The Results of Ulnar Shortening for Ulnar Impaction Syndrome

Loh, Y. C.; Abbeele, K Van den; Stanley, John; Trail, I. A.

doi:10.1054/jhsb.1999.0062

Cited by 100 publications

(94 citation statements)

References 13 publications

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“…20,[36][37][38] The disadvantages of ulnar shortening are nonunion/delayed union and hardware irritation. 6,10,15,[17][18][19] However, rates of complication can be low if the procedure is properly performed, 5,38 and many papers have actually reported low complication rates. 31,39 New devices to assist with ulnar shortening osteotomy may further reduce the risk of nonunion.…”

Section: Discussionmentioning

confidence: 99%

“…4 This procedure has been the standard treatment for ulnar impaction syndrome for many years. 5,6 Recent biomechanical studies have confirmed that an ulnar shortening osteotomy can improve the stability of the ulnar carpus and distal radioulnar joint (DRUJ). 7,8 As a result, this method is used for the treatment of ulnar-sided wrist pain, a common cause of upper-extremity disability, 2 and has achieved excellent results for posttraumatic TFCC injury and isolated lunotriquetral interosseous ligament (LTIL) tears.…”

mentioning

confidence: 99%

“…12 Various authors have noted the utility of performing an extra-articular ulnar shortening osteotomy in the treatment of both degenerative and traumatic tears of the TFCC in patients with both an ulnar positive and neutral variance. 5,6,10,[13][14][15][16][17][18][19][20] Shortening of the ulna obviously decreases the ulnar length and unloads the ulnar wrist, but it can also change the DRUJ morphology. Malalignment with respect to ulnar inclination and the sigmoid notch has been considered a relative contraindication for ulnar shortening osteotomy, 21 which might cause degenerative changes in the DRUJ.…”

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Ulnar Shortening Osteotomy for Ulnar-Sided Wrist Pain

et al. 2014

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The ulnar side of the wrist has been referred to as the "black box" of the wrist, and pathologies of this region have been compared with those of low back pain, 1,2 given the complex anatomy, myriad differential diagnosis, and varied treatment outcomes. Ulnar-sided wrist pain and arise from an acute traumatic injury or a chronic degenerative condition. Common causes of ulnar-sided wrist pain include isolated injuries to the triangular fibrocartilage complex (TFCC) or lunotriquetral ligament as well as ulnar impaction syndrome, which consists of a combination of these 2 conditions along with an Keywords ► ulnar shortening osteotomy ► ulnar-sided wrist pain ► TFCC ► DRUJ ► arthroscopy AbstractBackground The purpose of ulnar shortening osteotomy is literally to shorten the ulna. It can tighten the triangular fibrocartilage complex (TFCC), ulnocarpal ligaments, and interosseous membrane. Nowadays, this method is used to treat ulnar-sided wrist pain, for which we have also started to use a treatment algorithm. The purpose of this study was to review the long-term and clinical results based on our algorithm. Materials and Methods We retrospectively reviewed 30 patients with ulnocarpal impaction syndrome after a minimum follow-up of 5 years (Group A) and then retrospectively evaluated 66 patients with recalcitrant ulnar wrist pain treated based on our algorithm (Group B). Description of Technique Ulnocarpal abutment was confirmed arthroscopically. The distal ulna was approached through a longitudinal incision between the extensor carpi ulnaris and flexor carpi ulnaris. We performed a transverse resection of the ulna fixed with a small locking compression plate. The contralateral side served as the reference for the length of shortening (mean, 2.4 mm; range, 1-5 mm). Disappearance of ulnar abutment was then confirmed again arthroscopically. Results (Group A) Most patients showed good long-term clinical results. About half of the patients showed a bony spur at the distal radioulnar joint (DRUJ), but the clinical results did not significantly correlate with presence of bony spurs. Radiological parameters wre not related to the presence of bony spurs. (Group B) Twenty-four of the 66 patients investigated prospectively underwent an ulnar shortening osteotomy, with all showing good clinical results at 18 months postoperatively. Conclusions Ulnar shortening osteotomy can change the load of the ulnar side of the wrist and appears useful for ulnar-sided wrist pain in the presence of ulnar impaction. Level of evidence IV

