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Objective/Hypothesis: Arthritis at the distal interphalangeal (DIP) joint often results in pain and deformity. Arthrodesis of the DIP joint is commonly performed for symptomatic arthritis that has not responded adequately to nonoperative treatment. Although a variety of techniques have been described for DIP joint arthrodesis, the end result is a motionless joint. DIP fusion also carries the risk of malunion, nonunion, and implant-related complications. We hypothesize that an alternative technique involving an open dorsal cheilectomy and DIP joint debridement would result in adequate pain relief and cosmesis, while preserving joint motion and avoiding the potential complications associated with DIP arthrodesis. We present our experience with 78 patients with symptomatic osteoarthritis of the DIP joint who underwent an open dorsal cheilectomy and debridement of the DIP joint. Materials and Methods: There were 70 women and 8 men with a mean age of 64 years (range, 52-74 years) at the time of the surgery. The dominant hand was involved in 59 patients. The most common fingers were the middle (36 patients) and index (33 patients). Preoperative radiographic assessment demonstrated Kellgren and Lawrence grade 3 osteoarthritis in 44 patients and grade 4 in 34 patients. In all patients, through a lazy “S” incision over the dorsal DIP joint, an arthrotomy was performed on each side of the extensor tendon and debridement of the joint was performed removing osteophytes from the DIP joint, while preserving the insertion of the extensor mechanism. At completion, the DIP joint was immobilized in an extension splint. At 4 weeks postoperatively, the splint was removed and physical therapy was initiated for active range of motion. At the final follow-up, pain level, satisfaction, and DIP joint range of motion were assessed. Results: The mean final follow-up was 37 months (range, 24-62 months). All clinical parameters demonstrated statistically significant improvement at final follow-up. Mean patient pain visual analogue scale scores improved from 8.3 preoperatively to 1.2 postoperatively. Patient satisfaction scores significantly improved by an average of 7 points. Mean flexion contracture of the DIP joint significantly improved from 11.4° preoperatively to 4.6° postoperatively. There were no postoperative infections or tendon rupture. Six patients experienced mild extensor tendon weakness at the DIP joint. No patients required additional surgery. No other complications were encountered. Conclusions: Open dorsal cheilectomy and debridement of the DIP joint in patients with symptomatic DIP joint osteoarthritis is a safe and reliable alternative procedure. This surgical technique reduces pain while preserving DIP joint motion.

Objective/Hypothesis: Extra-articular ulnar-shortening osteotomy is a common procedure for the surgical treatment of ulnar impaction syndrome. Several techniques for this osteotomy have been developed to avoid the morbidity associated with a standard transverse osteotomy. However, these techniques require special instrumentation and are expensive. The purpose of this study was to evaluate the outcome of step-cut ulnar-shortening osteotomy without special jigs for ulnar impaction syndrome. Materials and Methods: A retrospective review was performed of 164 consecutive patients who underwent step-cut ulnar-shortening osteotomy between 2000 and 2010. Eighty-eight patients were female and 76 were male with a mean age of 36.8 years. Idiopathic ulnar impaction syndrome was diagnosed in 116 patients, while a posttraumatic etiology was seen in 48 patients. The step-cut osteotomy had its long arm oriented in the coronal plane parallel to the long axis of the ulna. The short arms of the osteotomy were perpendicular to the long axis in the axial plane. Fixation was performed with a palmar 3.5 mm standard neutralization plate and a lag screw. The goal of the osteotomy was to reduce ulnar variance by shortening the ulna 2 to 3 mm and not to create neutral variance. Ulnar variance was assessed radiographically preoperatively and postoperatively with the pronated grip view in all patients. The preoperative ulnar variance ranged from +1 mm to +6 mm. Results: Mean follow-up was 62.4 months (24-86 months). Union of the osteotomy was achieved with a mean of 8.2 weeks. The union rate was 98.78%. There were 2 cases of nonunion, which required additional surgery. The mean postoperative ulnar variance was +0.2 mm (range, −1 mm to +1.5 mm) after a mean overall shortening of 2.5 mm. Modified Mayo Wrist Scores improved significantly from a mean of 47.3 (25-65) preoperatively to 88.8 (60-100) postoperatively. All patients returned to their work in a mean of 4 months. Hardware removal was performed in 12 patients (7.3%) due to plate-related symptoms. No other complications were encountered. Conclusions: The step-cut ulnar-shortening osteotomy provides ample bone-to-bone contact and simplifies control of rotation. Stable internal fixation with standard techniques allowed early return to functional activities. Palmar placement of the plate diminishes the need for plate removal caused by irritation. The step-cut ulnar-shortening osteotomy is a simple and cost-effective technique for ulnar-shortening without the use of special instrumentation in patients with ulnar impaction syndrome.