Ulnocarpal Impaction
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Published:
Oct 10, 2021
Keywords:
Ulnar impactation syndrome, positive variance, osteotomy, shortening, wafer
Main Article Content
Abstract
The purpose of this article is to provide updated knowledge about ulnocarpal impaction syndrome (UCIS) and its treatment. Classic studies on biomechanics of the ulnar side of the wrist have shown that millimetrical changes in the relative lengths of the ulna and the radius significantly alter the load transmission between the carpal bones, the radius, and the ulna. Thus, an increase in the relative length of the ulna will generate an excessive load on the ulnocarpal joint, which will produce a spectrum of progressive degenerative changes in the ulnar dome, lunate, triquetrum, and the triangular fibrocartilage complex (TFCC), that will lead to ulnocarpal and distal radioulnar-joint (DRUJ) osteoarthritis. In its various degenerative stages, UCIS can be treated with osteotomies that seek to decompress the ulnocarpal load. These can be extra-articular or intra-articular. Within the extra-articular osteotomies, we find the diaphyseal, metaphyseal without joint exposure (subcapital), and the distal metaphyseal with joint exposure. Within the intra-articular ones, we find the wafer procedure, which resects the cartilage and subchondral bone of the ulnar dome, and can be performed either openly or arthroscopically. If there is associated DRUJ osteoarthritis, it can only be treated with salvage surgeries such as the Darrach, Sauvé-Kapandji, and Bowers procedures, or a DRUJ arthroplasty. These osteotomy techniques will be analyzed in detail in order to define their advantages and disadvantages. Finally, we propose a way to typify the UCIS to guide the reader towards the best possible treatment supported by current literature.
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How to Cite
Teruya, G. J., & Altamirano , N. (2021). Ulnocarpal Impaction. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 86(5), 666-680. https://doi.org/10.15417/issn.1852-7434.2021.86.5.1355
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Review article
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References
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PMID:6744728
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ulnocarpal abutment syndrome using distal ulna hook plate: case series. J Hand Surg Am 2012;37(8):1574-9.
https://doi.org/10.1016/j.jhsa.2012.04.034
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8. Cerezal L, del Piñal F, Abascal F. MR imaging findings in ulnar-sided wrist impaction syndromes. Magn Reson
Imaging Clin North Am 2004;12(2):281-99. https://doi.org/10.1016/j.mric.2004.02.005
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variance. J Hand Surg Am 1998;23(5):904-8. https://doi.org/10.1016/S0363-5023(98)80171-8
10. Barbaric K, Rujevcan G, Labas M, Delimar D, Bicanic G. Ulnar shortening osteotomy after distal radius fracture
malunion: review of literature. Open Orthop J 2015;9(1):98-106. https://doi.org/10.2174/1874325001509010098
11. Owens J, Compton J, Day M, Glass N, Lawler E. Nonunion rates among ulnar-shortening osteotomy for ulnar
impaction syndrome: a systematic review. J Hand Surg Am 2019;44(7):612.e1-612.e12.
https://doi.org/10.1016/j.jhsa.2018.08.018
12. Tomaino MM, Elfar J. Ulnar impaction syndrome. Hand Clin 2005;21(4):567-75. https://doi.org/10.1016/j.hcl.2005.08.011
13. Nakamura R, Horii E, Imaeda T, Nakao E, Kato H, Watanabe K. The ulnocarpal stress test in the diagnosis of ulnarsided wrist pain. J Hand Surg Br 1997;22(6):719-23. https://doi.org/10.1016/s0266-7681(97)80432-9
14. Baek GH, Chung MS, Lee YH, Gong HS, Lee S, Kim HH. Ulnar shortening osteotomy in idiopathic ulnar
impaction syndrome. Surgical technique. J Bone Joint Surg Am 2006;88(1):212-20. https://doi.org/10.2106/JBJS.F.00320
15. McBeath R, Katolik LI, Shin EK. Ulnar shortening osteotomy for ulnar impaction syndrome. J Hand Surg Am
2013;38(2):379-81. https://doi.org/10.1016/j.jhsa.2012.07.019
16. Tatebe M, Nishizuka T, Hirata H, Nakamura R. Ulnar shortening osteotomy for ulnar-sided wrist pain. J Wrist Surg 2014;3(2):77-4. https://doi.org/10.1055/s-0034-1372516
17. Baek GH, Lee HJ, Gong HS, Rhee SH, Kim J, Kim KW, et al. Long-term outcomes of ulnar shortening osteotomy
for idiopathic ulnar impaction syndrome: at least 5-years follow-up. Clin Orthop Surg 2011;3(4):295-301.
