Background: Ulnar shortening osteotomy (USO) is an effective treatment for ulnar impaction syndrome. However, there have been reports of osteoarthritis (OA) at the distal radioulnar joint (DRUJ) when USO was performed on patients with a reverse oblique sigmoid notch. This study aimed to evaluate the radiographic and functional outcomes following USO in patients with a reverse oblique sigmoid notch.
Methods: We retrospectively reviewed patients having a reverse oblique sigmoid notch who underwent USO for ulnar impaction syndrome between 2002 and 2013. We evaluated radiographic changes of the DRUJ and functional outcomes of patients.
Results: We enrolled 22 patients (22 wrists) with an average age of 49.6 years and a mean follow-up of 93.2 (range, 36–179; standard deviation [SD], 38.2) months. We found that there were changes in the inclination angle of the sigmoid notch, from an average reverse oblique of 14.9o (range, 11o–23o; SD, 3.4o) preoperatively to a more parallel 5.1o (range, 0o–11o; SD, 3.2o) at the final follow-up. The functional results at the final follow-up were good, with a mean visual analogue scale for pain of 0.2 (range, 0–1; SD, 0.4) at rest and 1.3 (range, 0–3; SD, 0.9) during activity, QuickDASH of 15.1 (range, 2.3–34.1; SD, 8.8), and modified Mayo Wrist Score of 91.6 (range, 70–100; SD, 6.4). Seven wrists (31.8%) had changes compatible with OA, but the wrists did not exhibit a significantly worse function when compared to wrists without OA changes, except for supination motion and grip strength.
Conclusions: For patients with a reverse oblique sigmoid inclination following USO, we observed that the inclination angle had a tendency to become parallel and some patients developed OA at the DRUJ. However, long-term functional outcomes could still be good. The reverse oblique sigmoid inclination does not seem to be an absolute contraindication for USO.

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This is a list of supplementary files associated with this preprint. Click to download.
Additional file 1: Checklist of STROBE criteria.
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Posted 19 Jan, 2021
On 27 Jan, 2021
On 10 Jan, 2021
On 10 Jan, 2021
On 10 Jan, 2021
On 30 Nov, 2020
On 30 Nov, 2020
On 30 Nov, 2020
On 24 Nov, 2020
On 18 Nov, 2020
On 18 Nov, 2020
On 18 Nov, 2020
On 09 Nov, 2020
Received 21 Oct, 2020
Received 20 Oct, 2020
On 05 Oct, 2020
On 03 Oct, 2020
Invitations sent on 02 Oct, 2020
On 02 Oct, 2020
On 29 Sep, 2020
On 28 Sep, 2020
On 28 Sep, 2020
On 01 Sep, 2020
Received 25 Aug, 2020
On 07 Aug, 2020
On 05 Aug, 2020
Received 05 Aug, 2020
Received 03 Jun, 2020
On 16 May, 2020
Invitations sent on 13 May, 2020
On 21 Apr, 2020
On 20 Apr, 2020
On 20 Apr, 2020
On 19 Apr, 2020
Background: Ulnar shortening osteotomy (USO) is an effective treatment for ulnar impaction syndrome. However, there have been reports of osteoarthritis (OA) at the distal radioulnar joint (DRUJ) when USO was performed on patients with a reverse oblique sigmoid notch. This study aimed to evaluate the radiographic and functional outcomes following USO in patients with a reverse oblique sigmoid notch.
Methods: We retrospectively reviewed patients having a reverse oblique sigmoid notch who underwent USO for ulnar impaction syndrome between 2002 and 2013. We evaluated radiographic changes of the DRUJ and functional outcomes of patients.
Results: We enrolled 22 patients (22 wrists) with an average age of 49.6 years and a mean follow-up of 93.2 (range, 36–179; standard deviation [SD], 38.2) months. We found that there were changes in the inclination angle of the sigmoid notch, from an average reverse oblique of 14.9o (range, 11o–23o; SD, 3.4o) preoperatively to a more parallel 5.1o (range, 0o–11o; SD, 3.2o) at the final follow-up. The functional results at the final follow-up were good, with a mean visual analogue scale for pain of 0.2 (range, 0–1; SD, 0.4) at rest and 1.3 (range, 0–3; SD, 0.9) during activity, QuickDASH of 15.1 (range, 2.3–34.1; SD, 8.8), and modified Mayo Wrist Score of 91.6 (range, 70–100; SD, 6.4). Seven wrists (31.8%) had changes compatible with OA, but the wrists did not exhibit a significantly worse function when compared to wrists without OA changes, except for supination motion and grip strength.
Conclusions: For patients with a reverse oblique sigmoid inclination following USO, we observed that the inclination angle had a tendency to become parallel and some patients developed OA at the DRUJ. However, long-term functional outcomes could still be good. The reverse oblique sigmoid inclination does not seem to be an absolute contraindication for USO.

Figure 1

Figure 2
This is a list of supplementary files associated with this preprint. Click to download.
Additional file 1: Checklist of STROBE criteria.
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