Ulnar Shortening Osteotomy (USO) is an orthopedic procedure performed on the forearm to alleviate chronic pain on the pinky-finger side of the wrist. This surgery involves cutting a precise segment out of the ulna bone and stabilizing the bone with a plate and screws. The goal is to shorten the ulna relative to the radius, reducing pressure within the wrist joint. USO is primarily recommended for patients diagnosed with ulnar impaction syndrome, a condition where the ulna is longer than the radius (positive ulnar variance). It is also used to treat chronic injuries to the Triangular Fibrocartilage Complex (TFCC) that have not responded to non-surgical treatments.
Duration of the Operation
The surgical phase of an Ulnar Shortening Osteotomy typically takes an average of 60 to 90 minutes to complete. The procedure’s duration can vary, with some cases completed in as little as 45 minutes, while more complex operations may extend toward two hours. This time frame covers the steps from making the incision to closing the wound, including bone removal and securing the ulna ends with a metal plate and screws.
The total time spent in the operating room (OR) suite is significantly longer than the surgical time itself, accounting for preoperative and postoperative phases. Before the incision, time is needed for anesthesia administration, patient positioning, application of a tourniquet, and sterile preparation of the surgical site. Following the procedure, surgical dressings are applied, and the patient is safely awakened from anesthesia before transfer to recovery. Patients can expect to be in the OR suite for a total of two to three hours.
Several factors influence the precise length of the procedure, including the specific surgical technique chosen by the surgeon, such as a transverse, oblique, or step-cut osteotomy. The complexity of the case, such as whether a concurrent arthroscopy is performed, can also add time to the operation. The type of fixation hardware used and the surgeon’s experience level contribute to the variability in surgical time. Surgeons often take extra time to ensure the proper amount of shortening, typically a reduction of 2 to 4 millimeters, is achieved to decompress the wrist joint.
Immediate Post-Surgical Care and Hospital Stay
Following the procedure, the patient is transferred to the Post-Anesthesia Care Unit (PACU) for close monitoring while recovering from anesthesia. This initial recovery usually lasts for a few hours, during which nursing staff monitors vital signs, pain level, and circulation in the hand. Pain management begins immediately, often involving a regional nerve block administered prior to surgery to provide initial comfort.
Swelling is common, so the arm is kept elevated above the heart to encourage fluid drainage and minimize discomfort. A bulky surgical dressing and a plaster splint are applied immediately after the operation to immobilize the forearm and protect the bone fixation. Patients are encouraged to move their fingers frequently to prevent stiffness and reduce swelling in the hand.
USO is often performed as an outpatient procedure or requires only a single overnight stay, depending on the patient’s health and surgeon’s preference. Patients are discharged once pain is controlled with oral medication, they can tolerate fluids, and they can safely manage initial post-operative care. The first follow-up appointment to check the wound and remove sutures typically occurs within one to two weeks.
Full Recovery and Rehabilitation Schedule
Long-term recovery is governed by the biological process of bone healing at the osteotomy site. The initial phase involves the arm being immobilized in a cast or splint, typically lasting six to eight weeks. This immobilization protects the metal plate and screws from excessive stress while new bone tissue, called a callus, forms to bridge the gap.
At approximately six weeks post-surgery, X-rays are taken to assess the progress of bony union and confirm the ulna segments are healing securely. If healing is satisfactory, the rigid cast is removed and replaced with a removable splint, marking the beginning of active rehabilitation. Physical or occupational therapy is a component of this stage, focusing on restoring the wrist’s range of motion and improving flexibility lost during immobilization.
Therapy involves gentle, passive range-of-motion exercises, gradually progressing to active exercises and strengthening activities over several weeks. Full weight-bearing activities, such as lifting heavy objects, are restricted until the bone is completely healed, which can take up to three months. A full return to normal activities, including sports or physically demanding work, usually spans three to six months. Smokers and patients with certain underlying health conditions should anticipate a prolonged healing time.