ULNAR-SIDED WRIST PAIN AFTER FOUR-CORNER FUSION IN A PREVIOUSLY-ASYMPTOMATIC ULNAR POSITIVE WRIST: A CASE REPORT

Hand Surgery ◽  
2009 ◽  
Vol 14 (01) ◽  
pp. 49-51 ◽  
Author(s):  
Hyun Sik Gong ◽  
Su Ha Jeon ◽  
Goo Hyun Baek
Keyword(s):  
Case Report ◽  
Wrist Pain ◽  
Stage Ii ◽  
Treatment Choices ◽  
Non Union ◽  
Ulnar Shortening Osteotomy ◽  
Shortening Osteotomy ◽  
Post Traumatic ◽  
Snac Wrist

Scaphoid excision and four-corner fusion is one of the treatment choices for patients who have stage II or III SLAC (scapholunate advanced collapse)/SNAC (scaphoid non-union advanced collapse) wrist arthritis. We report a case of ulnar-sided wrist pain which occurred after four-corner fusion for stage II SNAC wrist with a previously-asymptomatic ulnar positive variance, and was successfully treated by ulnar shortening osteotomy. This case highlights a possible coincidental pathology of the ulnocarpal joint in the setting of post-traumatic radiocarpal arthrosis.

scholarly journals Ulnar Shortening Osteotomy for Ulnar Wrist Pain.

1992 ◽  
Vol 41 (1) ◽  
pp. 143-146
Author(s):  
Manabu Kushida ◽  
Kotaro Imamura ◽  
Yoshifumi Nagatani ◽  
Eiji Hirano
Keyword(s):  
Wrist Pain ◽  
Ulnar Shortening Osteotomy ◽  
Shortening Osteotomy ◽  
Ulnar Wrist Pain

TRAUMATIC DISRUPTION OF A FIBROCARTILAGE LUNATE-TRIQUETRAL COALITION — A CASE REPORT AND REVIEW OF THE LITERATURE

Hand Surgery ◽  
2001 ◽  
Vol 06 (01) ◽  
pp. 103-108 ◽  
Author(s):  
J. van Schoonhoven ◽  
K.-J. Prommersberger ◽  
R. Schmitt
Keyword(s):  
Case Report ◽  
Wrist Pain ◽  
Review Of The Literature ◽  
X Ray ◽  
Herbert Screw ◽  
Persistent Symptoms ◽  
Lunotriquetral Ligament ◽  
Post Traumatic ◽  
High Degree ◽  
Ct And Mri

Whilst osseous coalitions of the lunate and the triquetrum are known to be asymptomatic, fibrocartilage lunate-triquetral coalitions can present an uncommon cause for ulnar-sided wrist pain. To diagnose this condition a high degree of suspicion is needed. We present a case with painful post-traumatic disruption of a fibrocartilage lunate-triquetral coalition that was primary misdiagnosed to be a disruption of the interosseous lunotriquetral ligament and was initially treated arthroscopically. Persistent symptoms lead to X-ray examination of the opposite wrist, revealing a complete osseous lunate-triquetral coalition. CT and MRI investigations demonstrated the fibrocartilage coalition of the affected wrist. Subsequently, lunotriquetral fusion using a cannulated Herbert screw was performed and settled the symptoms completely.

Ulnar Shortening Osteotomy for Ulnar Carpal Instability and Ulnar Carpal Impaction

1997 ◽  
Vol 22 (4) ◽  
pp. 451-456 ◽  
Author(s):  
M. KÖPPEL ◽  
I. C. HARGREAVES ◽  
T. J. HERBERT
Keyword(s):  
Distal Radioulnar Joint ◽  
Assessment System ◽  
Carpal Instability ◽  
Secondary Osteoarthritis ◽  
Non Union ◽  
Number Of Patients ◽  
Ulnar Shortening Osteotomy ◽  
Shortening Osteotomy ◽  
Wrist Function ◽  
Ulnar Impaction Syndrome

We report the results of a retrospective review of 47 ulnar shortening osteotomies carried out for ulnar carpal impaction and/or ulnar carpal instability. The average follow-up was 18 months. Wrist function was graded preoperatively and postoperatively using an assessment system modified from Chun and Palmer (1993) . The results show that distal ulnar shortening osteotomy successfully reduces pain and improves wrist function both for ulnar carpal instability (UCI) and ulnar impaction syndrome (UIS) and is equally effective for those patients with combined UIS and UCI. Grip strength and wrist stability were significantly improved and range of wrist and forearm motion was little affected by the procedure. Oblique osteotomies were found to heal faster and to have a lower non-union rate than transverse osteotomies. Although radiographs did show adaptive changes of the distal radioulnar joint in a significant number of patients, there is no evidence (as yet) to suggest that this leads to the development of secondary osteoarthritis.

