Meta-Analysis
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 26, 2023; 11(12): 2753-2765
Published online Apr 26, 2023. doi: 10.12998/wjcc.v11.i12.2753
Is metaphyseal ulnar shortening osteotomy superior to diaphyseal ulnar shortening osteotomy in the treatment of ulnar impaction syndrome? A meta-analysis
Hai-Lin Deng, Ming-Ling Lu, Zhe-Ming Tang, Qing-Long Mao, Jin-Min Zhao
Hai-Lin Deng, Jin-Min Zhao, Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Ming-Ling Lu, Ministry of Public Health, Department of Public Health Unit, Liuzhou Liunan District Center for Disease Control, Liuzhou 545005, Guangxi Zhuang Autonomous Region, China
Zhe-Ming Tang, Qing-Long Mao, Department of Hand, Foot and Ankle Surgery, Liuzhou Workers' Hospital, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou 545005, Guangxi Zhuang Autonomous Region, China
Author contributions: Deng HL and Zhao JM concepted the study; Deng HL, Lu ML and Mao QL collected the data; Deng HL, Lu ML, Tang ZM and Zhao JM contributed to the formal analysis; Deng HL and Zhao JM contributed to the investigation; Deng HL, Zhao JM and Lu ML contributed to the methodology; Deng HL, Zhao JM, Tang ZM and Lu ML supervised the study; Zhao JM validated the study; Deng HL and Lu ML contributed to the visualization of the study; Deng HL and Lu ML originally drafted the manuscript; Deng HL, Zhao JM, Tang ZM and Mao QL reviewed and edited the manuscript.
Conflict-of-interest statement: There is no conflict of interest.
PRISMA 2009 Checklist statement: The authors read the PRISMA 2009 checklist and prepared and revised the manuscript according to the PRISMA 2009 checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jin-Min Zhao, MD, Professor, Guangxi Medical University, No. 22 Shuangyong Road, Qingxiu District, Nanning 530021, Guangxi Zhuang Autonomous Region, China. denallen@163.com
Received: February 19, 2023
Peer-review started: February 19, 2023
First decision: February 28, 2023
Revised: March 6, 2023
Accepted: March 24, 2023
Article in press: March 24, 2023
Published online: April 26, 2023
Processing time: 65 Days and 13.1 Hours
Abstract
BACKGROUND

Although metaphyseal ulnar shortening osteotomy (MUSO) is safer for the treatment of ulnar impaction syndrome (UIS) than diaphyseal ulnar shortening osteotomy (DUSO), DUSO is widely used for UIS treatment.

AIM

To evaluate the effectiveness of DUSO and MUSO for UIS treatment and determine the factors that should be considered when choosing surgical treatment for UIS.

METHODS

Articles comparing the effectiveness of DUSO and MUSO for UIS treatment were systematically retrieved from MEDLINE (Ovid), PubMed, EMBASE, and Cochrane Library. The demography, incidence of complications, secondary operation rate, postoperative DASH score, wrist pain on the visual analogue scale, and grip strength improvement were also evaluated. In addition, the correlation between the improvement of grip strength and the shortening of osteotomy length of ulna was analyzed. The outcome of the patient was discontinuous, and the odds ratio, risk ratio (RR), and 95%CI were calculated and analyzed via RevMan5.3 software.

RESULTS

Six studies, including 83 patients receiving MUSO (experimental group) and 112 patients receiving DUSO (control group), were included in the meta-analysis. The second operation rate was significantly higher after DUSO than after MUSO. The DASH scores were slightly lower in the MUSO group than in the DUSO group. The patients receiving MUSO had slightly better pain relief effect than patients receiving DUSO. However, the incidence of complications and improvement of grip strength were not significantly different between the two groups.

CONCLUSION

Although DUSO and MUSO provide similar effects for UIS, MUSO is associated with a lower secondary operation rate, slightly lower postoperative DASH scores and slightly better pain relief effect than DUSO, indicating that MUSO can effectively be used for UIS treatment.

Keywords: Metaphyseal, Diaphyseal, Ulnar shortening osteotomy, Ulnar impaction syndrome, Meta-analysis

Core Tip: Ulnar impaction syndrome (UIS) is caused by overload of the ulnar wrist joint. This is the common cause of ulnar wrist pain. UIS is related to static or dynamic lateral positive change. If not treated in time, it may lead to the erosion and perforation of the triangular fibrocartilage complex, as well as the degeneration of the triangular, Lunate or ulnar head cartilage. Therefore, the basic treatment of UIS includes mechanical decompression of the overloaded ulnar wrist joint by reducing the ulnar variation. There are many surgical treatments that can reduce the excessive pressure on the ulnar side of the wrist joint, including diaphyseal ulnar shortening osteotomy (DUSO), thin section resection and metaphyseal ulnar shortening osteotomy (MUSO). The Wafer resection site of the distal ulna belongs to MUSO. Compare the effect of DUSO and MUSO ulnar shortening methods. In fact, both of these operations have specific advantages and disadvantages. It should be clear whether the treatment choice of UIS patients depends on the preferences of surgeons.