Ulnocarpal Impaction Syndrome Research Articles

Consolidation rate in ulnar shortening osteotomy with the APTUS Wrist plate

IntroductionUlnocarpal impaction syndrome causes pain on the ulnar side of the wrist. Various surgical techniques have been described. Ulnar shortening osteotomy is now a standard treatment. However, it is associated with complications such as non-union of the osteotomy site.The main study objective was to report the rate of radiographic consolidation after ulnar shortening osteotomy with a cutting guide. Material and methodsThis multicenter retrospective study of 30 cases reported clinical and radiographic criteria at a minimum 6 month’s follow-up. ResultsThe non-union rate was 3.4%. One case presented non-union of the osteotomy site. 87% of patients were satisfied or very satisfied with the procedure. Mean VAS pain rating was 2.7 ± 2.4. Mean QuickDASH and PRWE scores were 24.7 ± 19.2 and 28.6 ± 25. Mean strength on Jamar dynamometer was 27.4 ± 8.9 kg. One patient developed complex regional pain syndrome. Five patients required plate removal for hardware-related discomfort. DiscussionUlna shortening osteotomy with the Aptus Wrist plate provides a standardized approach to the surgical treatment of ulnocarpal impaction syndrome. Compared with other series in the literature, the procedure provided satisfactory consolidation and clinical results.

Arthroscopic Management of the Hamate Proximal Pole Arthrosis.

In this retrospective study, all patients with arthrosis of the proximal pole of the hamate encountered in a 10-year period treated with arthroscopy were reviewed. Patient demographics, arthroscopic details, associated injuries, and procedures were reviewed. Functional and patient-reported clinical outcomes after arthroscopic osteochondroplasty were analyzed. An analysis of 39 patients who underwent arthroscopic osteochondroplasty showed a type II lunate prevalence of 87.2%. On wrist arthroscopy, a triangular fibrocartilaginous complex tear was the most common diagnosis (64.1%), followed by scapholunate ligament tear (61.5%) and lunotriquetral ligament tear (35.9%). All patients were managed arthroscopically with 100% procedural success. Average follow-up of 42.8 ± 37.7 months showed statistically significant improvements in the visual analog score and Mayo wrist score postoperatively (P < 0.01). Three patients (7.7%) failed the procedure at a mean of 23 ± 31.4 months. Risk factors for salvage operations were nondominant wrist involvement 100% (P = 0.04), lunotriquetral ligament injury 100% (P = 0.04), the absence of triangular fibrocartilaginous complex injury 100% (P = 0.04), and the presence of scapholunate advanced collapse 100% (P < 0.01). Wrist arthroscopy is valuable for accurately diagnosing and treating hamate arthrosis and identifying a wide variety of pathologies associated. This study showed arthroscopic osteochondroplasty produced satisfactory clinical results. Furthermore, the presence of scapholunate advanced collapse wrist offers its prognostic value in determining treatment failure.

Results of isolated ulnar shaft shortening osteotomy in the treatment of idiopathic ulnocarpal impaction syndrome

The objective of this study was to evaluate the results of isolated ulnar shaft shortening osteotomy (USSO) in the treatment of idiopathic ulnocarpal impingement syndrome. This was a two-center retrospective study. All patients older than 18 years who underwent isolated USSO for idiopathic ulnocarpal impingement syndrome between 2006 and 2016 were included. The outcome measures were: patient satisfaction, decrease in pain intensity, change in occupation, QuickDASH and PRWE functional scores, secondary palliative surgery suggesting failure of the ulnar shaft shortening osteotomy, and postoperative ulnar variance. The main complications were analyzed. Thirty-one patients were included. Twenty-six (84%) were satisfied with the procedure. At an average follow-up of 62 months, there was no secondary palliative surgery. Mean pain intensity on VAS was 7/10 (range, 2–10) and 1.7/10 (range, 0–6) preoperatively and postoperatively, respectively, for a mean decrease of 5.3 ± 2.6 points; this decrease was statistically significant (p < 0.001). None of the manual workers had to alter their work. Mean postoperative QuickDASH score was 19.6/100 (range, 0–79.55) and mean postoperative PRWE score was 23/100 (range, 1–85). Mean postoperative ulnar variance was −0.5 mm. As for complications, 61% of patients (n = 19/31) had discomfort related to the plate; 9.7% (n = 3/31) had distal radioulnar osteoarthritis; 4% (n = 1/19) had a fracture after hardware removal; 13% (n = 4/31) had non-union. Despite a high rate of complications, the study confirmed the effectiveness, in terms of pain, of isolated USSO in the treatment of idiopathic ulnocarpal impingement syndrome. Level of evidenceIV; retrospective cohort.

