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Ulnar lengthening

- Discussion:
    - indications are essentially the same as for radial shortening;
    - advocates of ulnar lengthening for Kienbock's dz base their theorem on the fact that an ulnar lengthening procedure decreases the load
         across the radiolunate joint;
    - this procedure is ideally suited for pts w/ ulnar minus variance;
    - success have been reported even for pts w/ a lunate collapse;
    - because of impingement on ulnar side of wrist, reduction in ulnar deviation is not uncommon;
    - pts may also have postoperative pain following procedure, because of alteration of the distal radioulnar joint;
    - advocates of this procedure feel that there is less surgery involved w/ this procedure than w/ radial shortening, eventhough a bone
         graft is not required;
- Technique:
    - ulnar incision is used;
    - 4-hole slotted plate is fixed to ulna to allow lengthening w/in slots;
    - thru central cut, appropriate lengthening is accomplished by extending distal ulna until x-rays confirm that equal length has been obtained;
    - deficit is filled by iliac bone graft, & plate is compressed;
    - because this procedure requires a bone graft, pts do better w/ strict  immobilization which is provided by internal plate fixation;
- Complications:
    - 15 % nonunion;
    - ulnar impingement syndrome

Ulnar lengthening in the treatment of Kienbock's disease.

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