Ulna shortening osteotomy for ulnar impaction syndrome: impact of distal radioulnar joint morphology on clinical outcome

Abstract Ulnar shortening osteotomy (USO) for ulnar impaction syndrome potentially leads to degenerative changes of the distal radioulnar joint (DRUJ). The aim of this study was to evaluate the effect of the sigmoid notch morphology on the stress distribution pattern of the DRUJ using computed tomography (CT) osteoabsorptiometry (CT-OAM). We reviewed the pre- and postoperative transverse CT images of 15 wrists that had undergone USO. The examined wrists were classified into two groups based on the sigmoid notch morphology: the linear-type notch (type L) and the curved-type notch (type C). We calculated and statistically compared the percentage of the high-density area (%HDA) in each divided region of the sigmoid notch. In type L, %HDA was significantly larger in the distal-dorsal region of the sigmoid notch before USO. Postoperatively, in type L, no specific regions showed significantly different %HDA. In type C, %HDA was significantly larger in the distal-volar region of the sigmoid notch before USO. Postoperatively, %HDA of type C was significantly larger in the proximal-volar region. Our results suggest that in patients with USO, morphological evaluation of the sigmoid notch can serve as a predictor of osteoarthritis in the DRUJ with or without USO.

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Radiological degenerative changes in the distal radioulnar joint after ulnar shortening osteotomy in patients with idiopathic ulnar impaction syndrome

Journal of Orthopaedic Science ◽

10.1016/j.jos.2017.06.010 ◽

2017 ◽

Vol 22 (6) ◽

pp. 1042-1048 ◽

Cited By ~ 1

Author(s):

Soo Min Cha ◽

Byong San Choi ◽

Hyun Dae Shin

Keyword(s):

Distal Radioulnar Joint ◽

Degenerative Changes ◽

Radioulnar Joint ◽

Ulnar Shortening Osteotomy ◽

Ulnar Impaction ◽

Shortening Osteotomy ◽

Ulnar Impaction Syndrome

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Stress distribution pattern in the distal radioulnar joint before and after ulnar shortening osteotomy in patients with ulnar impaction syndrome

Scientific Reports ◽

10.1038/s41598-021-97398-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Kazutoshi Hontani ◽

Yuichiro Matsui ◽

Daisuke Kawamura ◽

Atsushi Urita ◽

Daisuke Momma ◽

...

Keyword(s):

Stress Distribution ◽

Distribution Pattern ◽

Distal Radioulnar Joint ◽

Radioulnar Joint ◽

Sigmoid Notch ◽

Ulnar Shortening Osteotomy ◽

Ulnar Impaction ◽

Shortening Osteotomy ◽

Type C ◽

Ulnar Impaction Syndrome

AbstractUlnar shortening osteotomy (USO) for ulnar impaction syndrome potentially leads to degenerative changes of the distal radioulnar joint (DRUJ). This study was performed to evaluate the effect of the sigmoid notch morphology on the stress distribution pattern of the DRUJ using computed tomography (CT) osteoabsorptiometry (CT-OAM). We reviewed the pre- and postoperative transverse CT images of 15 wrists that had undergone USO. The examined wrists were classified into two groups based on the sigmoid notch morphology: the linear-type notch (type L) and the curved-type notch (type C). We calculated and statistically compared the percentage of the high-density area (%HDA) in each divided region of the sigmoid notch. In type L, %HDA was significantly larger in the distal-dorsal region of the sigmoid notch before USO. Postoperatively, in type L, no specific regions showed a significantly different %HDA. In type C, %HDA was significantly larger in the distal-volar region of the sigmoid notch before USO. Postoperatively, %HDA of type C was significantly larger in the proximal-volar region. Our results suggest that in patients with ulnar impaction syndrome, morphological evaluation of the sigmoid notch can serve as a predictor of osteoarthritis in the DRUJ with or without USO.

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Arthroscopic Repair of Triangular Fibrocartilage Complex Tear

Archives of Hand and Microsurgery ◽

10.12790/ahm.20.0026 ◽

2020 ◽

Vol 25 (3) ◽

pp. 167-174

Author(s):

Hyunseok Seo ◽

Joo-Yup Lee

Keyword(s):

Clinical Outcomes ◽

Distal Radioulnar Joint ◽

Triangular Fibrocartilage Complex ◽

Radioulnar Joint ◽

Ulnar Shortening Osteotomy ◽

Ulnar Impaction ◽

Shortening Osteotomy ◽

Triangular Fibrocartilage ◽

Ulnar Impaction Syndrome ◽

Important Structure

Triangular fibrocartilage complex (TFCC) is an important structure for stability of distal radioulnar joint (DRUJ) and shock absorption of ulnocarpal joint. Recent studies on anatomy and biomechanics of TFCC have revealed that the deep fiber of distal radioulnar ligament plays a key role in stabilizing the DRUJ. Clinicians should evaluate the presence of the instability of DRUJ or ulnar impaction syndrome. If necessary, combined TFCC foveal repair and ulnar shortening osteotomy should be performed. This article introduces the authors’ preferred procedure of arthroscopic TFCC repair with satisfactory clinical outcomes.

