Factors Affecting the Occurrence of Distal Radioulnar Joint Arthritis after Ulnar Shortening Osteotomy

Chol-Jin Kim; Ho-Jin Gil; Yang-Guk Chung; Seung-Han Shin; Dong-Hyun Kim; Jun-Soo Park; Hyun-Chul Choi

doi:10.12790/jkssh.2014.19.2.57

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Kim, Gil, Chung, Shin, Kim, Park, and Choi: Factors Affecting the Occurrence of Distal Radioulnar Joint Arthritis after Ulnar Shortening Osteotomy

ORIGINAL ARTICLE

J Korean Soc Surg Hand 2014;19(2):57-64.

Published online: 11 June 2014

DOI: https://doi.org/10.12790/jkssh.2014.19.2.57

Factors Affecting the Occurrence of Distal Radioulnar Joint Arthritis after Ulnar Shortening Osteotomy

Chol-Jin Kim¹, Ho-Jin Gil², Yang-Guk Chung^2,, Seung-Han Shin², Dong-Hyun Kim², Jun-Soo Park², Hyun-Chul Choi²

¹Department of Orthopedic Surgery, The Armed Forces Dae Jeon Hospital, Daejeon, Korea

²Department of Orthopedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea

Correspondence to: Yang-Guk Chung, Department of Orthopedic Surgery, Seoul St. Mary’ Hospital, The Catholic University of Korea, 222 Banpodaero, Seocho-gu, Seoul 137-701, Korea, TEL: +82-2-2258-2837, FAX: +82-2-535-9834, E-mail: ygchung@catholic.ac.kr

^* This research was supported by the 2013 Seoul St. Mary's Hospital Clinical Medicine Research Program through the Catholic University of Korea.

Received 13 June 201415 June 2014 Accepted 16 June 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

Ulnar shortening osteotmy is a common operation for the treatment of ulnar impaction syndrome. The purpose of this study was to evaluate factors that may affect the occurrence of distal radioulnar joint (DRUJ) arthritis after ulnar shortening osteotomy.

Methods:

From September 2005 to August 2012, we performed 81 ulnar shortening osteotomies for ulnar impaction syndrome, and evaluated occurrence or deterioration of DRUJ arthritis in 58 patients with a minimum follow-up of 1 year. We analyzed potential factors that may affect the occurrence of DRUJ arthritis, such as, age, sex, hand dominance, pre- and postoperative ulnar variance, preexisting DRUJ arthritis, types of radial sigmoid notch, amount of ulnar shortening, and follow up period.

Results:

DRUJ arthritis occurred or deteriorated in 32 out of the 58 patients. Regression analysis indicated a significant correlation between the type of radial sigmoid notch (type 1) and DRUJ arthritis. Other factors were not found to be correlated with occurrence or deterioration of DRUJ arthritis.

Conclusion:

This study suggests that patients with type 1 radial sigmoid notch (ulnar inclination of more than 10 degrees) are more likely to develop DRUJ arthritis after ulnar shortening osteotomy.

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Keywords: Ulnar impaction syndrome, Ulnar shortening, Distal radioulnar joint arthritis, Pain

References

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Fig. 1.

Types of the sigmoid notchs of distal radioulnar joints. (A) Type I is a hemispherical type that sigmoid notch is tilted to the ulnar side, more than 10 degrees. (B) Type II is a cylinderical type. Sigmoid notch is tilted less than 10 degrees to the radial or ulnar side. (C) Type III is a conical type that sigmoid notch tilted to radial side more than 10 degrees.

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Fig. 2.

The patient with a complaining of right wrist pain for the past 1 year. (A) The radiograph showed 7 mm ulnar positive variance and sigmoid notch tilt to ulnar side (type II sigmoid notch). (B) Ulnar impaction syndrome was diagnosed and a ulnar shortening surgery was performed. The postoperative radiograph showed neutral ulnar variance. (C) Postoperative 14 months, there was no evidence of arthritic change. (D) Postoperative 27 months, there was little progression of arthritic change at distal radioulnar joint with sclerosis (white arrow). Visual analogue scale score was improved from 3 preoperatively to 0 at the last follow up and pain grade from 2 to 0 at the last follow-up.

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Fig. 3.

The patient has been complaining with a left wrist pain for five months. (A) The radiograph showed 5 mm ulnar positive variance and sigmoid notch tilt to ulnar side (type I). (B) A ulnar shortening surgery was performed. The postoperative radiograph showed 2 mm ulnar negative variance. (C) Postoperative 5 months, there was little osteophyte formation at distal radioulnar joint (white arrow). (D) Postoperative 9 months, progression of arthritic changes and more osteophyte formation were found (white arrow), which resulted in painful pronation/supination motion. (E) The osteophytes were excised. Visual analogue scale score was improved from 8 preoperatively to 2 at the last follow up and pain grade from 2 to 1 at postosteophyte-excision 18 months.

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Table 1.

Radiographic criteria for assessment of distal radioulnar joint arthritis

Radiographic grade	Classification	Description
0	Normal	No features of arthritis
I	Doubtful	Sclerosis
II	Mild	Small^*, single osteophyte
III	Moderate	Large^†, multiple osteophyte
IV	Severe	Joint destruction

^* Small, less than 2 mm in size;

^† Large, greater than 2 mm in size.

Table 2.

Independent variable of distal radioulnar joint arthritis

Independent variable	Number of cases
Age (yr)
<50	29
≥50	29
Sex
Male	14
Female	44
Dominant hand
Dominant	31
Non-dominant	27
Preoperative ulnar variance
<4 mm	10
≥4 mm	48
Preoperative arthritis
0	36
I	7
II	13
III	2
IV	0
Types of sigmoid notch
I	17
II	20
III	21
Ulnar shortening length
<4.6 mm	14
≥4.6 mm	44
Postoperative ulnar variance
<2 mm	54
≥2 mm	4
Follow-up term
<24 mo	32
≥24 mo	26

Table 3.

Results of simple linear regression analysis for factors affecting on distal radioulnar joint arthritis

Independent variable	p-value	Correlation coefficient
Age	0.186	0.176
Sex	0.339	0.128
Dominant hand	0.877	0.021
Preoperative ulnar variance	0.168	0.183
Preoperative arthritis	0.168	0.183
Types of sigmoid notch	0.005	0.368
Ulnar shortening length	0.339	0.128
Postoperative ulnar variance	0.139	0.197
Follow-up term	0.488	0.071

Table 4.

The outcomes of VAS score and pain grade

	Preoperative	At last follow-up	p-value
VAS score	6.29±2.38	1.63±1.65	<0.05
Pain grade^*	1.53±0.54	0.65 ±0.62	<0.05

Values are presented as mean±standard deviation.

VAS, visual analogue scale.

^* Pain grade: 0, no pain; 1, pain on excertion; 2, pain on rest.

Table 5.

Comparison of VAS score and pain grade with/without DRUJ arthritis

	No osteoarthritis	Osteoarthritis	p-value
Visual analogue scale score
Preoperative	7.07±2.29	5.70±2.46	0.05
At last follow-up	1.16±1.42	1.61±1.81	0.91
Pain grade
Preoperative	1.71±0.46	1.41±0.56	0.053
At last follow-up	0.76±0.62	0.58±0.62	0.30

Values are presented as mean±standard deviation.

VAS, visual analogue scale; DRUJ, distal radioulnar joint.

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