Ulnocarpal Impaction.

Ulnocarpal impaction syndrome is a common cause for ulnarsided wrist pain caused by an abutment between the ulnar head and the lunotriquetral complex. This pain is typically triggered by load bearing and rotation of the forearm. Radiographic examination is often associated with positive ulnar variance and cysts in the lunate, edema of the ulnoproximal lunate is shown in MRI. Operative treatment aims to reduce load on the lunate, either by open ulnar shortening osteotomy or arthroscopic wafer procedure.

Evaluation of Diagnostic Procedures for Ulnar Sided Wrist Pain: 25 Years of Experience

The purpose of this paper was to evaluate the diagnostic tests for USWP defined specifically as a positive diagnosis for triangular fibrocartilage complex (TFCC) tears, lunotriquetral ligament (LT) tears and ulnocarpal impaction syndrome (UIS). The diagnostic measures examined in this study included LT laxity test, bone scintography, radiocarpal (RC) arthogram, and midcarpal (MC) arthogram. All tests were evaluated using arthroscopy as the reference standard.

Temporary epiphysiodesis in adolescent patients with ulnocarpal impaction syndrome: a preliminary case series of seven wrists.

Adolescents with ulnar positive variance can develop ulnocarpal symptoms due to ulnocarpal impaction syndrome. Common treatment methods are conservative therapy, distal ulna epiphysiodesis or eventually ulnar shortening osteotomy. The aim of this preliminary case series was to investigate a recently described, new therapeutic approach using a reversible, temporary epiphysiodesis technique, following the principles of guided growth. Seven cases with the diagnosis of a painful ulnar positive variance, which underwent a temporary epiphysiodesis, were retrospectively evaluated. These cases consisted of four individual patients who received an intraoperatively customized plate fixation to slow down growth. The following parameters were collected: diagnosis, age at surgery, age at explantation, growth plate status at explantation, ulnar variance before and after surgery, complications and any clinical and radiological abnormalities. The radiological measurements of ulnar variance were performed according to the Gelbermann method. The seven investigated cases (average age at surgery 12.4 years; average age at explantation 14.7 years), in which a temporary epiphysiodesis was performed, showed an average ulnar variance of +3.9 mm (range: from +1.9 mm to +6.1 mm) before the start of therapy. After explantation, an average ulnar variance of +0.1 mm (range: from –3.2 mm to +5.0 mm) was observed, which corresponds to an average reduction/improvement of –3.8 mm (range: from –0.5 mm to –9.3 mm). The ulnocarpal wrist complaints were significantly reduced after the intervention. One case needed a secondary ulnar shortening osteotomy. The described method of a temporary, reversible epiphysiodesis is an elegant, less invasive technique to correct the ulnar positive variance without irreversibly closing the growth plate. In case of therapy failure, a secondary ulna shortening osteotomy is still possible.

Radioscapholunate Fusion for Radiocarpal Osteoarthritis: Prognostic Factors of Clinical and Radiographic Outcomes.

