Combined Arthroscopic Wafer Procedure and Triangular Fibrocartilage Complex Debridement versus Ulnar Shortening Diaphyseal Osteotomy in Management of Ulnar Impaction Syndrome: A Randomized Clinical Trial

Ahmed El-Tayar; Samir El-Ghandour; Adel Ghazal; Ibrahim Rakha; Asser Sallam

doi:10.1055/s-0043-1776399

Journal of Wrist Surgery, Inhaltsverzeichnis

J Wrist Surg 2024; 13(06): 500-507
DOI: 10.1055/s-0043-1776399

Scientific Article

Combined Arthroscopic Wafer Procedure and Triangular Fibrocartilage Complex Debridement versus Ulnar Shortening Diaphyseal Osteotomy in Management of Ulnar Impaction Syndrome: A Randomized Clinical Trial

Ahmed El-Tayar

¹Department of Orthopedic Surgery and Trauma, Faculty of Medicine, Suez Canal University, Suez, Egypt

,

Samir El-Ghandour

¹Department of Orthopedic Surgery and Trauma, Faculty of Medicine, Suez Canal University, Suez, Egypt

,

Adel Ghazal

¹Department of Orthopedic Surgery and Trauma, Faculty of Medicine, Suez Canal University, Suez, Egypt

,

Ibrahim Rakha

¹Department of Orthopedic Surgery and Trauma, Faculty of Medicine, Suez Canal University, Suez, Egypt

,

Asser Sallam

¹Department of Orthopedic Surgery and Trauma, Faculty of Medicine, Suez Canal University, Suez, Egypt

²Department of Orthopedic Surgery and Trauma, Faculty of Medicine, Suez University, Suez, Egypt

› Institutsangaben

Abstract

Background The literature presents great challenge in comparing the arthroscopic wafer procedure (AWP) versus ulnar shortening osteotomy (USO) in the treatment of ulnar impaction syndrome (UIS).

Purpose We aimed primarily to compare the clinical and functional outcomes of AWP with triangular fibrocartilage complex (TFCC) debridement versus USO in the management of UIS.

Methods The study was conducted as a randomized clinical trial including 43 patients with UIS whose ulna variance was less than 4 mm. Patients were randomly allocated to either the AWP group (21 patients) who underwent AWP and TFCC debridement or the USO group (22 patients) who underwent diaphyseal USO. Patients were followed up for at least 12 months. The primary outcome measure was the Modified Mayo Wrist (MMW) score. The Disabilities of the Arm, Shoulder, and Hand (DASH) score, the mean operative time, postoperative complications, and patient satisfaction were our secondary outcomes.

Results Radiological correction of variance was achieved in all patients. The mean operative time was significantly shorter in the AWP group. The postoperative MMW and DASH scores were better in the AWP group than in the USO group. Fewer complications occurred in the AWP group (1 of 21 patients) compared with the USO group (3 of 22 patients).

Conclusions AWP with TFCC debridement is a reliable and safe method for the management of UIS with a positive variance of less than 4 mm with better clinical and functional results than diaphyseal USO.

Type of study/level of evidence Therapeutic type II.

Keywords

wafer procedure - ulnar shortening - ulnar impaction - arthroscopic wafer - ulnar positive variance

