Distal Metaphyseal Ulnar-Shortening Osteotomy: Surgical Technique

Hammert, Warren C.; Williams, Richard; Greenberg, Jeffrey A.

doi:10.1016/j.jhsa.2012.02.031

Cited by 24 publications

(31 citation statements)

References 20 publications

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“…It has been shown that debridement of TFCC tears alone in ulnar-positive wrists has provided incomplete relief in up to 25% of patients. 7 Tomaino and Shah 8 in 2001 showed good results when combining TFCC debridement with the arthroscopic wafer procedure in patients who were ulnar positive. Constantine et al 6 in 2000 compared ulnar-shortening osteotomies with the arthroscopic wafer procedure, showing that both were effective at relieving pain but that the arthroscopic wafer procedure was not complicated by hardware and nonunion problems.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic Wafer Procedure for Ulnar Impaction Syndrome

Colantoni

Chadderdon

Gaston

2014

Arthroscopy Techniques

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Ulnar impaction syndrome is abutment of the ulna on the lunate and triquetrum that increases stress and load, causing ulnar-sided wrist pain. Typically, ulnar-positive or -neutral variance is seen on a posteroanterior radiograph of the wrist. The management of ulnar impaction syndrome varies from conservative, symptomatic treatment to open procedures to shorten the ulna. Arthroscopic management has become increasingly popular for management of ulnar impaction with ulnar-positive variance of less than 3 mm and concomitant central triangular fibrocartilage complex tears. This method avoids complications associated with open procedures, such as nonunion and symptomatic hardware. The arthroscopic wafer procedure involves debridement of the central triangular fibrocartilage complex tear, along with debridement of the distal pole of the ulna causing the impaction. Debridement of the ulna arthroscopically is taken down to a level at which the patient is ulnar neutral or slightly ulnar negative. Previous studies have shown good results with relief of patient symptoms while avoiding complications seen with open procedures.U lnar impaction syndrome is abutment of the ulna on the lunate and sometimes the triquetrum seen with increases in stress and load across the joint. The continuum of findings includes ulnar-positive variance, triangular fibrocartilage complex (TFCC) tear, and lunate-triquetrum ligament tear.1 Small changes in variance can dramatically affect loads across the joint. Palmer and Werner 2,3 showed that a neutral wrist has 18% of its load through the ulna whereas 42% of the load crosses the ulna in a 2-mm ulnar-positive wrist and 4% in a 2-mm ulnar-negative wrist. Common associated findings are TFCC tears, lunotriquetral ligament tears, scapholunate ligament tears, and radial shortening from previous trauma. Presenting symptoms include pain over the dorsal and ulnar wrist, with ulnar deviation and with axial loading. Findings on radiographs include ulnar-positive variance and sclerosis of the lunate and/or ulnar head. Conservative measures involve immobilization, anti-inflammatory medications, and corticosteroid injections. Surgical options include isolated TFCC debridement and ulnar shortening procedures including open or arthroscopic wafer procedures, as well as diaphyseal or distal metaphyseal osteotomies. 3,4,5 The arthroscopic wafer procedure is an effective method to debride TFCC tears, along with decompressing ulnar-positive wrists. It has been found to have equivalent results to an open procedure, with fewer complications. 6 This technique avoids hardware complications and the risk of nonunion associated with ulnar shortening osteotomy. Indications for the wafer procedure are failed nonoperative treatment for at least 3 months, central TFCC tear, and less than 3 mm of ulnar-positive variance. Surgical TechniqueThe patient is placed in the supine position after undergoing general or regional anesthesia and receiving appropriate preoperative antibiotics. Video 1 illustrates the procedure. Th...

