Ulnar Impaction Syndrome: Ulnar Shortening vs. Arthroscopic Wafer Procedure

Abstract

The 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 incapacity was 7?months in the ulnar shortening group and 6.1 months in the wafer group. The differences between the two groups were not statistically significant.

Keywords

ulnar impaction - shortening osteotomy - arthoscopy - TFCC - wafer

• References

• 1 Friedman SL, Palmer AK. The ulnar impaction syndrome. Hand Clin 1991; 7 (2) 295-310
• 2 Werner FW, Glisson RR, Murphy DJ, Palmer AK. Force transmission through the distal radioulnar carpal joint: effect of ulnar lengthening and shortening. Handchir Mikrochir Plast Chir 1986; 18 (5) 304-308
• 3 Markolf KL, Tejwani SG, Benhaim P. Effects of wafer resection and hemiresection from the distal ulna on load-sharing at the wrist: a cadaveric study. J Hand Surg Am 2005; r; 30 (2) 351-358
• 4 Baek GH, Chung MS, Lee YH, Gong HS, Lee S, Kim HH. Ulnar shortening osteotomy in idiopathic ulnar impaction syndrome. J Bone Joint Surg Am 2005; 87 (12) 2649-2654
• 5 Boulas HJ, Milek MA. Ulnar shortening for tears of the triangular fibrocartilaginous complex. J Hand Surg Am 1990; 15 (3) 415-420
• 6 Chun S, Palmer AK. The ulnar impaction syndrome: follow-up of ulnar shortening osteotomy. J Hand Surg Am 1993; 18 (1) 46-53
• 7 Darrow Jr JC, Linscheid RL, Dobyns JH, Mann III JM, Wood MB, Beckenbaugh RD. Distal ulnar recession for disorders of the distal radioulnar joint. J Hand Surg Am 1985; 10 (4) 482-491
• 8 Horn PC. The long ulnar sliding osteotomy. J Hand Surg Am 2004; 29 (5) 871-876
• 9 Hulsizer D, Weiss AP, Akelman E. Ulna-shortening osteotomy after failed arthroscopic debridement of the triangular fibrocartilage complex. J Hand Surg Am 1997; 22 (4) 694-698
• 10 Jain R, Hudak P, Bowen CV. Health status following recessional ulnar osteotomy. Hand Surg 2000; 5 (1) 11-17
• 11 Köppel M, Hargreaves IC, Herbert TJ. Ulnar shortening osteotomy for ulnar carpal instability and ulnar carpal impaction. J Hand Surg [Br] 1997; 22: 451-456
• 12 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 (3) 316-320
• 13 Minami A, Kato H. Ulnar shortening for TFCC tears associated with ulnar positive variance. J Hand Surg Am 1998; 23: 904-908
• 14 Moermans A, Degreef I, De Smet L. Ulnar shortening osteotomy for ulnar ideopathic impaction syndrome. Scand J Plast Reconstr Surg Hand Surg 2007; 41 (6) 310-314
• 15 Tatebe M, Shinohara T, Okui N, Yamamoto M, Hirata H, Imaeda T. Clinical, radiographic, and arthroscopic outcomes after ulnar shortening osteotomy: a long-term follow-up study. J Hand Surg Am 2012; 37: 2468-2474
• 16 Van Sanden S, De Smet L. Ulnar shortening after failed arthroscopic treatment of triangular fibrocartilage complex tears. Chir Main 2001; 20 (5) 332-336
• 17 Vandenberghe L, Degreef I, Didden K, Moermans A, Koorneef P, De Smet L. Ulnar shortening or arthroscopic wafer resection for ulnar impaction syndrome. Acta Orthop Belg 2012; 78 (3) 323-326
• 18 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 (4) 731-737
• 19 Schuurman AH, Bos KE. The ulno-carpal abutment syndrome. Follow-up of the wafer procedure. J Hand Surg [Br] 1995; 20 (2) 171-177
• 20 Tomaino MM, Shah M. Treatment of ulnar impaction syndrome with the wafer procedure. Am J Orthop 2001; 30 (2) 129-133
• 21 Feldkamp G. The arthroscopic “wafer procedure” in degenerative disc ulnocarpal tears with ulnocarpal compression syndrome. Techniques, indications, results [in German]. Orthopade 2004; 33 (6) 685-691
• 22 Tomaino MM, Weiser RW. Combined arthroscopic TFCC debridement and wafer resection of the distal ulna in wrists with triangular fibrocartilage complex tears and positive ulnar variance. J Hand Surg Am 2001; 26 (6) 1047-1052
• 23 Bernstein M, Nagle D, Martinez A, Stogin Jr JM, Wiedrich TA. A comparison of combined arthroscopic triangular fibrocartilage debridement and arthroscopic wafer distal ulna resection versus arthroscopic triangular fibrocartilage debridement and ulnar shortening osteotomy for ulnocarpal abutment syndrome. Arthroscopy 2004; 20: 392-401
• 24 Meftah M, Keefer EP, Panagopoulos G, Yang SS. Arthroscopic wafer resection for ulnar impaction syndrome: prediction of outcomes. Hand Surg 2010; 15 (2) 89-93