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

Affiliations
  • 1Department of Orthopedic Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea. kbsos@schmc.ac.kr

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.


Cited by  3 articles

Intraoperative Arthroscopic Findings of Ulnar Impaction Syndrome
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Current Treatment of Triangular Fibrocartilage Complex Injuries
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J Korean Soc Surg Hand. 2013;18(2):85-94.    doi: 10.12790/jkssh.2013.18.2.85.

Ulnar impaction syndrome: how to diagnose and treat?
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Arch Hand Microsurg. 2022;27(2):105-118.    doi: 10.12790/ahm.21.0149.


Reference

1. Sachar K. Ulnar-sided wrist pain: evaluation and treatment of triangular fibrocartilage complex tears, ulnocarpal impaction syndrome, and lunotriquetral ligament tears. J Hand Surg Am. 2008. 33(9):1669–1679.
Article
2. Cooney WP, Linscheid RL, Dobyns JH. Triangular fibrocartilage tears. J Hand Surg Am. 1994. 19(1):143–154.
Article
3. Hudak PL, Amadio PC, Bombardier C. The Upper Extremity Collaborative Group (UECG). Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. Am J Ind Med. 1996. 29(6):602–608.
Article
4. Chun S, Palmer AK. The ulnar impaction syndrome: follow-up of ulnar shortening osteotomy. J Hand Surg Am. 1993. 18(1):46–53.
Article
5. Yeh GL, Beredjiklian PK, Katz MA, Steinberg DR, Bozentka DJ. Effects of forearm rotation on the clinical evaluation of ulnar variance. J Hand Surg Am. 2001. 26(6):1042–1046.
Article
6. Lauder AJ, Luria S, Trumble TE. Oblique ulnar shortening osteotomy with a new plate and compression system. Tech Hand Up Extrem Surg. 2007. 11(1):66–73.
Article
7. Chen NC, Wolfe SW. Ulna shortening osteotomy using a compression device. J Hand Surg Am. 2003. 28(1):88–93.
Article
8. Palmer AK. Triangular fibrocartilage complex lesions: a classification. J Hand Surg Am. 1989. 14(4):594–606.
Article
9. Bickel KD. Arthroscopic treatment of ulnar impaction syndrome. J Hand Surg Am. 2008. 33(8):1420–1423.
Article
10. 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(6):1047–1052.
Article
11. 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(3):406–411.
Article
12. Fulcher SM, Poehling GG. The role of operative arthroscopy for the diagnosis and treatment of lesions about the distal ulna. Hand Clin. 1998. 14(2):285–296.
Article
13. Moritomo H, Murase T, Arimitsu S, Oka K, Yoshikawa H, Sugamoto K. Change in the length of the ulnocarpal ligaments during radiocarpal motion: possible impact on triangular fibrocartilage complex foveal tears. J Hand Surg Am. 2008. 33(8):1278–1286.
Article
14. Nishiwaki M, Nakamura T, Nagura T, Toyama Y, Ikegami H. Ulnar-shortening effect on distal radioulnar joint pressure: a biomechanical study. J Hand Surg Am. 2008. 33(2):198–205.
Article
15. 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(4):719–726.
Article
16. 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(12):2649–2654.
Article
17. Tatebe M, Horii E, Nakao E, et al. Repair of the triangular fibrocartilage complex after ulnar-shortening osteotomy: second-look arthroscopy. J Hand Surg Am. 2007. 32(4):445–449.
Article
18. Bernstein MA, Nagle DJ, Martinez A, Stogin JM Jr, Wiedrich TA. A comparison of combined arthroscopic triangular fibrocartilage complex debridement and arthroscopic wafer distal ulna resection versus arthroscopic triangular fibrocartilage complex debridement and ulnar shortening osteotomy for ulnocarpal abutment syndrome. Arthroscopy. 2004. 20(4):392–401.
Article
19. Iwasaki N, Ishikawa J, Kato H, Minami M, Minami A. Factors affecting results of ulnar shortening for ulnar impaction syndrome. Clin Orthop Relat Res. 2007. 465:215–219.
Article
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