Ulnar Shortening Osteotomy: Our Experience[*]Artikel in mehreren Sprachen: português | English
Objective The objective of the present study was to evaluate the clinical and radiographic results of our series regarding ulnar shortening osteotomy, as well as to briefly review the pathology, indications and surgical options of ulnocarpal conflict.
Methods We performed a retrospective analysis of consecutive patients who were treated with ulnar shortening osteotomy between January 2012 and June 2017 at our hospital. We clinically evaluated pain, articular range of motion, grip strength and functional outcomes using the quick-DASH questionnaire. We radiographically measured the pre- and postoperative ulnar variance and the shortening performed.
Results We identified eight operated patients, and it was possible to evaluate seven of them. Pain decreased in this population (visual analogue scale [VAS] score changed from 7 to 2.6, p < 0.05), there was a decrease in quick-DASH (64 to 28, p < 0.05) and we found a decrease in the articular amplitude ∼ 7° for flexion (p = 0.2), and of 5.5° for supination (p = 0.3), as well as decreasing grip strength to about 86% on the contralateral side (p = 0.07). The ulnar variance changed from a mean of + 5.5 mm to - 1.1 mm (p < 0.05). Two out of 8 patients (25%) presented plaque-related symptoms and one of them underwent a new intervention to extract the material.
Conclusions Ulnar shortening osteotomy is an effective surgical procedure both in the treatment of ulnocarpal conflict and in the discharge of the ulna. The results presented agreement with other results published in the literature, with good clinical and radiographic results.
* Work carried out at the Department of Orthopedics and Traumatology, Hospital Beatriz Ângelo, Loures, Portugal.
Eingereicht: 12. August 2019
Angenommen: 29. November 2019
06. April 2020 (online)
© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Sociedade Brasileira de Ortopedia e Traumatologia. Published by Thieme Revinter Publicações Ltda
Rio de Janeiro, Brazil
- 1 Sachar K. Ulnar-sided wrist pain: evaluation and treatment of triangular fibrocartilage complex tears, ulnocarpal impaction syndrome, and lunotriquetral ligament tears. J Hand Surg Am 2008; 33 (09) 1669-1679
- 2 Viegas SF. The lunatohamate articulation of the midcarpal joint. Arthroscopy 1990; 6 (01) 5-10
- 3 Sammer DM, Rizzo M. Ulnar impaction. Hand Clin 2010; 26 (04) 549-557
- 4 Milch H. Cuff resection of the ulna for malunited Colles' fracture. J Bone Joint Surg Am 1941; 23: 311-313
- 5 Chun S, Palmer AK. The ulnar impaction syndrome: follow-up of ulnar shortening osteotomy. J Hand Surg Am 1993; 18 (01) 46-53
- 6 Loh YC, Van Den Abbeele K, Stanley JK, Trail IA. The results of ulnar shortening for ulnar impaction syndrome. J Hand Surg Br 1999; 24 (03) 316-320
- 7 El-Karef E. Staged reconstruction for malunited fractures of the distal radius. J Hand Surg Br 2005; 30 (01) 73-78
- 8 Orfale AG, Araújo PMP, Ferraz MB, Natour J. Translation into Brazilian Portuguese, cultural adaptation and evaluation of the reliability of the Disabilities of the Arm, Shoulder and Hand Questionnaire. Braz J Med Biol Res 2005; 38 (02) 293-302
- 9 Sagerman SD, Zogby RG, Palmer AK, Werner FW, Fortino MD. Relative articular inclination of the distal radioulnar joint: a radiographic study. J Hand Surg Am 1995; 20 (04) 597-601
