Ulnar Impaction Syndrome: Ulnar Shortening vs. Arthroscopic Wafer Procedure

Abstract

The basis of treatment of ulnar impaction 1 is mechanical decompression of the ulnocarpal articulation by decreasing ulnar variance. Shortening of the ulna or resection of the distal ulna significantly decreases forces across the ulnar wrist. 2,3Various surgical procedures have been proposed to treat this ulnar impaction syndrome. They are all based on decompression of the ulnocarpal joint. Biomechanical studies of Palmer et al have shown that 18% of the loading pressure across the wrist is borne by the ulnocarpal articulation and that, by shortening the ulna 2.5 mm, this loading pressure is decreased to 4.3%.2 The ulnar shortening osteotomy is an extra-articular technique and has the theoretical advantage of maintaining the distal radioulnar joint (DRUJ) and the peripheral aspect of the triangular fibrocartilage complex (TFCC). The outcomes of ulnar shortening osteotomy, described in the literature, were good or excellent in the majority of the cases. 21-23In our patients, however, the results of ulnar shortening were not as positive.14 The overall outcome was not that good, and ulnar shortening osteotomy did not always seem to be the ultimate successful procedure for ulnar abutment. Complications were procedure linked and not related to an incomplete diagnosis of ulnar wrist pain. In recent years we performed an arthroscopic resection of the distal ulna with similar results. This article will summarize the results of a retrospective case-control series. The data of these surveys has been reported in previous papers. 14,16,17Ulnar ShorteningIn this survey we studied the outcome in 28 patients (22 women and 6 men) following an ulnar shortening osteotomy for ulnar impaction. The mean age at operation was 38 years (range 16-61). The dominant hand was affected in 13 patients, 17 of them were treated previously with an arthroscopic débridement. 15 For the shortening osteotomy, the distal ulna was approached through a dorsoulnar longitudinal incision between the extensor carpi ulnaris (ECU) and flexor carpi ulnaris (FCU). The dorsal branch of the ulnar nerve was protected and the ulna was exposed in an extraperiosteal fashion. A seven-hole, 3.5-mm AO dynamic compression plate (DCP)-was used. A longitudinal saw cut along the plate was made as a rotational marker. The plate was swung away and two parallel osteotomies were performed, either transverse or oblique. In this series there were 19 transverse and 9 oblique osteotomies. The plate was aligned again, and bicortical screws were introduced, three distal and three proximal Keywords ► ulnar impaction ► shortening osteotomy ► arthoscopy ► TFCC ► wafer AbstractThe outcome of ulnar shortenings was compared with that of arthroscopic wafer resections for ulnar impaction (or abutment) syndrome in patients with a positive ulnar variance. The outcome was measured by DASH score, visual analog scale for pain, and working incapacity. The mean DASH score in the ulnar shortening group was 26; in the wafer group it was 36. The VAS scores were respectively 4.4 and 4.6. The working...

Treatment of Hand and Wrist Cartilage Defects in Athletes

“…6,49 Both of the above procedures serve to decrease ulnar load, and each has demonstrated positive results in the literature. 22,54,55 Tatebe et al 22 studies reported an average grip strength increase from 53% to 78%, and improvements in flexion-extension arc from 82% to 93%, in patients with neutral and even ulnar-negative variance who underwent ulnar shortening osteotomy. Del Gaudio et al 56 studied 24 patients undergoing the arthroscopic wafer procedure with an average ulnar head resection of 2.5 mm and found "very good" results in 23 of 24 patients.…”

“…Del Gaudio et al 56 studied 24 patients undergoing the arthroscopic wafer procedure with an average ulnar head resection of 2.5 mm and found "very good" results in 23 of 24 patients. De Smet et al 54 studied ulnar shortening surgery versus the arthroscopic wafer procedure in the setting of ulnar impaction syndrome. These authors found a lower duration of time off of work in the arthroscopic group as well as an increased number of secondary procedures in the osteotomy group, with clinical outcomes between the 2 groups largely similar.…”