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Abstract
Purpose
To retrospectively analyze the follow-up results of patients with ulnar impaction syndrome, who were treated with arthroscopic debridement, thermal shrinkage and a simultaneous ulnar shortening osteotomy.
Materials and Methods
Eleven wrists from ten patients with ulnar impaction syndrome, which were diagnosed by the clinical history, physical examination, radiological evaluation and arthroscopic findings, and were treated by arthroscopic debridement, thermal shrinkage and ulnar shortening osteotomy were enrolled in this study. The minimum duration of the follow-up was one year. The ulnar variance was measured using Kreder's method, and the follow-up results were analyzed radiographically as well as clinically using the Chun and Palmer wrist score.
Results
According to the wrist scoring system, seven wrists were fair and four poor preoperatively. However, after surgery, eight wrists were excellent and three good. The average wrist score increased from 62 preoperatively to 93 at the last follow-up. The mean ulnar variance decreased from +3.3 mm (+0.4-+6.4 mm) preoperatively to +0.1 mm (-0.8-+1.3 mm) at the last follow-up. Radiological union of the osteotomy site was achieved after an average of 12 weeks. There were no cases of nonunion or malunion.
Figures and Tables
Fig. 1
Case 3. (A) Ulnar variance was measured on a preoperative posteroanterior radiograph. The preoperative film shows a positive ulnar variance (+2.1 mm). (B) The preoperative T2 weighted coronal MRI at the wrist demonstrates TFCC degeneration. (C) Arthroscopic findings of a chondromalacia of the lunate and TFCC tear (Class IIC). (D) Arthroscopic debridement and thermal shrinkage were performed. (E) The ulnar variance was measured on an posteroanterior radiograph taken after the ulnar shortening osteotomy and fixation with a reconstruction plate. Radiograph taken at postoperative 12 months shows a neutral ulnar variance and radiologic union of the osteotomy site.
Fig. 2
Case 10. (A) The ulnar variance was measured on a preoperative posteroanterior radiograph. The preoperative film shows a positive ulnar variance (+3.6 mm). (B) The preoperative T2 weighted coronal MRI at the wrist demonstrates a degeneration of the TFCC with a perforation. (C) The arthroscopic findings of a chondromalacia of the lunate with a indentation of the articular cartilage. (D) TFCC demonstrates a IIC lesion. (E) The ulnar variance was measured on an posteroanterior radiograph taken after the ulnar shortening osteotomy and fixation with a reconstruction plate. Radiograph taken at postoperative 9 months shows a neutral ulnar variance.
References
1. Bernstein MA, Nagle DJ, Martinez RN, Stogin JM Jr, Wiedrich TA. A comparison of combined artrhroscopic triangular fibrocartilage complex debridement and arthroscopic wafer distal ulna resection versus arthroscopic triangular fibrocartilage complex debridement and ulnar shortening osteotomy for ulnocarpal abutment syndrome. J Hand Surg Br. 1997. 22:451–456.
2. Chun S, Palmer AK. The ulnar impaction syndrome: follow-up of ulnar shortening osteotomy. J Hand Surg Am. 1993. 18:46–53.
3. Constantine KJ, Tomaino MM, Herndon JH, Sotereanos DG. Comparison of ulnar shortening osteotomy and the wafer resection procedure as treatment for ulnar impaction syndrome. J Hand Surg Am. 2000. 25:55–60.
4. Coons DA, Barber FA. Thermal medial retinaculum shrinkage and lateral release for the treatment of recurrent patellar instability. Arthroscopy. 2006. 22:166–171.
5. Darlis NA, Weiser RW, Sotereanos DG. Partial scapholunate ligament injuries treated with arthroscopic debridement and thermal shrinkage. J Hand Surg Am. 2005. 30:908–914.
6. DeWal H, Ahn A, Raskin KB. Thermal energy in arthroscopic surgery of the wrist. Clin Sports Med. 2002. 21:727–735.
7. Escobedo EM, Bergman AG, Hunter JC. MR imaging of ulnar impaction. Skeletal Radiol. 1995. 24:85–90.
8. Fricker R, Pfeiffer KM, Troeger H. Ulnar shortening osteotomy in posttraumatic ulnar impaction syndrome. Arch Orthop Trauma Surg. 1996. 115:158–161.
9. Feldon P, Terrono AL, Belsky MR. Wafer distal ulna resection for triangular fibrocartilage tear and/or ulna impaction syndrome. J Hand Surg Am. 1992. 17:731–737.