Background Radioscapholunate (RSL) fusion is a surgical option to manage radiocarpal osteoarthritis. Many authors upgrade the procedure by adding distal scaphoid excision with or without excision of the triquetrum. Our objective was to identify the prognostic factors for good clinical and radiographic outcomes of RSL arthrodesis. Purpose Distal scaphoid excision improves both scaphotrapeziotrapezoidal osteoarthritis and radiocarpal fusion, and excision of the triquetrum is not critical to achieving satisfactory outcomes. Methods In this retrospective and bicentric investigation, all wrists were managed with RSL fusion for posttraumatic radiocarpal osteoarthritis. A total of 85 patients were included and evaluated at the revision by clinical (pain, wrist motion, and strength), functional (Disabilities of the Arm, Shoulder, and Hand questionnaire, Patient-Related Wrist Evaluation score, and Modified Mayo Wrist Score), and radiological (scaphotrapeziotrapezoidal, midcarpal osteoarthritis, and radiocarpal nonunion) examinations. We assessed prognostic factors for clinical and radiographic (osteoarthritis and nonunions) outcomes. Results The average follow-up was 9.1 years (1-21.4). Work-related accidents adversely impacted the clinical outcomes, and distal scaphoid excision significantly improved them and decreased scaphotrapeziotrapezoidal osteoarthritis and nonunion. Neither distal scaphoid excision nor excision of the triquetrum influenced midcarpal osteoarthritis. Radiocarpal fusion was significantly promoted by memory staples and bone grafting. Discussion Distal scaphoid excision should be preferred to improve the functional results while decreasing scaphotrapeziotrapezoidal osteoarthritis and radiocarpal nonunion rates. Excision of the triquetrum appears to be an alternative to radioulnar resection-arthroplasty to solve ulnocarpal impaction syndrome. Strict surgical procedure must be observed to promote RSL fusion combining solid bone fixation and the use of bone graft. Level of evidence This is a level IV, case series, retrospective series.

Subchondral Cyst Involving the Ulnar Aspect of the Lunate

Introduction: The etiology of subchondral cyst formation is not well known; however, there are several articles which address that it can be occurred by recurrent minor trauma which results in cartilage injury and consequently makes joint fluid to enter the bone marrow spaces of the subchondral bone to form a cyst. The purpose of this study was to find out the relationship between lunate cyst with ulnocarpal impaction which could give repeated mechanical stress to lunate. Methods: From March 2012 to January 2014, total of 387 patients’ 3D upper extremity computed tomography (CT) images at Chung-Ang University Hospital that includes wrist images were reviewed. Among these patients, 10 patients had been diagnosed of ulnocarpal impaction syndrome (group 1). Nine patients had been treated with ulnar shortening and 1 patient had injection to ulnar fovea. In the rest of 377 patients, none of the patients had specific ulnar side pain of their wrist (group 2). Among these images, 35 patients (9.26%) had lunate cysts positioned near distal ulna which can be suggested as ulnolunate impaction. They were assessed for difference, correlation, and logistic regression to evaluate if there is true relationship between lunate cyst and the degree of ulnar positive variance or age. Results: In total, 241 patients had ulnar positive variance on their wrist and 41 patients (17%) had lunate cyst. The prevalence of lunate cyst was significantly higher in group 1 (6 patients [60%] vs. 35 patients [9.26%], P &lt; .001, respectively). However, there was no difference of the size of lunate cyst in groups 1 and 2 ( P = .242). The size of lunate cyst had no correlation to ulnar positive variance or patient’s age as well ( P = .857, P = .349, respectively). Logistic regression analysis demonstrated that the presence of lunate cyst was associated with the patient’s age (odds ratio = 1.045, P &lt; .001) and also the association between the presence of lunate cyst and the degree of ulnar positive variance was found (odds ratio = 1.186, P = .022). Patients with lunate cyst had more positive ulnar variance ( P = .020). However, only 15% of patients with lunate cyst had symptomatic ulnocarpal impaction syndrome. In addition, in the patients with lunate cyst, there was no difference of cyst size whether the patients had the symptomatic ulnocarpal impaction syndrome or not ( P = .262). Conclusion: In our study, the lunate cyst was associated with patient’s age and ulnar positive variance. However, we could not find significant effect of symptomatic ulnocarpal impaction on the formation of subchondral cyst in lunate.

