Jnl Wrist Surg
DOI: 10.1055/s-0037-1607073
Scientific Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Treatment of Ulnar Impaction Syndrome with and without Central TFC Lesion

Steffen Löw
Section of Hand Surgery, Department of Orthopaedic and Trauma Surgery, Caritas-Krankenhaus, Bad Mergentheim, Germany
,
Alexandra Herold
Section of Hand Surgery, Department of Orthopaedic and Trauma Surgery, Caritas-Krankenhaus, Bad Mergentheim, Germany
,
Frank Unglaub
Department of Hand Surgery, Vulpius Clinic, Bad Rappenau, Germany
,
Kai Megerle
Department for Plastic Surgery and Hand Surgery, Klinikum rechts der Isar, Technische Universität München, München, Germany
,
Holger Erne
Department for Plastic Surgery and Hand Surgery, Klinikum rechts der Isar, Technische Universität München, München, Germany
› Author Affiliations
Further Information

Publication History

28 June 2017

22 August 2017

Publication Date:
26 October 2017 (eFirst)

Abstract

Background Arthroscopic debridement of the triangular fibrocartilage (TFC) is well accepted in patients with ulnar impaction syndrome with central TFC lesions. Treatment remains controversial, however, when there is no such lesion from radiocarpal view.

Purpose This study assessed the clinical outcome of arthroscopic central TFC resection and debridement and secondary ulnar shortening in patients with ulnar impaction with central TFC lesion compared with patients without TFC lesion.

Patients and Methods Thirty-two consecutive patients with ulnar impaction syndrome were arthroscopically treated, 16 of whom had a central lesion of the TFC that was debrided. In the 16 patients with no lesion from the radiocarpal view, the TFC was centrally resected and debrided to decompress the ulnocarpal joint. Persisting symptoms necessitated ulnar shortening in four patients in each group. Two patients underwent repeat arthroscopic TFC debridement. All patients were examined at 3, 6, and 12 months, and at final follow-up (mean: 1.7 years) following arthroscopy, respectively ulnar shortening or hardware removal.

Results In both groups, pain, Krimmer, and DASH scores significantly improved. Improvements of DASH scores were significantly higher in patients without lesion at 12 months and at final follow-up. For other parameters, no significant difference was found between the two groups.

Conclusion In both situations, with and without central TFC lesion, resection and debridement sufficiently reduced the ulnar-sided wrist pain and improved function in three out of four patients, and therefore qualified as the first-line treatment of ulnar impaction syndrome as arthroscopy is performed, anyway. Those patients who complained of persisting or recurrent ulnar-sided wrist pain finally benefitted from ulnar shortening osteotomy as the secondary procedure.

Level of Evidence Therapeutic III, case–control study.

Note

The ethical committee of the University Hospital of Würzburg, Germany approved the clinical review of these patients.