Refracture after plate removal following ulnar shortening osteotomy for ulnar impaction syndrome – a retrospective case–control study

Abstract

Refracture after plate removal following ulnar shortening osteotomy (USO) is a rare, but very distressing for both the patient and surgeon. This case–control study was performed to identify predictive factors for refracture incidence. A total of 245 patients, who had undergone USO between 2008 and 2018 were included in the study. We evaluated the basic demographic characteristics/clinical factors preoperatively. Radiological variables, such as dorsal subluxation of the ulna and pre/postoperative ulnar variance, and variables associated with operative conditions, such as triangular fibrocartilage complex degeneration classification, the use of a parallel double-blade saw, the type of plate, number of screws, and plate position, were investigated. Finally, the accuracy of osteotomy and any traces of incomplete healing after plate removal were evaluated. The no-refracture group consisted of 234 patients, whereas the refracture group consisted of eleven patients. The results of univariate analyses revealed that age, bone mineral density, accuracy of osteotomy, and presence of osteotomy traces were significantly associated with refracture. However, during multivariate analysis, low BMD was the only factor significantly associated with refracture. Nevertheless, the accuracy of osteotomy and absence of osteotomy traces were strongly associated with each other in the no-refracture group (p < 0.001, Cram’s V coefficient = 0.36). Low BMD was sole independent predicting factor of refracture after plate removal in USO. Additionally, precise parallel osteotomy is critical for safety after plate removal following USO. Subsequent healing with no radiological traces of osteotomy after plate removal would be associated with absence of refracture.

Level of Evidence

Level III, case–control study.

Keywords:

• Ulnar shortening osteotomy
• ulnar impaction
• refracture
• plate
• independent variable

Disclosure statement

The authors declare that they have no conflict of interest.

Additional information

Funding

This work was supported by a research fund from Chungnam National University, 2019.