Volltext

Referenzen

References
1 Tomaino MM, Elfar J. Ulnar impaction syndrome. Hand Clin 2005; 21 (04) 567-575
2 Sammer DM, Rizzo M. Ulnar impaction. Hand Clin 2010; 26 (04) 549-557
3 Katz DI, Seiler III JG, Bond TC. The treatment of ulnar impaction syndrome: a systematic review of the literature. J Surg Orthop Adv 2010; 19 (04) 218-222
4 Slutsky DJ. Arthroscopic management of ulnocarpal impaction syndrome and ulnar styloid impaction syndrome. Hand Clin 2017; 33 (04) 639-650
5 Palmer AK, Werner FW. The triangular fibrocartilage complex of the wrist–anatomy and function. J Hand Surg Am 1981; 6 (02) 153-162
6 Palmer AK, Werner FW. Biomechanics of the distal radioulnar joint. Clin Orthop Relat Res 1984; (187) 26-35
7 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 2012; 37 (07) 1489-1500
8 Chun S, Palmer AK. The ulnar impaction syndrome: follow-up of ulnar shortening osteotomy. J Hand Surg Am 1993; 18 (01) 46-53
9 Slade III JF, Gillon TJ. Osteochondral shortening osteotomy for the treatment of ulnar impaction syndrome: a new technique. Tech Hand Up Extrem Surg 2007; 11 (01) 74-82
10 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; 30 (02) 351-358
11 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 (05) 304-308
12 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
13 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 (12) 2468-2474
14 Afifi A, Ali AM, Abdelaziz A, Abuomira IE, Saleh WR, Yehya M. Arthroscopic wafer procedure versus ulnar shortening osteotomy for treatment of idiopathic ulnar impaction syndrome: a randomized controlled trial. J Hand Surg Am 2022; 47 (08) 745-751
15 Schulz KF, Altman DG, Moher D, Consort G. [CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials (Chinese version)]. J Chin Integr Med 2010; 8 (07) 604-612 http://www.ncbi.nlm.nih.gov/pubmed/20619135
16 Palmer AK. Triangular fibrocartilage complex lesions: a classification. J Hand Surg Am 1989; 14 (04) 594-606
17 Cooney WP, Bussey R, Dobyns JH, Linscheid RL. Difficult wrist fractures. Perilunate fracture-dislocations of the wrist. Clin Orthop Relat Res 1987; (214) 136-147
18 Hudak PL, Amadio PC, Bombardier C. The Upper Extremity Collaborative Group (UECG). Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. Am J Ind Med 1996; 29 (06) 602-608
19 Hjermstad MJ, Fayers PM, Haugen DF. et al; European Palliative Care Research Collaborative (EPCRC). Studies comparing numerical rating scales, verbal rating scales, and visual analogue scales for assessment of pain intensity in adults: a systematic literature review. J Pain Symptom Manage 2011; 41 (06) 1073-1093
20 Mathiowetz V, Weber K, Volland G, Kashman N. Reliability and validity of grip and pinch strength evaluations. J Hand Surg Am 1984; 9 (02) 222-226
21 Oh WT, Kang HJ, Chun YM, Koh IH, An HMS, Choi YR. Arthroscopic wafer procedure versus ulnar shortening osteotomy as a surgical treatment for idiopathic ulnar impaction syndrome. Arthroscopy 2018; 34 (02) 421-430
22 Auzias P, Delarue R, Camus EJ. VOL. Ulna shortening osteotomy versus arthroscopic wafer procedure in the treatment of ulnocarpal impingement syndrome. Hand Surg Rehabil 2020; (20) 30229-2
23 Bernstein MA, Nagle DJ, Martinez A, Stogin Jr JM, Wiedrich TA. A comparison of combined arthroscopic triangular fibrocartilage complex debridement and arthroscopic wafer distal ulna resection versus arthroscopic triangular fibrocartilage complex debridement and ulnar shortening osteotomy for ulnocarpal abutment syndrome. Arthroscopy 2004; 20 (04) 392-401
24 Yamanaka Y, Nakamura T, Sato K, Toyama Y. How does ulnar shortening osteotomy influence morphologic changes in the triangular fibrocartilage complex?. Clin Orthop Relat Res 2014; 472 (11) 3489-3494
25 Terzis A, Koehler S, Sebald J, Sauerbier M. Ulnar shortening osteotomy as a treatment of symptomatic ulnar impaction syndrome after malunited distal radius fractures. Arch Orthop Trauma Surg 2020; 140 (05) 681-695
26 Moermans A, Degreef I, De Smet L. Ulnar shortening osteotomy for ulnar idiopathic impaction syndrome. Scand J Plast Reconstr Surg Hand Surg 2007; 41 (06) 310-314
27 Chan SK, Singh T, Pinder R, Tan S, Craigen MA. Ulnar shortening osteotomy: are complications under reported?. J Hand Microsurg 2015; 7 (02) 276-282
28 Smet LD, Vandenberghe L, Degreef I. Ulnar impaction syndrome: ulnar shortening vs. arthroscopic wafer procedure. J Wrist Surg 2014; 3 (02) 98-100
29 Del Gaudio T, Haerle M. Die arthroskopische ulnokarpale Dekompression durch Teilresektion des Ulnakopfs. Oper Orthop Traumatol 2016; 28 (04) 263-269