https://doi.org/10.4055/cios.2011.3.4.295
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(4):719-26. https://doi.org/10.1016/j.jhsa.2005.04.015
19. Arimitsu S, Moritomo H, Kitamura T, Berglund LJ, Zhao K, An K, et al. The stabilizing effect of the distal
interosseous membrane on the distal radioulnar joint in an ulnar shortening procedure: a biomechanical study. J
Bone Joint Surg Am 2011;93(21):2022-30. https://doi.org/10.2106/JBJS.J.00411
20. 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):731-7. https://doi.org/10.1016/0363-5023(92)90325-j
21. 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):1047-52. https://doi.org/10.1053/jhsu.2001.28757
22. Griska A, Feldon P. Wafer resection of the distal ulna. J Hand Surg Am 2015;40(11):2283-8.
https://doi.org/10.1016/j.jhsa.2015.08.018
23. Slade JF, Gillon TJ. Osteochondral shortening osteotomy for the treatment of ulnar impaction syndrome: a new technique. Tech Hand Up Extrem Surg 2007;11(1):74-82. https://doi.org/10.1097/bth.0b013e3180337df9
24. Barry JA, Macksoud WS. Cartilage-retaining wafer resection osteotomy of the distal ulna. Clin Orthop Relat Res 2008;466(2):396-401. https://doi.org/10.1007/s11999-007-0059-5
25. Greenberg JA, Werner FW, Smith JM. Biomechanical analysis of the distal metaphyseal ulnar shortening osteotomy. J Hand Surg Am 2013;38(10):1919-24. https://doi.org/10.1016/j.jhsa.2013.06.038
2. Palmer AK, Werner FW. Biomechanics of the distal radioulnar joint. Clin Orthop Relat Res 1984;(187):26-35.
PMID:6744728
3. Nakamura R, Tanaka Y, Imaeda T, Miura T. The influence of age and sex on ulnar variance. J Hand Surg Br
1991;16(1):84-8. https://doi.org/10.1016/0266-7681(91)90136-c
4. Orbay JL, Levaro-Pano F, Vernon LL, Cronin MH, Orbay JA, Tremols EJ. The parallelogram effect: the association
between central band and positive ulnar variance. J Hand Surg Am 2018;43(9):827-32. https://doi.org/10.1016/j.jhsa.2018.03.058
5. 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(3):423-8.
https://doi.org/10.1016/0363-5023(92)90342-m
6. Nunez FA Jr, Barnwell J, Zhongyu L, Nunez FA Sr. Metaphyseal ulnar shortening osteotomy for the treatment of
ulnocarpal abutment syndrome using distal ulna hook plate: case series. J Hand Surg Am 2012;37(8):1574-9.
