Clin Orthop Surg.  2011 Sep;3(3):184-190. 10.4055/cios.2011.3.3.184.

A Comparison of Ulnar Shortening Osteotomy Alone Versus Combined Arthroscopic Triangular Fibrocartilage Complex Debridement and Ulnar Shortening Osteotomy for Ulnar Impaction Syndrome

• Kim BS
• Song HS

• KMID: 1743908
• DOI: http://doi.org/10.4055/cios.2011.3.3.184

Abstract

BACKGROUND
This study compared the results of patients treated for ulnar impaction syndrome using an ulnar shortening osteotomy (USO) alone with those treated with combined arthroscopic debridement and USO.
METHODS
The results of 27 wrists were reviewed retrospectively. They were divided into three groups: group A (USO alone, 10 cases), group B (combined arthroscopic debridement and USO, 9 cases), and group C (arthroscopic triangular fibrocartilage complex [TFCC] debridement alone, 8 cases). The wrist function was evaluated using the modified Mayo wrist score, disabilities of the arm, shoulder and hand (DASH) score and Chun and Palmer grading system.
RESULTS
The modified Mayo wrist score in groups A, B, and C was 74.5 +/- 8.9, 73.9 +/- 11.6, and 61.3 +/- 10.2, respectively (p < 0.05). The DASH score in groups A, B, and C was 15.6 +/- 11.8, 19.3 +/- 11.9, and 33.2 +/- 8.5, respectively (p < 0.05). The average Chun and Palmer grading score in groups A and B was 85.7 +/- 8.9 and 84.7 +/- 6.7, respectively. The difference in the Mayo wrist score, DASH score and Chun and Palmer grading score between group A and B was not significant (p > 0.05).
CONCLUSIONS
Both USO alone and combined arthroscopic TFCC debridement with USO improved the wrist function and reduced the level of pain in the patients treated for ulnar impaction syndrome. USO alone may be the preferred method of treatment in patients if the torn flap of TFCC is not unstable.

Keyword

Ulnar impaction syndrome; Triangular fibrocartilage complex; Ulnar shortening osteotomy; Arthroscopic debridement

MeSH Terms

Adult
Aged
*Arthroscopy
*Debridement
Female
Humans
Joint Diseases/surgery
Male
Middle Aged
Orthopedic Procedures/methods
*Osteotomy
Triangular Fibrocartilage/*surgery
Ulna/*surgery
Wrist Joint/*surgery

Figure

• 

  Fig. 1 (A) A 35-year-old female showing positive ulnar variance on a preoperative anteroposterior radiograph. (B) CT arthrography findings of a perforation of the triangular fibrocartilage complex and subchondral cyst in the ulnar border of the lunate in ulnar impaction syndrome. (C) Arthroscopic view of a central Palmer 2C lesion exposing the ulnar head through the defect in the articular disc. (D) An anteroposterior radiograph made after ulnar shortening osteotomy alone and fixation with a dynamic compression plate and screws. (E) A 30-month final follow-up anteroposterior radiograph.

• 

  Fig. 2 (A) A 45-year-old female showing positive ulnar variance on a preoperative anteroposterior radiograph. (B) Computed tomography arthrography findings of a perforation of the triangular fibrocartilage complex (TFCC) and subchondral cyst in the lunate in ulnar impaction syndrome. (C) Wear in the central portion of the TFCC on arthroscopy. (D) Tear of membraneous portion of the lunatotriquetral ligament on arthroscopy. (E) Arthroscopic photo of Palmer 2D TFCC defect after debridement. (F) An anteroposterior radiograph made after arthroscopic debridement and ulnar shortening osteotomy and fixation with a dynamic compression plate and screws. (G) An 18-month final follow-up anteroposterior radiograph.

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