J Korean Orthop Assoc.  2007 Jun;42(3):310-317. 10.4055/jkoa.2007.42.3.310.

Treatment of Ulnar Impaction Syndrome using Arthroscopy and Ulnar Shortening Osteotomy

• Cheon SJ
• Kang JH
• Cho JY
• Lim JM

• KMID: 2186554
• DOI: http://doi.org/10.4055/jkoa.2007.42.3.310

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.
CONCLUSION
When ulnar impaction syndrome is diagnosed by the clinical, radiological and arthroscopic findings, arthroscopic debridement, thermal shrinkage and simultaneous ulnar shortening osteotomy are useful treatments for relieving the patients symptoms.

Keyword

Ulnar impaction syndrome; Arthroscopic debridement; Thermal shrinkage; Ulnar shortening osteotomy

MeSH Terms

Arthroscopy*
Debridement
Follow-Up Studies
Humans
Osteotomy*
Physical Examination
Retrospective Studies
Wrist

Figure

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  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.

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