Comparison of dynamic compression plate systems with oblique osteotomy and locking plate fixation versus transverse osteotomy and non-locking plate fixation for ulnar shortening osteotomy.

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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 of evidence: Level 4.