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Ulna shortening osteotomy
Ulnar shortening osteotomy is a surgical procedure that shortens the ulna bone at the wrist to relieve pain caused by ulnar impaction syndrome, where the ulna is longer than the radius and presses against the wrist bones. By removing a small section of bone and stabilising it with a plate, the procedure reduces this abnormal loading and improves wrist comfort and function.
At a glance
Anaesthetic
General anaesthetic
Where
The Avenue Hospital
Day case or overnight
Usually day case; occasionally an overnight stay
First post operative review
Approximately two weeks after surgery
Driving
Not until out of splint and you have adequate wrist strength and control, generally 6 weeks or more
Post Operative Hand Therapy
Required for splint fitting and after splint removal to restore wrist and forearm movement and grip strength
Splinting
Yes - a splint is worn for a period after surgery, even with plate fixation
Pain relief
Usually paracetamol and/or ibuprofen; stronger pain relief may be needed initially
Return to repetitive & heavy loading
Usually 2-3 months or more before resuming heavy or repetitive wrist loading, guided by x-ray healing
Surgical shortening of the ulna to relieve ulnar-sided wrist pain from ulnar impaction
Ulna shortening osteotomy is surgery to shorten the ulna (the forearm bone on the little-finger side) by a small, precisely calculated amount, to relieve ulnar-sided wrist pain caused by ulnar impaction syndrome, where a relatively long ulna causes it to abut against the wrist bones and triangular fibrocartilage complex (TFCC) with load-bearing and forearm rotation.
Who is this procedure for?
- People with ulnar-sided wrist pain and confirmed positive ulnar variance (a relatively long ulna) on x-ray
- People with ulnar impaction syndrome and associated TFCC or cartilage wear confirmed on imaging
- People whose symptoms have not settled with activity modification, splinting, or injections
- People being considered for, or who have had, TFCC surgery where correcting an underlying positive ulnar variance is part of definitive treatment
What does the surgery involve?
Surgery involves an incision over the ulna, where a precisely measured segment of bone is removed (osteotomy) and the two ends are brought together and compressed, then held with a plate and screws while the bone heals in its shortened position. Shortening the ulna by even a small amount (often just 2-3mm) reduces the load transmitted through the ulnar side of the wrist and can significantly relieve impaction symptoms.
Alternatives to surgery
Ulna shortening osteotomy is one option for ulnar impaction syndrome. Depending on your situation, the alternatives may include:
- Non-surgical management: activity modification, splinting, and corticosteroid injection, appropriate as a first step for many people
- Arthroscopic wafer procedure: removal of a small amount of bone from the end of the ulna through the wrist joint arthroscopically, an alternative to formal osteotomy for milder degrees of positive variance
- TFCC debridement or repair alone: may be sufficient if the TFCC tear is the primary problem without significant positive ulnar variance
What happens if left untreated: ongoing ulnar impaction can lead to progressive cartilage wear and degeneration of the wrist joint and TFCC over time.
Dr Tomlinson will discuss which options suit your specific situation at your consultation.
Frequently Asked Questions
Where will my surgery be done?
At The Avenue Hospital.
How much time will I need to have away from work?
This depends on what your job involves. Desk-based work may be possible within a couple of weeks with the arm splinted. Manual work or activities requiring forearm rotation and wrist loading are usually deferred for a longer period, often 3 months or more, until the osteotomy has healed. Dr Tomlinson will give you advice tailored to your job at your consultation.
When will I be able to drive again?
Multiple things affect this: which hand was treated, whether you’re wearing a bandage, whether you can grip the wheel and respond safely in an emergency, whether you are driving for personal or commercial purposes, the nature of the vehicle you are driving, and your pain levels and medications. You also need to be safely in control of the vehicle for insurance purposes – you should be able to grip the steering wheel strongly with both hands and be able to take evasive action in an emergency before you get behind the wheel. As a guide: plan not to drive for eight weeks after the procedure.
When can I do a full day of administrative or desk work?
Often from 2 weeks after surgery, particularly with some temporary adjustments (see below). Keeping your hand elevated and taking regular breaks helps reduce swelling and discomfort in the early days. If you need to drive to work or carry or lift objects as part of your administrative work then alternate or half days may be a prudent measure when first returning to work.
What workplace modifications might help?
