Clinical and Radiographic Correlates for the Treatment of Ulnocarpal Impaction

Abstract

Background Ulnocarpal impaction (UCI) is a described cause of ulnar side wrist pain. Questions Does absolute ulnar variance (UV) or change in UV with grip affect patient-rated outcome scores (PROS) in patients with symptomatic UCI undergoing surgery? Does UV differ between symptomatic and contralateral wrists? Does arthroscopic grade of triangular fibrocartilaginous complex (TFCC) tears and lunotriquetral (LT) ligament tears influence PROS? Do PROS improve following ulnar shortening osteotomy (USO) or wafer procedures and does improvement depend on the amount of shortening or achievement of negative UV? Patients and Methods We analyzed information on patients undergoing USO or wafer procedures for UCI as recorded in a database of prospectively collected information on individuals with ulnar side wrist pain. This included (1) patient-rated wrist evaluation and QuickDASH scores on enrolment, 3 and 12 months postoperatively; (2) standardized bilateral posteroanterior (PA) wrist radiographs, including PA grip views of the symptomatic wrist; and (3) arthroscopic findings. Results Larger changes in UV between PA neutral and grip views prior to surgery were associated with smaller improvements in PROS, 12 months after surgery. Actual UV value before and after surgery did not affect PROS. There was no difference in UV between symptomatic and contralateral wrists. The presence of TFCC or LT ligament tears did not influence PROS. Mean PROS improved postoperatively. Conclusions Ulnar shortening procedures result in improvement in PROS in patients with UCI. Variation in UV with rotation and grip results in variable outcomes. Level of Evidence This is a Level II, cohort study.

Increase of weight-bearing capacity of patients with lesions of the TFCC using a wrist brace

“…3 A study on ulnocarpal impaction found no difference in static ulnar variance between the symptomatic and contralateral wrist. 19 Static ulnar variance had no influence on the clinical results in our sample.…”

Postoperative Imaging of Ulnar Wrist Pain

“…The Wafer technique described by Feldon is an open surgery procedure with a dorsal approach and resection of a 2to 3-mm lamina of the distal ulna. [33][34][35] Most hand surgeons now prefer to perform the Wafer technique arthroscopically, both in stage 2B, with a degenerated and thinned central portion of the TFC, and 2C, with central perforation of the TFC, due to arthroscopy's less aggressive nature and better functional results. This procedure consists of debridement of the central portion of the TFCC and resection through the defect of a small segment of the ulnar dome (►Fig.…”

“…6). [33][34][35] The different techniques of distal ulna resection arthroplasty and prosthesis are usually evaluated with conventional radiographs that make possible the assessment of the resection performed, the placement of the prostheses, the alignment of the bone structures, and the stability of the DRUJ. 5,6 Complications Surgical techniques used to treat the different lesions of the TFCC present general complications common to any surgical procedure, such as arthrofibrosis, infection, or complex regional pain syndrome.…”

“…6), or pain related to hardware that requires removal. 34,35 Distal ulna resection arthroplasty techniques alter the stability and dynamics of the entire forearm. The most frequent complication in these procedures, such as the Darrach technique, is ulnar impingement due to opposing forces that cause convergence and impact of the ulnar stump with the distal radius (►Fig.…”

Surgical Anatomy of the Distal Radioulnar Joint

“…The more positive the UV (less negative), the smaller the coronal length of the SN (from the inferior edge of the SN proximally to where it meets the ulnar articular surface of the lunate facet distally) [1]. The UV has also been shown to have a dynamic component and has been found to increase with grip [7].…”