Ulnar Shortening Osteotomy
The ulna bone is the smaller forearm bone on the outside of the forearm. When the distance between the end of the ulna and the wrist bones is decreased, pain is noted due to rubbing on the wrist bones. This surgery shortens the ulna bone and places a plate across the repair site.
Therapy
- Initially, therapy will make you a splint to protect your surgical site and go over hand exercises. This splint will go up past your elbow to your upper arm. This stops the forearm from turning palm up or down.
- Therapy will start within one week to 10 days after surgery.
- You will wear your splint for 6 weeks before routine therapy is started. This delay is to allow the surgical site to heal with fresh bone.
Downtime
- With this injury, you are in the long arm splint for 6 weeks and then it is shortened and this is worn for approximately 4 more weeks depending on your healing
- You will not be able to use your hand post-surgery for any work or self-care tasks for 6-8 weeks depending on the type of work you are returning to.
Post-op
- Do not remove your post-operative dressings/splint. Keep your dressings/splint clean and dry. Cover your dressings/splint with a plastic bag for bathing.
- Your dressings will be removed during your first post-operative visit or during your first occupational therapy visit. These visits are scheduled during the scheduling of your surgery.
Pain Medication
- You may use Tylenol (acetaminophen). DO NOT EXCEED 3000 mg of Tylenol in 24 hours.
- You may also alternate ibuprofen (NSAID’s) with Tylenol to supplement pain control.
- It is recommended to use narcotics ONLY as needed (and directed) for additional pain control. Take it with food to prevent nausea. Extended use of narcotics can lead to dependency/addiction and cause severe constipation and GI complications.
Activity
- Please keep the area elevated as much as possible for at least the first 5 days or until the swelling improves. You are using gravity to help assist fluid movement out of the area.
- Please refrain from full-body exercises or activities that increased blood pressure and heart rate to prevent increased bleeding from the wound.
- You are encouraged to move your fingers while in the post-operative/OT splint. Moving the fingers helps assist in fluid movement of the surgical area preventing joint stiffness, pain and loss of function.
- You will be instructed to NOT use your hand for any work or self-care tasks for about 6-8 weeks depending on the type of work you are returning to. Too much activity too soon may alter the placement of the hardware or may cause a non-union of the ulna bone.
- NO DRIVING while under the influence of narcotic pain medication.
- NO SMOKING. Smoking interferes with bone healing, circulation and wound healing. Continuing to smoke can create serious complications such as wound infections and/or unification of the ulna bone. It is in your best interest to refrain from smoking.
First Post-op Visit
- Often 8-10 days post-op unless directed otherwise. This visit is scheduled during the scheduling of your surgery.
- Your first Occupational Therapy visit is often scheduled just before or after your first post-operative visit. Therapy will transition you into a removable forearm-based thumb-spica splint for about 3.5-4 weeks followed by a hand-based splint for an additional 2 months.
- Sutures are often removed between 8-14 days depending on the extent of the wound and your past medical history. Uncontrolled blood sugar (diabetes), smoking, certain medically conditions and some medications can delay healing. Sutures are left in longer in situations of possible delayed healing and you may be directed to return at a later date for suture removal.
- You will be directed on continued wound care. At this time, showers are often permitted out of the splint and uncovered. DO NOT SUBMERGE the wound until fully healed. No bathtubs, hot tubs, pools, and/or dish water. This type of environment is often unsanitary and can lead to possible infection.
- Scar Tissue Massage
- Post-operative wounds/incisions heal with scar tissue. The network of fibers that make up scar tissue changes and improves over time. Massaging a healing wound causes the fibers to align themselves to the directional stress you apply making the skin more pliable like normal skin. This action also desensitizes the wound. The best way to see it is to “move the tissue around and over the scar in all directions like kneading dough.”
- Occupational Therapy will guide you through this process.
- Time-frame for post-operative recovery
- Everyone recovers from surgery at their own pace. You can anticipate a return to activities “as tolerated” without restrictions 3 months following surgery.
- Returning to activities as tolerated without restrictions does not mean there is an expectation you will be pain/symptom free. The hand will need time to develop muscular endurance as you expose it to increasing activity much the same way an athlete develops endurance to run 10 miles.
- Your post-operative pain, swelling, range of motion and overall function will depend on how proactive/compliant you are with your post-operative care, activity modifications/restrictions, therapy and home exercise program.
When to Call?
Please call the office if you have any questions or concerns regarding your post-operative care. If any of these symptoms are present please call:
- Persistent fever greater than 101.5 °F or 38.5 °C
- Increasing pain or swelling not controlled with medications
- Excessive drainage or bleeding on the bandage
- Chest pain, difficulty breathing, nausea, vomiting
- Cold fingers, or painful fingers that are not normal in color
- Increasing redness beginning 7 days after surgery