- 10 Tolat AR, Sanderson PL, De Smet L, Stanley JK. The gymnast's wrist: acquired positive ulnar variance following chronic epiphyseal injury. J Hand Surg Br 1992; 17 (06) 678-681
- 11 Palmer AK, Werner FW. Biomechanics of the distal radioulnar joint. Clin Orthop Relat Res 1984; (187) 26-35
- 12 Werner FW, Palmer AK, Fortino MD, Short WH. Force transmission through the distal ulna: effect of ulnar variance, lunate fossa angulation, and radial and palmar tilt of the distal radius. J Hand Surg Am 1992; 17 (03) 423-428
- 13 Palmer AK, Glisson RR, Werner FW. Relationship between ulnar variance and triangular fibrocartilage complex thickness. J Hand Surg Am 1984; 9 (05) 681-682
- 14 Fischer J, Thompson NW, Harrison JW. Triangular Fibrocartilage Complex Lesions—A Classification. London: Springer London; 2014: 371-372
- 15 Nakamura R, Horii E, Imaeda T, Nakao E, Kato H, Watanabe K. The ulnocarpal stress test in the diagnosis of ulnar-sided wrist pain. J Hand Surg Br 1997; 22 (06) 719-723
- 16 Cerezal L, del Piñal F, Abascal F, García-Valtuille R, Pereda T, Canga A. Imaging findings in ulnar-sided wrist impaction syndromes. Radiographics 2002; 22 (01) 105-121
- 17 Tomaino MM. The importance of the pronated grip x-ray view in evaluating ulnar variance. J Hand Surg Am 2000; 25 (02) 352-357
- 18 Nishiwaki M, Nakamura T, Nakao Y, Nagura T, Toyama Y. Ulnar shortening effect on distal radioulnar joint stability: a biomechanical study. J Hand Surg Am 2005; 30 (04) 719-726
- 19 Moritomo H. The distal interosseous membrane: current concepts in wrist anatomy and biomechanics. J Hand Surg Am 2012; 37 (07) 1501-1507
- 20 Hollevoet N, Verdonk R, Van Maele G. The influence of articular morphology on non-traumatic degenerative changes of the distal radioulnar joint. A radiographic study. J Hand Surg Br 2006; 31 (02) 221-225
- 21 Feldon P, Terrono AL, Belsky MR. Wafer distal ulna resection for triangular fibrocartilage tears and/or ulna impaction syndrome. J Hand Surg Am 1992; 17 (04) 731-737
- 22 Tomaino MM. Results of the wafer procedure for ulnar impaction syndrome in the ulnar negative and neutral wrist. J Hand Surg [Br] 1999; 24 (06) 671-675
- 23 Constantine KJ, Tomaino MM, Herndon JH, Sotereanos DG. Comparison of ulnar shortening osteotomy and the wafer resection procedure as treatment for ulnar impaction syndrome. J Hand Surg Am 2000; 25 (01) 55-60
- 24 Nishizuka T, Tatebe M, Hirata H, Shinohara T, Yamamoto M, Iwatsuki K. Simple debridement has little useful value on the clinical course of recalcitrant ulnar wrist pain. Bone Joint J 2013; 95-B (12) 1687-1696
- 25 Rayhack JM, Gasser SI, Latta LL, Ouellette EA, Milne EL. Precision oblique osteotomy for shortening of the ulna. J Hand Surg Am 1993; 18 (05) 908-918
- 26 Darlis NA, Ferraz IC, Kaufmann RW, Sotereanos DG. Step-cut distal ulnar-shortening osteotomy. J Hand Surg Am 2005; 30 (05) 943-948
- 27 Moermans A, Degreef I, De Smet L. Ulnar shortening osteotomy for ulnar ideopathic impaction syndrome. Scand J Plast Reconstr Surg Hand Surg 2007; 41 (06) 310-314
- 28 Doherty C, Gan BS, Grewal R. Ulnar shortening osteotomy for ulnar impaction syndrome. J Wrist Surg 2014; 3 (02) 85-90
- 29 Fufa DT, Carlson MG, Calfee RP, Sriram N, Gelberman RH, Weiland AJ. Mid-term results following ulna shortening osteotomy. HSS J 2014; 10 (01) 13-17
- 30 Rajgopal R, Roth J, King G, Faber K, Grewal R. Outcomes and complications of ulnar shortening osteotomy: an institutional review. Hand (N Y) 2015; 10 (03) 535-540