Depending on your job, helpful temporary modifications can include:
– Half days or alternate days to begin with
– No heavy lifting
– Lighter duties or being off tools
– More frequent breaks
– Using a headset instead of holding a phone
– Voice-to-text or dictation instead of typing
– Keeping the hand elevated at your workstation
– Avoiding repetitive gripping
– Help with carrying or moving items
– Moving temporarily to reception or phone duties if your role is normally manual
– Protecting the wound if your work exposes your hands to water or contamination (e.g. food handling, healthcare, wet trades)
We’re happy to provide a letter for your employer outlining recommended modifications.
I take a GLP-1 medication (such as Ozempic, Wegovy, Mounjaro or Trulicity) — how does this affect my procedure?
GLP-1 medications, used for diabetes or weight management, slow the emptying of the stomach. This can increase the risk of stomach contents being present during sedation or a general anaesthetic. In line with current ANZCA guidance you’ll be asked to follow a clear-fluid-only diet for 24 hours before your procedure, followed by the standard 6-hour fast. Please tell us and your anaesthetist that you take this medication — your anaesthetist will give you specific instructions.
How long will I need to wear a splint?
A splint is typically worn for eight weeks after surgery to protect the plate and screws while the osteotomy heals, even though the fixation itself is generally stable.
Will I need to see a hand therapist afterwards? May I see one if I'd like?
Yes. Hand therapy is routinely recommended once the splint is removed, to restore forearm rotation, wrist movement and grip strength, which are typically reduced after a period of immobilisation.
What pain medication will I need afterwards?
Usually simple pain relief – paracetamol and ibuprofen – is all that’s needed. Some procedures are more uncomfortable and you may need stronger pain relief. We can always prescribe stronger painkillers if you need them.
Risks & complications
General risks of hand surgery
- Bleeding and bruising; rarely, a collection of blood (haematoma) that may need draining
- Infection, which may require antibiotics or, rarely, further surgery
- Pain — usually temporary, occasionally persistent
- Swelling – common, and usually settles over weeks to months
- Scarring – scars are permanent and occasionally become thickened, raised or sensitive
- Allergic reaction to the local anaesthetic, antiseptic, dressings, tape or suture material
- Delayed or problematic wound healing
- Stiffness or reduced movement in the fingers, hand or wrist
- Injury to nerves, causing numbness, altered sensation or, rarely, a painful neuroma
- Injury to blood vessels (arteries)
- Injury to tendons
- Injury to bone (fracture)
- Failure to fully relieve your symptoms, or symptoms returning over time (recurrence)
- Complex regional pain syndrome (CRPS) – an uncommon but significant condition causing ongoing pain, stiffness and swelling
- Cold intolerance – the hand becoming more sensitive to cold, usually improving with time
- The need for further surgery
- Blood clots in the leg or lung (DVT/PE) – uncommon in hand surgery, with a slightly higher risk after a general anaesthetic or prolonged immobilisation
Specific risks of this surgery
- Irritation from the plate, which is a common reason for a further operation to remove it once the bone has healed
- Nonunion or delayed union at the site where the bone was shortened
- Refracture of the bone if it breaks again after the plate is removed
- Change in the mechanics of the wrist joint where the forearm bones meet
Anaesthetic
Your anaesthetist will discuss the specific risks of general anaesthesia with you separately.
Recovery & rehabilitation
First 48 hours
Keep your hand elevated for 72 hours to reduce bleeding and post-operative swelling. Local anaesthetic lasts 6–24 hours (occasionally 1–3 days); your hand may have some numbness or altered sensation along the little finger side of the hand during this time.
First week
Keep the dressing dry and intact until your post-operative review. Listen to your hand and do not perform activities that cause discomfort. After the first three days you should find that your post surgery discomfort lessens each day.
Second week
The forearm remains splinted and protected while the osteotomy begins to heal. Finger movement is encouraged early to prevent stiffness, while forearm rotation and wrist movement are restricted until the surgeon advises otherwise.
6 weeks
Full grip strength may take several months to return. The scar may feel tight and firm. Massage assists with improving scar mobility and minimising scar firmness.
3 months
Assuming successful bone healing has been confirmed at 8-12 weeks on imaging, you should be gradually regaining your forearm muscle strength and hand strength.
Long term
Bone healing is confirmed with x-ray, typically over 8-12 weeks, though it can take longer. Hand therapy continues through this period to restore movement and strength. Plates are not routinely removed unless they cause irritation.
Want to know more about Ulna Shortening Osteotomy?
Contact us to schedule an appointment with Dr Tomlinson.
Fees and costs
You will receive a written financial quotation after your consultation, once your operation and any third-party requirements are confirmed. See our Fees and informed financial consent page for how our fees work, what your quotation includes, and the resources available to you.