors. Clinicians should rely on careful neurovascular assessment and clinical suspicion rather than fracture type or mechanism alone. Early recognition and surgical intervention are critical to preserve limb function.

Pediatric distal radius fractures with epiphyseal growth arrest can lead to ulnar positive variance and ulnar carpal abutment. In these cases, where there is an associated distally facing sigmoid (or reverse oblique sigmoid, Tolat type III), an ulna shortening osteotomy can result in incongruity of the distal radioulnar joint (DRUJ). We present a series of patients with a distally facing sigmoid who had undergone an ulna shortening osteotomy and sigmoid notch rotational osteotomy to treat the ulnar carpal abutment and adjust for the incongruity of the DRUJ. A review of patients who had undergone sigmoid notch rotational osteotomy with ulna shortening osteotomy was performed. All patients had a history of pediatric distal radius fracture, ulnar abutment syndrome, and Tolat type III DRUJ. Data on clinical history, postoperative physical examination, visual analog scale score, Disabilities of Arm, Shoulder, and Hand, Patient-Rated Wrist Evaluation, and plain radiographs of both the operated and unaffected wrists were collected. Of the 6 patients treated, 4 were available for follow-up, with an age range of 13-23 years. The mean follow-up period was 99 months (range: 66-168 months). The mean follow-up value for visual analog score pain score was 0.5. Physical examination demonstrated a similar range of motion and grip strength of both the operated and unaffected wrists. Plain film radiography confirmed union of all osteotomy sites and reversal of the sigmoid notch angle, matching the ulnar seat angle. Ulna shortening with sigmoid notch rotationplasty is an effective option to relieve the symptoms from ulnar carpal abutment associated with a distally facing sigmoid. Therapeutic V.

Ulnar shortening osteotomy (USO) is a well-established surgical technique for ulnar impaction syndrome and triangular fibrocartilage complex injuries, but complications like delayed union and nonunion are often encountered. Transverse and oblique osteotomy techniques are commonly used, yet direct comparisons using advanced implants are limited. This study aims to compare the clinical and radiological outcomes of USO using the Jplate with a transverse osteotomy device and the APTUS Wrist Ulna Shortening System 2.5 with an oblique osteotomy device. We retrospectively reviewed 37 patients who underwent USO (15 and 22 treated with the Jplate and APTUS systems, respectively) from July 2009 to October 2022. Clinical outcomes were measured using the visual analog scale (VAS), grip strength, range of motion, Quick Disabilities of the Arm, Shoulder, and Hand questionnaire, and Hand20 scores. Radiological outcomes included time to bone union, delayed union, and nonunion rates. Statistical analyses involved Mann-Whitney and Kruskal-Wallis tests and multivariable linear regression models adjusted for age, sex, and smoking status. Time to union was faster in the APTUS group compared to the Jplate group, with a significantly higher delayed union rate in the Jplate group than in the APTUS group. Postoperative pain reduction was significantly greater in the APTUS group compared to the Jplate group. Improvements in Hand20 scores were also significantly higher in the APTUS group compared to the Jplate group. Multivariable regression analyses confirmed that the APTUS system significantly shortened time to union and improved VAS and Hand20 scores. The APTUS system provides superior clinical and radiological outcomes compared to the Jplate, with significant reductions in delayed union rates and postoperative pain and earlier bone healing. This system enables oblique osteotomy and compression of the osteotomy site with a single device, which may have contributed to the observed differences in our study. Level 4.

We primarily aimed to report the results of ulnar shortening osteotomy (USO) in cases of ulna impaction syndrome (UIS), and secondarily to assess the influence of etiology, radiographic parameters, and comorbidities on the outcome. Patients with USO performed for UIS between 2014 and 2022 at our department were included in the study. Demographic, surgical, and postoperative data, including complications and revisions, were recorded retrospectively. An additional study-specific follow-up was performed in all available cases, including subjective outcome measures as Patient Related Wrist Evaluation (PRWE) and Quick Disability of the Arm Shoulder and Hand (Quick-DASH) scores, and standardized 90-90° wrist radiographs. 47 patients were treated with USO at mean age 45.8 years (standard deviation [SD] 16.7); 28 were female; median follow-up was 37 months (interquartile range [IQR] 22-57). Isolated USO was performed in 27 cases; the rest received a combination of procedures, e.g., wrist arthroscopy. USO-specific devices were used in all cases. Reoperations were performed in 12 cases, with implant removal in 11. Postoperative complications such as chronic regional pain syndrome or pseudoarthrosis were detected in 9 patients. 29 patients were additionally examined at median 36 months (IQR 22-49) follow-up. A median PRWE score of 7 (IQR 0-19) and a median Quick-DASH score of 4.5 (IQR 0-15.9) were reported. The subjective improvement was rated as very high by 24 patients. Radiographs showed a mean ulnar shortening of 2.9 mm (SD 1.1) and bone consolidation was achieved in all osteotomies at last follow-up. Relevant comorbidities weakly correlated with worse outcome scores (ρ = 0.41, 95% confidence interval [CI] -0.05 to 0.74 for PRWE and ρ = 0.40, CI -0.06 to 0.73 for Quick-DASH). No statistically significant difference could be detected in any other variables, including UIS etiology. We found that USO had good subjective results measure scores, but with relatively high complication and revision rates, including implant removal.