Reconstructed animation from four-phase grip MRI of the wrist with ulnar-sided pain

2013 ◽  
Vol 38 (7) ◽  
pp. 746-750 ◽  
Author(s):  
T. Oda ◽  
T. Wada ◽  
K. Iba ◽  
M. Aoki ◽  
M. Tamakawa ◽  
...  
Keyword(s):  
Distal Radioulnar Joint ◽  
Triangular Fibrocartilage Complex ◽  
Wrist Pain ◽  
Articular Disc ◽  
Ulnar Head ◽  
Dynamic Variations ◽  
Ulnar Shortening Osteotomy ◽  
Shortening Osteotomy ◽  
Ulnar Wrist Pain ◽  
Triangular Fibrocartilage

In order to visualize dynamic variations related to ulnar-sided wrist pain, animation was reconstructed from T2* coronal-sectioned magnetic resonance imaging in each of the four phases of grip motion for nine wrists in patients with ulnar pain. Eight of the nine wrists showed a positive ulnar variance of less than 2 mm. Ulnocarpal impaction and triangular fibrocartilage complex injury were assessed on the basis of animation and arthroscopy, respectively. Animation revealed ulnocarpal impaction in four wrists. In one of the four wrists, the torn portion of the articular disc was impinged between the ulnar head and ulnar proximal side of the lunate. In another wrist, the ulnar head impacted the lunate directly through the defect in the articular disc that had previously been excised. An ulnar shortening osteotomy successfully relieved ulnar wrist pain in all four cases with both ulnocarpal impaction and Palmer’s Class II triangular fibrocartilage complex tears. This method demonstrated impairment of the articular disc and longitudinal instability of the distal radioulnar joint simultaneously and should be of value in investigating dynamic pathophysiology causing ulnar wrist pain.

scholarly journals A Study Comparing the Outcomes of Transverse Ulnar Shortening Osteotomy Fixed with a DCP to Oblique Osteotomy Fixed with a Procedure Specific Plate

2020 ◽  
Vol 25 (04) ◽  
pp. 441-446
Author(s):  
Rohit Singhal ◽  
Nisarg Mehta ◽  
Phil Brown ◽  
Graham Cheung ◽  
Daniel J. Brown
Keyword(s):  
Removal Rate ◽  
Dynamic Compression ◽  
Implant Removal ◽  
Union Rate ◽  
Non Union ◽  
Oblique Osteotomy ◽  
Ulnar Shortening Osteotomy ◽  
Shortening Osteotomy ◽  
Radiological Healing ◽  
Removal Of Hardware

Background: Ulnar shortening osteotomy (USO) is a well-established procedure for ulnar impaction syndrome. Various types of osteotomies have been described. Methods: A retrospective cohort study was conducted to compare the results of transverse osteotomy (TO) fixed with a small fragment dynamic compression plate (Synthes, Pennsylvania, USA), to oblique osteotomy (OO) fixed with a procedure specific plate and instrumentation system (Acumed LLC, Oregon, USA). A total of 39 patients underwent TO and 62 patients underwent OO between 2007 and 2016. The main outcomes compared were rate of union, duration of radiological healing, implant removal rate and other complications. Results: The two groups were comparable with regards to demographics, side operated and smoking status (p > 0.05). Amongst the TO group; 36 out of 39 patients (92.3%) achieved union, 3 patients (7.7%) developed non-union. Six out of the 36 healed TO (16.6%) required removal of hardware due to implant-related pain. No other complications were recorded amongst TO group needing surgical intervention. Amongst the OO group, 2 of the early cohort of 62 patients (3.2%) sustained acute failure of the metalwork due to technical error. One of the remaining 60 patients (1.6%) developed non-union giving an overall union rate of 95.2%. Two patients out of 59 healed OO (3.3%) required removal of hardware. Conclusions: Although there were 2 early failures, there was a trend towards improved union rate with OO, but this did not reach statistical significance (p > 0.05). There was a significantly higher hardware removal rate recorded in TO group (p = 0.023). The OO showed shorter duration for radiological healing than TO (p < 0.05). USO performed with an OO and fixed with procedure specific plate has lower implant removal rate, a shorter duration for radiological healing and comparable union rate to TO fixed with DCP, but needs careful attention to detail.

scholarly journals Clinical and Radiographic Correlates for the Treatment of Ulnocarpal Impaction

2019 ◽  
Vol 08 (03) ◽  
pp. 192-197
Author(s):  
Tendai Mwaturura ◽  
Parham Daneshvar ◽  
Jeffrey Pike ◽  
Thomas Joseph Goetz
Keyword(s):  
Cohort Study ◽  
Wrist Pain ◽  
Level Of Evidence ◽  
Ulnar Side ◽  
Level Ii ◽  
Ulnar Shortening Osteotomy ◽  
Arthroscopic Findings ◽  
Shortening Osteotomy ◽  
Outcome Scores ◽  
Before And After

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.

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