Nonunion Rate following Ulnar Shortening Osteotomy using Brand-Specific Systems: A Systematic Review.

Objectives: This study aims to compare nonunion rates between conventional plates versus specific systems for ulnar shortening osteotomy (USO). Materials and Methods: To identify relevant studies, we searched various databases, including MEDLINE via Ovid, Embase.com, Web of Science Core Collection, Cochrane CENTRAL via Wiley, and Google Scholar. The level of evidence was assessed independently by three evaluators. Preferred reporting items for systematic reviews (PRISMA) recommendations were followed during the study selection process, which involved applying inclusion and exclusion criteria. All studies that reported the postoperative nonunion rates and mentioned the manufacturer of the fixation device were included. A total of 42 studies were analyzed, with information retrieved on osteotomy type, fixation type, manufacturer, bone union period, and nonunion rate for each study. Results: A total of 42 relevant articles were included in this study, with a total sample size of 1617 cases. The nonunion rate with the conventional plates was 5% (41 nonunion out of 815 cases).The reported nonunion rate was 0% (0 out of 67 cases) for the Stryker Trauma plates, 1.9% (three nonunion out of 157 cases) for the Rayhack plates, 4% (11 nonunion out of 271 cases) for the Acumed plates, 10.3% (3 nonunion out of 29 cases) for the specialized AO plates and 5% (14 nonunion and out of 278 cases) for the TriMed plates. Conclusion: Despite advances in plate designs for USO, the overall nonunion rate with USO-specific systems is almost comparable to that of conventional plates. So, it seems likely that the surgical technique and patient characteristics may play a more significant role than the type of device when planning for a USO. Cost and time savings should be weighed and considered when choosing between the less expensive conventional plates versus USO-specific systems. Level of Evidence: Prognostic level IV.