Outcome of Ulnar Shorting Osteotomy

Introduction: Ulnar shortening is a treatment option for ulnar wrist pain. Most frequently, this procedure is performed for ulnocarpal impingement, but it may also be useful in patients with persistent ulnar wrist pain after a sprain. The aim of the study was to assess outcome of patients who were operated on in our hospital with a diaphysial ulnar shortening osteotomy; to look for complications; and to find out if results were influenced by factors such as age, gender, hand dominance, smoking, type of osteotomy (horizontal or oblique), and length of follow-up; and whether or not a trauma was involved. Methods: Between 2006 and 2014, 37 out of 46 patients who were operated on in our hospital were available for evaluation with a mean follow-up of 54 months (range, 7-69). Mean age at the time of surgery was 39 years (range, 15-69), 24 were women, in 19 the dominant hand was involved, 15 were smokers, and in 28 a horizontal and in 9 an oblique osteotomy was performed. In 18 a trauma was involved, and in 14 there was an associated fracture of the radius or ulna. In all patients, Disability of Arm Shoulder and Hand (DASH) questionnaire, patient rated wrist hand evaluation (PRWE), visual analogue scale (VAS) for pain, satisfaction, and complications could be assessed, and in 25 grip strength and range of motion were determined. Statistical analyses (Mann-Whitney U test, independent samples t test) were performed to find out which factors had an influence on the outcome. Multiple regression analysis was done to assess influences on the DASH score. Results: Mean DASH was 22 (range, 0-75) and mean PRWE score 33 (range, 0-90). Mean VAS for pain was 2.6 (range, 0-7.8). Thirty patients were satisfied and 7 would not undergo the same operation again. In 17 the plate and screws had to be removed. In 3 cases with a horizontal osteotomy, a second operation had to be performed for nonunion. Two of them were smokers. Mean grip strength was 84%, mean wrist flexion 84%, extension 75%, pronation 85%, and supination 86% of the contralateral side. PRWE and DASH scores were significantly better in smokers. PRWE was significantly worse in posttraumatic ulnocarpal impaction syndrome. Multiple regression analysis showed a significantly better DASH score in smokers, in patients operated on the nondominant side and with a longer follow-up. Discussion and Conclusion: Ulnar shortening may not be able to solve ulnar wrist pain in all patients as one fifth was not satisfied. Complications should not be underestimated. Reoperations were needed in half of patients. Outcomes were better in idiopathic ulnocarpal impaction. In posttraumatic cases, ligamentous lesions may also play a role in causing ulnar wrist pain. Results were better when the follow-up was longer which may indicate that recovery after ulnar shortening may take long time or that patients may have adapted their activities. In contrast to other studies, outcome scores in the present study were better in smokers, but 2 of the 3 patients with nonunion were smokers.

A finite element model to investigate the effect of ulnar variance on distal radioulnar joint mechanics.

Ulnocarpal impaction syndrome involves excessive loading of the ulnocarpal joint. Ulnar shortening osteotomies are an effective way to reduce ulnocarpal loading but alter contact mechanics at the distal radioulnar joint (DRUJ). This study used a computational model to investigate the relationship between ulnar length and DRUJ mechanics. Detailed, finite element models of the radius and ulna bones were constructed from magnetic resonance imaging data. The length of the ulna bone model was increased and decreased up to 5 mm in 1 mm increments. A computational model was used to predict joint contact at the DRUJ for each ulnar length. Lengthening the ulna caused a slight decrease in DRUJ contact pressure, with a more substantial decrease in contact area. Shortening the ulna caused a substantial increase in contact area, with a smaller increase in DRUJ contact pressure. The location of contact on the radial sigmoid notch changed with 2 mm lengthening and 3 mm shortening. The results of this study demonstrate the sensitivity of DRUJ contact to ulnar length changes, which may explain the DRUJ cartilage degeneration that often follows ulnar osteotomies. The joint contact model implemented in this study allowed the relationship between ulnar length and DRUJ contact to be examined systematically, in a way that is difficult to achieve through cadaveric experimentation. The results confirmed published experimental data showing an increased DRUJ contact pressure with ulnar shortening. It is important that clinicians consider the influence of ulnar osteotomies, not only on ulnocarpal loading but also on DRUJ mechanics. Copyright © 2016 John Wiley & Sons, Ltd.

Ulnar shortening osteotomy for ulnar-sided wrist pain.

