Arch Hand Microsurg.  2019 Dec;24(4):303-310. 10.12790/ahm.2019.24.4.303.

Dorsal Translation of Ulnar Head after the Arthroscopic Wafer Procedure for Ulnar Impaction Syndrome

Affiliations
  • 1Department of Orthopedic Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea. kbsos@schmc.ac.kr
  • 2Department of Orthopedic Surgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.
  • 3Department of Orthopedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea.

Abstract

PURPOSE
The purpose of this study was to evaluate the results of the arthroscopic wafer procedure (AWP) for ulnar impaction syndrome (UIS) and identify preoperative factors and degree of distal radioulnar joint (DRUJ) translation that could assist in predicting outcomes.
METHODS
We retrospectively reviewed the medical records of 9 patients (11 wrists) who underwent AWP for UIS. Among these, 5 cases were converted to secondary ulnar shortening osteotomy and were categorized to group A and the remaining 6 cases were categorized to group B. The ulnar variance (UV), radioulnar ratio (RUR) by computed tomography or magnetic resonance imaging (MRI), MRI evidence of mechanical impaction in the ulnar or lunate, grip power, Disability of Shoulder, Arm and Hand (DASH) score, and Mayo wrist score were examined before and after AWP.
RESULTS
The MRI evidence did not differ significantly between groups A and B (p>0.05). The average UV and RUR changed from 1.6±0.7 mm and 0.68±0.17 before AWP to −1.5±0.9 mm and 0.54±0.10 after AWP, respectively. The difference between the preoperative RUR (0.65) and postoperative RUR in group B (0.49) was significant (p=0.027, Pearson correlation coefficient=0.862). The grip strength, DASH score, and Mayo wrist score improved from 77.1%, 47.6, and 69.1 to 85.2%, 16.8, and 85.5, respectively.
CONCLUSION
If patients have persisting pain and DRUJ dorsal translation is not reduced after wafer procedure, secondary ulnar shortening osteotom may be required.

Keyword

Ulnar head; Dorsal translation; Arthroscopy

MeSH Terms

Arm
Arthroscopy
Hand
Hand Strength
Head*
Humans
Joints
Magnetic Resonance Imaging
Medical Records
Osteotomy
Retrospective Studies
Shoulder
Wrist

Figure

  • Fig. 1 The radioulnar ratio methods used for quantifying degree of distal radioulnar joint subluxation by computed tomography or magnetic resonance imaging. The center of the ulnar head was identified by using concentric circles. From this point, a line perpendicular to the line that connected the volar and dorsal margins of the sigmoid notch was drawn. The ratio of the length of AD to AB was then calculated.

  • Fig. 2 (A) The degree of ulnar head dorsal subluxation on the magnetic resonance imaging axial image before the arthroscopic wafer procedure (AWP) in secondary ulnar shortening osteotomy patient. (B) The degree of ulnar head dorsal subluxation was not reduced after the AWP. Degree of distal radioulnar joint (DRUJ) ligament tension could be decreased because sudden disappearance of ulnar head pole reduce contact pressure between triangular fibrocartilage complex proximal surface and ulnar head pole, even though DRUJ ligament volar and dorsal limbs as well as the radial and ulnar attachments was carefully protected during the AWP.


Reference

1. Constantine KJ, Tomaino MM, Herndon JH, Sotereanos DG. Comparison of ulnar shortening osteotomy and the wafer resection procedure as treatment for ulnar impaction syndrome. J Hand Surg Am. 2000; 25:55–60.
Article
2. 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; 20:392–401.
Article
3. Markolf KL, Tejwani SG, Benhaim P. Effects of wafer resection and hemiresection from the distal ulna on load-sharing at the wrist: a cadaveric study. J Hand Surg Am. 2005; 30:351–358.
Article
4. Bickel KD. Arthroscopic treatment of ulnar impaction syndrome. J Hand Surg Am. 2008; 33:1420–1423.
Article
5. Griska A, Feldon P. Wafer resection of the distal ulna. J Hand Surg Am. 2015; 40:2283–2288.
Article
6. Lapner PC, Poitras P, Backman D, Giachino AA, Conway AF. The effect of the wafer procedure on pressure in the distal radioulnar joint. J Hand Surg Am. 2004; 29:80–84.
Article
7. 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; 30:719–726.
Article
8. Nakamura R, Horii E, Imaeda T, Nakao E, Kato H, Watanabe K. The ulnocarpal stress test in the diagnosis of ulnar-sided wrist pain. J Hand Surg Br. 1997; 22:719–723.
Article
9. Rhee PC, Sauvé PS, Lindau T, Shin AY. Examination of the wrist: ulnar-sided wrist pain due to ligamentous injury. J Hand Surg Am. 2014; 39:1859–1862.
Article
10. Ruland RT, Hogan CJ. The ECU synergy test: an aid to diagnose ECU tendonitis. J Hand Surg Am. 2008; 33:1777–1782.
Article
11. Cooney WP, Linscheid RL, Dobyns JH. Triangular fibrocartilage tears. J Hand Surg Am. 1994; 19:143–154.
Article
12. Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med. 1996; 29:602–608.
13. Steyers CM, Blair WF. Measuring ulnar variance: a comparison of techniques. J Hand Surg Am. 1989; 14:607–612.
Article
14. Levis CM, Yang Z, Gilula LA. Validation of the extensor carpi ulnaris groove as a predictor for the recognition of standard posteroanterior radiographs of the wrist. J Hand Surg Am. 2002; 27:252–257.
Article
15. Lo IK, MacDermid JC, Bennett JD, Bogoch E, King GJ. The radioulnar ratio: a new method of quantifying distal radioulnar joint subluxation. J Hand Surg Am. 2001; 26:236–243.
Article
16. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977; 33:159–174.
Article
17. Canham CD, Schreck MJ, Maqsoodi N, Messing S, Olles M, Elfar JC. Distal radioulnar joint reaction force following ulnar shortening: diaphyseal osteotomy versus wafer resection. J Hand Surg Am. 2015; 40:2206–2212.
Article
18. Meftah M, Keefer EP, Panagopoulos G, Yang SS. Arthroscopic wafer resection for ulnar impaction syndrome: prediction of outcomes. Hand Surg. 2010; 15:89–93.
Article
19. Gartland JJ Jr, Werley CW. Evaluation of healed Colles' fractures. J Bone Joint Surg Am. 1951; 33:895–907.
Article
20. Park MJ, Kim JP. Reliability and normal values of various computed tomography methods for quantifying distal radioulnar joint translation. J Bone Joint Surg Am. 2008; 90:145–153.
Article
Full Text Links
  • AHM
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr