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

• Yun K
• Jung KJ
• Nho JH
• Cho W
• Kim BS

• KMID: 2464465
• DOI: http://doi.org/10.12790/ahm.2019.24.4.303

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.

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