Background The purpose of ulnar shortening osteotomy is literally to shorten the ulna. It can tighten the triangular fibrocartilage complex (TFCC), ulnocarpal ligaments, and interosseous membrane. Nowadays, this method is used to treat ulnar-sided wrist pain, for which we have also started to use a treatment algorithm. The purpose of this study was to review the long-term and clinical results based on our algorithm. Materials and Methods We retrospectively reviewed 30 patients with ulnocarpal impaction syndrome after a minimum follow-up of 5 years (Group A) and then retrospectively evaluated 66 patients with recalcitrant ulnar wrist pain treated based on our algorithm (Group B). Description of Technique Ulnocarpal abutment was confirmed arthroscopically. The distal ulna was approached through a longitudinal incision between the extensor carpi ulnaris and flexor carpi ulnaris. We performed a transverse resection of the ulna fixed with a small locking compression plate. The contralateral side served as the reference for the length of shortening (mean, 2.4 mm; range, 1-5 mm). Disappearance of ulnar abutment was then confirmed again arthroscopically. Results (Group A) Most patients showed good long-term clinical results. About half of the patients showed a bony spur at the distal radioulnar joint (DRUJ), but the clinical results did not significantly correlate with presence of bony spurs. Radiological parameters wre not related to the presence of bony spurs. (Group B) Twenty-four of the 66 patients investigated prospectively underwent an ulnar shortening osteotomy, with all showing good clinical results at 18 months postoperatively. Conclusions Ulnar shortening osteotomy can change the load of the ulnar side of the wrist and appears useful for ulnar-sided wrist pain in the presence of ulnar impaction. Level of evidence IV.

Ulnocarpal impaction syndrome: treatment with a transverse ulnar shortening osteotomy from an ulnodorsal approach

Ulnocarpal impaction syndrome is a common cause of chronic ulnar-sided wrist pain. The distal ulnar shortening osteotomy addresses the often present positive ulnar variance and therefore relieves the excessive load on the ulnocarpal joint. In the present study, the results of a technique that uses an ulnodorsal approach with a compression device and a transverse osteotomy are presented and compared to other techniques. This retrospective study includes 92 wrists with an ulnocarpal impaction syndrome, which were treated with an ulnar shortening osteotomy. The mean duration of postoperative follow-up was 50 months. The mean ulnar variance was 2.17 ± 1.56 mm preoperatively and after the ulnar shortening osteotomy -1.36 ± 1.67 mm (p < 0.05). Radiological consolidation of the osteotomy could be shown in 91 wrists 6 months postoperatively. Patients rated the preoperative pain level at a VAS 7.9 ± 1.7 which decreased to a of VAS 2.4 ± 2.5 (p < 0.05). 19 patients complained of mechanical irritation. There was no neurological irritation. It could be shown that the distal ulnar shortening osteotomy by a transverse osteotomy using a compression device and an ulnodorsal approach has a low complication rate. It is comparable to the oblique osteotomy in effectiveness and safety.

The Change of the Ulnar Variance in Accordance with the Wrist Position in Ulnocarpal Impaction Syndrome

Purpose: We evaluated the change of the ulnar variance (UV) as forearm rotation in patients with ulnocarpal impaction syndrome (UIS). Methods: Twenty patients who suffered from ulnar side pain of the wrist and had abnormal lesions at ulno-basal side of the lunate in the radiologic examinations were included in this study. Their UVs in six wrist position (neutral, supination, pronation, neutral and grip, supination and grip, pronation and grip) were measured by the method of perpendiculars. UVs and the maximum change of UV in patients with UIS were compared with those of control group statistically. Results: There were statistically significant differences in UVs of all forearm rotation and grip status. The maximum change of UV was in supination position to pronation and grip status for all cases. The mean maximum change of UV in patients with UIS was 2.03±1.03 mm, and that of control group was 1.86 ±0.86 mm. But there was no significant difference between them. The ulnar shortening osteotomy was performed for thirteen UIS patients, and one patient with osteoarthritis at distal radio-ulnar joint was operated with Darrach procedure. Six patients underwent conservative treatment. Conclusion: There were no significant differences in the maximum change of UV as forearm rotation between UIS patients and control group.

