Name: Ulnar Shortening Osteotomy
Uploaded: 2024-05-31T00:00:00.0000000
Duration: T00H07M04S
Description: Ulnar Shortening Osteotomy

Name: Ulnar Shortening Osteotomy

Description: Ulnar Shortening Osteotomy

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Duration: T00H07M04S

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Upload Date: 2024-05-31T00:00:00.0000000

Transcript: Language: EN.
Segment:0 .
ISAAC GAMMAL: Hello. This will be a case presenting an ulnar shortening osteotomy. This is a 61-year-old female with ulnar positive variance and ulnar carpal impaction syndrome, which can be seen on the MRI as well, especially in the ulnar border of the lunate.
JAMES MULLEN: Here's the incision marked out approximately 3 to 4cm proximal to the distal end of the ulnar, incisions about 9 to 10cm in length. So we're going through skin and subcutaneous tissue. Next we're sharply incising through the fascia, directly down onto the bone of the ulnar in the FC, ECU interval. Next we are subperiosteally elevating
JAMES MULLEN: any remaining tissue off of the ulnar, ulnar shaft using a freer. At this point, the plate with the jig is inserted onto the ulnar. Once the plate is in proper position, a 2.5 cortical screw is then inserted into the distal portion of the plate in order to suck it down to the ulnar.
JAMES MULLEN: Next our attention is taken to the proximal portion of the plate where a drill hole is drilled into the most proximal portion of the oblong hole in order to allow for compression and sliding of the plate along the ulnar up to eight millimeters. Here you can see two five locking screws, then inserted into the distal portion of the plate.
JAMES MULLEN: Next the tension bolt is put in. This is a one size screw which helps adequately, adequately secure the drill guide to the plate and the bone.
JAMES MULLEN: The first of two cuts is now being made. As you can see, we are irrigating the bone as we cut. In this case, we are setting the jig to a six millimeter cut and the second cut is being made.
JAMES MULLEN: Now we're removing the cutting slot and removing the bone wafer. Next, we are checking to make sure there is no soft tissue or irregularities in the cut to make sure that we will be able to achieve adequate compression at the osteotomy site. Next we are slightly loosening the tension bolt as well as the proximal cortical screw to allow the plate to slide
JAMES MULLEN: on the bone. And we're taking a line drawn clamp along with the tensioning device in order to close down the gap. As the gap is about to close, we move the lion jaw to aid in compression against the plate. Next, a lag screw is drilled first with a 2-0 drill bit, and then the proximal cortex is drilled with a 2-6 drill bit
JAMES MULLEN: and the lag screw is placed. The screws are then re-tightened and the rest of the screws, both in the proximal and distal portion of the plate, are then filled in with either locking or non locking screws.
JAMES MULLEN: The tension bolt is removed, the line jaw is removed. Here you can see the osteotomy site, which is just completely closed down. And then finally the cutting jig is removed as well. Holes that were previously obstructed by the cutting jig itself are then drilled and screws are inserted.
JAMES MULLEN: And here you can see the final product in which the osteotomy site is barely able to be identified. Next, we are closing the fascia
JAMES MULLEN: and then finally the skin is closed. Here you can see a final X-ray of the osteotomy, and here's an X-ray of the now ulnar negative wrist.

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