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Ulnar Shortening Osteotomy for Ulnar-Sided Wrist Pain

et al. 2014

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“…Despite these benefits, ulna shortening osteotomies are historically not without complications and challenges including technical difficulty, risk of nonunion, and painful hardware (and even fractures associated with premature hardware removal) [2,3,6,8,12,18,21,24]. In rationalizing the need for an improved ulna shortening system, Rayhack et al noted excessive healing times and risk of nonunion, imprecise cuts, and "struggles with fixing the osteotomy" as all problems with free-hand techniques [21].…”

Section: Discussionmentioning

confidence: 99%

“…Of the reported complications, painful hardware seems to be the most predominant. Complaints of plate irritation have been found in multiple studies-60% [2], 68% [12], and 100% [24]-often lowering patient satisfaction rates and necessitating a second surgery to remove the plate [3,12] which occasionally resulted in fracture through the osteotomy site [18,24]. This particular problem has led some surgeons to favor the wafer procedure (excision of the distal 2-4 mm of ulna) over extra-articular ulna shortening [6,8].…”

Section: Discussionmentioning

confidence: 99%

A Prospective Study on the Initial Results of a Low Profile Ulna Shortening Osteotomy System

Isaacs¹,

Howard

Gulkin³

2009

Hand (New York, N,Y.)

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Extra-articular ulna shortening osteotomy, in principle, is an accepted treatment option for symptomatic degenerative and traumatic triangular fibrocartilage complex (TFCC) tears. Despite the benefits of this surgical approach, potential disadvantages include risk of nonunion, soft tissue irritation, and the need for future hardware removal. A recently introduced low profile ulna shortening system was designed to decrease these potential complications. A single-surgeon prospective study was performed to evaluate this system. Ten consecutive patients undergoing ulna shortening for ulnar-sided wrist pain compatible with TFCC pathology participated in the study. Subjective, objective, and radiographic assessments were performed preoperatively and up to 24 weeks postoperatively. Based on visual analog scale (VOS) ratings (0 to 10), pain scores significantly improved (p<0.05) and average patient satisfaction was 8.7. DASH and PRWE scores improved at three month follow-up (p<0.05). Osteotomy healing time averaged 10.3 weeks, and there were no nonunions. Average discomfort associated with palpation of the plate at final follow-up was 3.3 (using VOS), and one patient requested removal of the hardware. In this short-term follow-up study, the assessed ulna shortening system appears effective and, in general, well tolerated.

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A finite element model to investigate the effect of ulnar variance on distal radioulnar joint mechanics

Greybe

Boland

et al. 2016

Numer Methods Biomed Eng

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Ulnocarpal impaction syndrome involves excessive loading of the ulnocarpal joint. Ulnar shortening osteotomies are an effective way to reduce ulnocarpal loading but alter contact mechanics at the distal radioulnar joint (DRUJ). This study used a computational model to investigate the relationship between ulnar length and DRUJ mechanics. Detailed, finite element models of the radius and ulna bones were constructed from magnetic resonance imaging data. The length of the ulna bone model was increased and decreased up to 5 mm in 1 mm increments. A computational model was used to predict joint contact at the DRUJ for each ulnar length. Lengthening the ulna caused a slight decrease in DRUJ contact pressure, with a more substantial decrease in contact area. Shortening the ulna caused a substantial increase in contact area, with a smaller increase in DRUJ contact pressure. The location of contact on the radial sigmoid notch changed with 2 mm lengthening and 3 mm shortening. The results of this study demonstrate the sensitivity of DRUJ contact to ulnar length changes, which may explain the DRUJ cartilage degeneration that often follows ulnar osteotomies. The joint contact model implemented in this study allowed the relationship between ulnar length and DRUJ contact to be examined systematically, in a way that is difficult to achieve through cadaveric experimentation. The results confirmed published experimental data showing an increased DRUJ contact pressure with ulnar shortening. It is important that clinicians consider the influence of ulnar osteotomies, not only on ulnocarpal loading but also on DRUJ mechanics. Copyright © 2016 John Wiley & Sons, Ltd.

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The Results of Ulnar Shortening for Ulnar Impaction Syndrome

Cited by 100 publications

References 13 publications

Ulnar Shortening Osteotomy for Ulnar-Sided Wrist Pain

Ulnar Shortening Osteotomy for Ulnar-Sided Wrist Pain

A Prospective Study on the Initial Results of a Low Profile Ulna Shortening Osteotomy System

A finite element model to investigate the effect of ulnar variance on distal radioulnar joint mechanics

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