10. Friedman SL, Palmer AK. The ulnar impaction syndrome. Hand Clin. 1991. 7:295–310.
11. Gartland JJ Jr, Werley CW. Evaluation of healed Colles' fractures. J Bone Joint Surg Am. 1951. 33:895–907.
12. Baek GH, Chung MS, Lee YH, Jeong GI, Lee CH. Arthroscopy of the wrist and ulnar shortening osteotomy for the treatment of the ulnar impaction syndrome. J Korean Orthop Assoc. 2001. 36:207–214.
13. Baek GH, Chung MS, Lee YH, Gong HS, Lee S, Kim HH. Ulnar shortening osteotomy in idiopathic ulnar impaction syndrome. J Bone Joint Surg Am. 2005. 87:2649–2654.
14. Gupta R, Bingenheimer E, Fornalski S, McGarry MH, Osterman AL, Lee TQ. The effect of ulnar shortening on lunate and triquetrum motion-a cadaveric study. Clinical Biomech. 2005. 20:839–845.
15. Hulsizer D, Weiss AP, Akelman E. Ulnar-shortening osteotomy after failed arthroscopic debridement of the triangular fibrocartilagenous complex. J Hand Surg Am. 1997. 22:694–698.
16. Imaeda T, Nakamura R, Shionoya K, Makino N. Ulnar impaction syndrome: MR imaging findings. Radiology. 1996. 201:495–500.
17. Köppel M, Hargreaves IC, Herbert TJ. Ulnar shortening osteotomy for ulnar carpal instability and ulnar carpal impaction. J Hand Surg Br. 1997. 22:451–456.
18. Kreder HJ, Hanel DP, McKee M, Jupiter J, McGillivary G, Swiontkowski MF. X-ray film measurement for healed distal radius fractures. J Hand Surg Am. 1996. 21:31–39.
19. Labosky DA, Waggy CA. Oblique ulnar shortening osteotomy by a single saw cut. J Hand Surg Am. 1996. 21:48–59.
20. Loh YC, Van Den Abbeele K, Stanley JK, Trail IA. The results of ulnar shortening for ulnar impaction syndrome. J Hand Surg Br. 1999. 24:316–320.
21. Markolf KL, Tejwani SG, Benhaim P. Effects of wafer resection and hemiresection from the distal ulna on load-sharing at the wrist: a cadaveric study. J Hand Surg Am. 2005. 30:351–358.
22. Minami A, Ishikawa J, Suenaga N, Kasashima T. Clinical results of treatment of triangular fibrocartilage complex tears by arthroscopic debridement. J Hand Surg Am. 1996. 21:406–411.
23. Nishiwaki M, Nakamura T, Nakao Y, Nagura T, Toyama Y. Ulnar shortening effect on distal radioulnar joint stability: a biomechanical study. J Hand Surg Am. 2005. 30:719–726.
24. Palmer AK. Triangular fibrocartilage complex lesions: a classification. J Hand Surg Am. 1989. 14:594–606.
25. Palmer AK, Glisson RR, Werner FW. Relationship between ulnar variance and triangular fibrocartilage complex thickness. J Hand Surg Am. 1984. 9:681–682.
26. Palmer AK, Werner FW. Biomechanics of the distal radioulnar joint. Clin Orthop Relat Res. 1984. 187:26–35.
27. Tatebe M, Nakamura R, Horii E, Nakao E. Results of ulnar shortening osteotomy for ulnocarpal impaction syndrome in wrists with neutral or negative ulnar variance. J Hand Surg Br. 2005. 30:129–132.
28. Tomaino MM. Results of the wafer procedure for ulnar impaction syndrome in the ulnar negative and neutral wrist. J Hand Surg Br. 1999. 24:671–675.
29. Tomaino MM. Ulnar impaction syndrome in the ulnar negative and neutral wrist. Diagnosis and pathoanantomy. J Hand Surg Br. 1998. 23:754–757.
30. Tomaino MM, Weiser RW. Combined arthroscopic TFCC debridement and wafer resection of the distal ulna in wrists with triangular fibrocartilage complex tears and positive ulnar variance. J Hand Surg Am. 2001. 26:1047–1052.
31. Wehbe MA, Cautilli DA. Ulnar shortening using the AO small distractor. J Hand Surg Am. 1995. 20:959–964.
32. Wnorowski DC, Palmer AK, Werner FW, Fortino MD. Anatomic and biomechanical analysis of the arthroscopic wafer procedure. Arthroscopy. 1992. 8:204–212.
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