SPECT/CT Imaging in Ulnocarpal Impaction Syndrome

We report a 42-year-old man who presented with ulnar-sided wrist pain. MR image revealed bone marrow edema in the lunate bone. Ulnocarpal impaction syndrome was diagnosed by MRI and arthrography. Bone scintigraphy showed increased uptake in the wrist. SPECT/CT with 2- and 3-dimensional reconstruction images clearly demonstrated abnormal accumulation on the ulnar side of the lunate bone.

A unique case of temporary epiphysiodesis in an adolescent patient with ulnocarpal impaction syndrome

A unique case of temporary epiphysiodesis in an adolescent patient with ulnocarpal impaction syndrome

Tme diagnosis and treatment of nontrauatic ulnocarpal impaction syndrome

Objective To explore the characteristics of non-traumatic ulnocrpal impaction syndrome without typical X-ray features and discuss the diagnosis criteria and treatment methods.Methods Fifty-five cases of definite diagnosis of ulnocarpal impaction syndrome treated from October 2003 to October 2010 were retrospectively reviewed.25 cases were identified as with no definite trauma history and no typical X-ray features.Based on the diagnostic criteria described by Kostas,ulnocarpal stress test,dynamic positive ulnar variance and early MRI and wrist arthroscopty findings of these 25 cases were analyzed.All the cases underwent ulnar shortening osteotomy with compression plate fixation,among which 16 with transverse osteotomy (Darrow procedure) and 9 with oblique osteotomy (Rayhack procedure).Results were scored using the criteria described by Darrow.Results Among the 25 cases,ulnocarpal stress test was positive in 84％ of the cases,dynamic positive ulnar variance was present in 52％ of the cases,and abnormal changes in signal intensity occurred in theMRI findings of 82％ cases.These changes were always located at the ulnar side of the lunate and (or) at the waist or bottom of the triquetrum.TFCC degeneration and cartilage degeneration on ulnar head and lunate were present in wrist arthroscopy of all the cases.Follow-up period ranged from 4 to 48 months with an average of 26months.Bone union was achieved in all 25 cases.Union time averaged 4.5 months after transverse osteotomy and 2.5 menthe after oblique osteotomy.Function evaluation revealed excellent results in 7 cases,good results in 15 cases,fair results in 2 cases and poor results in 1 case.The overall good-excellent rate was 88％.There were no complications.The clinical outcomes were satisfactory.Conclusion It is difficult to differentiate non-traumatic ulnocarpal impaction syndrome from other etiologies of ulnar side wrist pain due to its lack of a traumatic history and typical X-ray features.Ulnocarpal stress test,dynamic positive ulnar variance and early MRI imaging studies can improve the early diagnosis rate.Wrist arthroscopy can allow assessment of pathology and be used as a diagnostic tool for differential diagnosis.Ulnar shortening osteotomy is an effective method and oblique osteotomy is recommended. Key words: Carpal joints; Diagnosis; Ulna; Osteotomy; Nontraumatic; Ulnocarpal impaction

Oblique Ulnar Styloid Osteotomy—A Treatment for Ulnar Styloid Impaction Syndrome

We report a series of 5 patients (mean age, 41 y) presenting with ulnar styloid impingement syndrome (USIS) and treated by an oblique ulnar styloid osteotomy. The purpose of the study was to determine whether the osteotomy is an effective method for treating USIS. The diagnosis of USIS was made based on a history of ulnar-sided wrist pain supported by clinical and radiological findings. Clinical assessment included provocative tests to differentiate USIS from pain associated with ulnocarpal impaction syndrome. The ulnar styloid length was assessed with a posteroanterior X-ray using the methods of Garcia-Elias and Biyani. The ulnar styloid was deemed excessively long if the ulnar styloid process index was greater than 0.21 or if the overall styloid length was greater than 6 mm. Ulnar variance was recorded. All wrists were assessed by computed tomography arthrography and magnetic resonance imaging studies to rule out any associated soft tissue abnormalities, including ligamentous injuries. Preoperative and postoperative pain levels were recorded using a pain scoring system. Patients were followed up for a mean of 46 months. Before surgery, the mean styloid length was 10 mm, and the ulnar styloid process index was 0.32. The reported pain score was significantly reduced following surgery and all patients, except one, returned to premorbid levels of activity. Oblique ulnar styloid osteotomy is an effective means of relieving impaction of the ulnar styloid while preserving the integrity of the intrinsic ulnar styloid ligaments. Therapeutic IV.