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Section: Discussionmentioning

confidence: 99%

Arthroscopic Wafer Procedure for Ulnar Impaction Syndrome

Colantoni

Chadderdon

Gaston

2014

Arthroscopy Techniques

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“…The standard method is performing diaphyseal osteotomy, but several authors reported good results with metaphyseal osteotomy as well, reporting better union rates and less soft tissue irritation. [8][9][10] Diaphyseal osteotomies have the advantage of improving radioulnar stability because of the tensioning effect on the distal interosseous ligament. 11 Oblique, 12 transverse, 13 and step-cut osteotomy have been described.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of the Ulnar Shortening Osteotomy Using a Dynamic Compression Plate on the Ulnar Surface of the Ulna

El-Gammal

Rozée

2017

Jnl Wrist Surg

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The purpose of this study is to evaluate the results of patients with ulnar impaction syndrome treated with diaphyseal osteotomy using freehand technique and fixation with ulnar osteotomy compression plate placed on the ulnar surface of the ulna. A retrospective chart review of patients with ulnar impaction syndrome between 2010 and 2014 identified 38 patients. The following clinical data were observed: patient age, sex, range of motion, grip strength, visual analog scale (VAS), Disabilities of the Arm, Shoulder, and Hand (DASH) score, radiological assessment, and complications. The mean follow-up period is 30 months. Eleven patients were excluded from the study. Compared with the contralateral side, the 27 patients included in this study attained 93 to 96% of wrist and forearm motion and 81% of the grip strength. The average DASH score was 18 in a mean follow-up period of 30 months. Three patients required plate removal and one case showed nonunion and a further operation was needed. Two patients reported persistent ulnar-sided wrist pain. We concluded that placing the ulnar osteotomy plate on the ulnar surface of the ulna is a quicker procedure, with less soft tissue dissection and irritation, and very high union rate. Level IV.

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“…18 Since then many techniques of surgical shortening of the ulna have been developed. [19][20][21][22] The most popular methods are the open or arthroscopic wafer procedure and the diaphyseal shortening osteotomy with plate and screw fixation. [23][24][25][26][27] This article describes the oblique metaphyseal shortening osteotomy of the distal ulna, starting proximal-ulnar, and ending distal-radial just proximal to the ulnar head, respecting an inclination between 30 and 45 degrees.…”

Section: Discussionmentioning

confidence: 99%

The Oblique Metaphyseal Shortening Osteotomy of the Distal Ulna: Surgical Technique and Results of Ten Patients

Benis

Goubau

Mermuys³

et al. 2016

Jnl Wrist Surg

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Background Ulnocarpal abutment is a common condition following distal radius fractures. There are different surgical methods of treatment for this pathology: open and arthroscopic wafer procedure or an ulnar shortening osteotomy. We describe an oblique metaphyseal shortening osteotomy of the distal ulna using two cannulated headless compression screws. We report the results of 10 patients treated with this method. Materials and Methods Out of 17 patients, 10 could be reviewed retrospectively for this study. Patient-rated outcomes were measured using the VAS (visual analogue scale) for pain, PRWHE (patient-rated wrist and hand evaluation) survey, and Quick-DASH (disability of arm, shoulder and hand) survey for functional outcomes. At the review we measured the range of motion (ROM) of the wrist (extension and flexion, ulnar and radial deviation, pronation and supination). Grip strength, pronation, and supination strength of the forearm was measured using a calibrated hydraulic dynamometer. ROM and strength of the affected wrist was compared with ROM and strength of the unaffected wrist. Surgical Procedure Oblique long metaphyseal osteotomy of the distal ulna (from proximal-ulnar to distal-radial), fixed with two cannulated headless compression screws. Results The average postoperative VAS score for pain was 23.71 (standard deviation [SD] of 30.41). The average postoperative PRWHE score was 32.55 (SD of 26.28). The average postoperative Quick-DASH score was 28.65 (SD of 27.21). The majority of patients had a comparable ROM and strength between the operated side and the nonoperated side. Conclusion This surgical technique has the advantage of reducing the amount of hardware and to decrease the potential hinder caused by it on medium term. Moreover, the incision remains smaller, and the anatomic metaphyseal localization of the osteotomy potentially allows a better and rapid healing.

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Distal Metaphyseal Ulnar-Shortening Osteotomy: Surgical Technique

Cited by 24 publications

References 20 publications

Arthroscopic Wafer Procedure for Ulnar Impaction Syndrome

Arthroscopic Wafer Procedure for Ulnar Impaction Syndrome

Outcomes of the Ulnar Shortening Osteotomy Using a Dynamic Compression Plate on the Ulnar Surface of the Ulna

The Oblique Metaphyseal Shortening Osteotomy of the Distal Ulna: Surgical Technique and Results of Ten Patients

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