https://doi.org/10.1016/j.jhsa.2012.04.034
7. Friedman SL, Palmer AK. The ulnar impaction syndrome. Hand Clin 1991;7(2):295-310. PMID: 1880164
8. Cerezal L, del Piñal F, Abascal F. MR imaging findings in ulnar-sided wrist impaction syndromes. Magn Reson
Imaging Clin North Am 2004;12(2):281-99. https://doi.org/10.1016/j.mric.2004.02.005
9. Minami A, Kato H. Ulnar shortening for triangular fibrocartilage complex tears associated with ulnar positive
variance. J Hand Surg Am 1998;23(5):904-8. https://doi.org/10.1016/S0363-5023(98)80171-8
10. Barbaric K, Rujevcan G, Labas M, Delimar D, Bicanic G. Ulnar shortening osteotomy after distal radius fracture
malunion: review of literature. Open Orthop J 2015;9(1):98-106. https://doi.org/10.2174/1874325001509010098
11. Owens J, Compton J, Day M, Glass N, Lawler E. Nonunion rates among ulnar-shortening osteotomy for ulnar
impaction syndrome: a systematic review. J Hand Surg Am 2019;44(7):612.e1-612.e12.
https://doi.org/10.1016/j.jhsa.2018.08.018
12. Tomaino MM, Elfar J. Ulnar impaction syndrome. Hand Clin 2005;21(4):567-75. https://doi.org/10.1016/j.hcl.2005.08.011
13. Nakamura R, Horii E, Imaeda T, Nakao E, Kato H, Watanabe K. The ulnocarpal stress test in the diagnosis of ulnarsided wrist pain. J Hand Surg Br 1997;22(6):719-23. https://doi.org/10.1016/s0266-7681(97)80432-9
14. Baek GH, Chung MS, Lee YH, Gong HS, Lee S, Kim HH. Ulnar shortening osteotomy in idiopathic ulnar
impaction syndrome. Surgical technique. J Bone Joint Surg Am 2006;88(1):212-20. https://doi.org/10.2106/JBJS.F.00320
15. McBeath R, Katolik LI, Shin EK. Ulnar shortening osteotomy for ulnar impaction syndrome. J Hand Surg Am
2013;38(2):379-81. https://doi.org/10.1016/j.jhsa.2012.07.019
16. Tatebe M, Nishizuka T, Hirata H, Nakamura R. Ulnar shortening osteotomy for ulnar-sided wrist pain. J Wrist Surg 2014;3(2):77-4. https://doi.org/10.1055/s-0034-1372516
17. Baek GH, Lee HJ, Gong HS, Rhee SH, Kim J, Kim KW, et al. Long-term outcomes of ulnar shortening osteotomy
for idiopathic ulnar impaction syndrome: at least 5-years follow-up. Clin Orthop Surg 2011;3(4):295-301.
https://doi.org/10.4055/cios.2011.3.4.295
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(4):719-26. https://doi.org/10.1016/j.jhsa.2005.04.015
19. Arimitsu S, Moritomo H, Kitamura T, Berglund LJ, Zhao K, An K, et al. The stabilizing effect of the distal
interosseous membrane on the distal radioulnar joint in an ulnar shortening procedure: a biomechanical study. J
Bone Joint Surg Am 2011;93(21):2022-30. https://doi.org/10.2106/JBJS.J.00411
20. 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):731-7. https://doi.org/10.1016/0363-5023(92)90325-j
21. 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):1047-52. https://doi.org/10.1053/jhsu.2001.28757
22. Griska A, Feldon P. Wafer resection of the distal ulna. J Hand Surg Am 2015;40(11):2283-8.
https://doi.org/10.1016/j.jhsa.2015.08.018
23. Slade JF, Gillon TJ. Osteochondral shortening osteotomy for the treatment of ulnar impaction syndrome: a new technique. Tech Hand Up Extrem Surg 2007;11(1):74-82. https://doi.org/10.1097/bth.0b013e3180337df9
24. Barry JA, Macksoud WS. Cartilage-retaining wafer resection osteotomy of the distal ulna. Clin Orthop Relat Res 2008;466(2):396-401. https://doi.org/10.1007/s11999-007-0059-5
25. Greenberg JA, Werner FW, Smith JM. Biomechanical analysis of the distal metaphyseal ulnar shortening osteotomy. J Hand Surg Am 2013;38(10):1919-24. https://doi.org/10.1016/j.jhsa.2013.06.038