J Korean Soc Surg Hand.  2014 Jun;19(2):57-64. 10.12790/jkssh.2014.19.2.57.

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

• Kim CJ
• Gil HJ
• Chung YG
• Shin SH
• Kim DH
• Park JS
• Choi HC

• KMID: 2097610
• DOI: http://doi.org/10.12790/jkssh.2014.19.2.57

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.

Keyword

Ulnar impaction syndrome; Ulnar shortening; Distal radioulnar joint arthritis; Pain

MeSH Terms

Arthritis*
Colon, Sigmoid
Follow-Up Studies
Hand
Humans
Joints*
Osteotomy*

Figure

• 

  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.

• 

  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.

• 

  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.

Reference

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