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Do triangular fibrocartilage complex foveal injuries affect the clinical outcome of ulnar shortening osteotomy for ulnar impaction syndrome?

Journal of Orthopaedic Science ◽

10.1016/j.jos.2021.11.016 ◽

2021 ◽

Author(s):

Masahiro Tatebe ◽

Michiro Yamamoto ◽

Shigeru Kurimoto ◽

Katsuyuki Iwatsuki ◽

Hidemasa Yoneda ◽

...

Keyword(s):

Clinical Outcome ◽

Triangular Fibrocartilage Complex ◽

Ulnar Shortening Osteotomy ◽

Ulnar Impaction ◽

Shortening Osteotomy ◽

Triangular Fibrocartilage ◽

Ulnar Impaction Syndrome

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Distal radioulnar joint configurations in three-dimensional computed tomography in patients with idiopathic ulnar impaction syndrome

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193419828330 ◽

2019 ◽

Vol 44 (5) ◽

pp. 488-495 ◽

Cited By ~ 1

Author(s):

Jihyeung Kim ◽

Jaewoo Cho ◽

Yo-Han Lee ◽

Sohee Oh ◽

Hyun Sik Gong ◽

...

Keyword(s):

Computed Tomography ◽

Three Dimensional ◽

Joint Space ◽

Distal Radioulnar Joint ◽

Radioulnar Joint ◽

Ulnar Head ◽

Sigmoid Notch ◽

Ulnar Shortening Osteotomy ◽

Ulnar Impaction ◽

Ulnar Impaction Syndrome

We retrospectively reviewed 26 patients diagnosed with idiopathic ulnar impaction syndrome and measured the slopes of the sigmoid notch and ulnar head at their centre using their preoperative three-dimensional computed tomography. We found that the slope of the sigmoid notch and that of the ulnar head were not parallel to each other. There was a significant linear relation between the slope of the ulnar head and the changes in the closest joint space of the distal radioulnar joint at the centre of the sigmoid notch after ulnar shortening. We conclude that the slope of the ulnar head is more strongly correlated with changes in the closest joint space in the distal radioulnar joint than that of the sigmoid notch. Our findings suggest that slope of the ulnar head might be as important a predisposing factor as that of the sigmoid notch for the progression of distal radioulnar joint arthritis after ulnar-shortening osteotomy. We should consider the slopes of both the sigmoid notch and ulnar head before the osteotomy. Level of evidence: IV

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Long-Term Subjective Satisfaction after Ulna Shortening Osteotomy for Ulnar Impaction Syndrome

The Journal Of Hand Surgery ◽

10.1016/s0363-5023(12)60047-1 ◽

2012 ◽

Vol 37 (8) ◽

pp. 34-35

Author(s):

Duretti Fufa ◽

Michelle Gerwin Carlson ◽

Ryan P. Calfee ◽

Nandita Sriram ◽

Richard H. Gelberman ◽

...

Keyword(s):

Subjective Satisfaction ◽

Ulnar Impaction ◽

Shortening Osteotomy ◽

Ulnar Impaction Syndrome ◽

Ulna Shortening Osteotomy

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Operative treatment of ulnar impaction syndrome: a systematic review

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193414541749 ◽

2014 ◽

Vol 40 (5) ◽

pp. 470-476 ◽

Cited By ~ 17

Author(s):

D. J. Stockton ◽

M.-E. Pelletier ◽

J. M. Pike

Keyword(s):

Future Research ◽

Scoring Methods ◽

Ovid Medline ◽

Ulnar Impaction ◽

Shortening Osteotomy ◽

Ulnar Impaction Syndrome ◽

Surgical Treatments ◽

Satisfaction Rates ◽

Participant Outcomes ◽

Ulna Shortening Osteotomy

This article critically and systematically reviews the surgical treatments for ulnar impaction syndrome. Three types of treatments currently exist: arthroscopic wafer procedure, open wafer procedure, and ulna shortening osteotomy. A total of 36 articles were included from searching the electronic databases PubMed MEDLINE, Ovid MEDLINE, and Ovid EMBASE. Studies were evaluated for quality using the Modified Detsky Score. Of these, 14 articles had a Modified Detsky Score of 6/10 or higher. Satisfaction rates were 100% for arthroscopic wafer procedure, 89% for open wafer procedure, and 84% for ulna shortening osteotomy. The percentage of participants reporting an excellent or good outcome was 82% for arthroscopic wafer procedure, 87% for open wafer procedure, and 76% for ulna shortening osteotomy. In conclusion, available evidence shows that arthroscopic wafer procedure and open wafer procedure may be viable alternatives to the more popular ulna shortening osteotomy, but clinical superiority is yet to be established. Future research should focus on prospective cohort methods and should report participant outcomes using validated scoring methods.

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