Reconstruction of Forearm Deformity by Distraction Osteogenesis in Children With Relative Shortening of the Ulna Due to Multiple Cartilaginous Exostosis

In patients with multiple cartilaginous exostosis, distal ulnar osteochondromas frequently cause forearm deformities, with relative ulnar shortening, wrist joint deviation, and varus bowing. Progressive deformation often leads to pain, functional impairment, and cosmetic problems. Surgical ulnar lengthening is necessary to restore the carpal balance. The results of fixator-controlled ulnar lengthening were investigated in this study, using appropriate clinical and radiologic parameters and focusing on medium-term functional and structural outcomes. Twelve children (3 boys, 9 girls; mean age 9.8 y) with multiple cartilaginous exostosis-induced ulnar shortening treated with fixator-controlled ulnar callotasis were evaluated retrospectively based on clinical and radiographic examinations preoperatively, after fixator removal, and at a follow-up investigation. Subjective symptoms and objective joint function were assessed clinically, whereas the extent of ulnar shortening, radial articular angle, carpal slip, and radial head dislocation were determined radiographically. The average follow-up period was 24.6 months. The mean ulnar shortening and radial articular angle improved significantly, from 14.3 mm or 38.7 degrees preoperatively to 1.7 mm or 25.6 degrees after fixator removal and showed a slight but significant increase to 5.2 mm or 30.1 degrees at the follow-up. Carpal slip and radial head dislocation remained unchanged. With the exception of radial abduction, no notable functional advancement was observed. One unintended ulnar overlengthening with a subsequent ulnocarpal impaction syndrome, one premature callus consolidation, and two fixator dislocations were noted. In agreement with literature reports, carpal balance can be restored over the medium term. However, mild recurrences of ulnar shortening and radial malformation were observed during further development. To prevent deformity progression in immature patients, surgery should be carried out early. The optimal timing of surgery needs to be calculated precisely to take advantage of the high remodeling potential and an acceptable degree of recurrent deformity. Ulnar lengthening is necessary, but overcorrection is inadvisable due to possible ulnocarpal impaction syndrome. As significant remodeling effects on the radius were observed, simultaneous radial correction procedures are not recommended a priori.

SPECT/CT arthrography of the wrist in ulnocarpal impaction syndrome

Ulnar-sided wrist pain is a diagnostic challenge for hand surgeons and radiologists due to the complex anatomy of the involved small structures. Along with the clinical history and physical examination, imaging is important in the evaluation of ulnar-sided wrist pain [1–4]. Ulnocarpal impaction syndrome can lead to severe damage to the cartilage, triangular fibrocartilagecomplex (TFCC) and bone. The new generation of SPECT/CT devices allow SPECT and high-resolution CT imaging of the wrist with a spatial resolution of 0.33 mm in one imaging step [5]. CT arthrography of the wrist is a wellestablished investigation [6]. Combining wrist arthrography (arrowheads intraarticular contrast medium) and SPECT/CT (Arthro-SPECT/CT) offers a one-stop shop imaging approach for patients with ulnocarpal impaction. In our 63-year-old male patient with ulnar-sided wrist pain for 3 months, Arthro-SPECT/CT demonstrated severe osteoarthritis of the distal radioulnar joint (DRUJ), profound damage to the cartilage of the ulnotriquetral joint (short arrow) and a large defect in the central part of the TFCC (short arrow). Concomitant increased uptake was observed in the triquetral bone (long arrow )a nd DRUJ. Arthro-SPECT/CT of the wrist is feasible and offers unique anatomic and metabolic information to the hand surgeon in patients with ulnar-sided wrist pain. Arthro-SPECT/CTseems to be a promising alternative to wrist MRI. Conflicts of interest None.

Surgical Management of Ulnocarpal Impaction Syndrome

A 34-year-old, right hand–dominant man who does not smoke presents with the insidious onset of right wrist pain, progressive over the past 2 years. He is tender to palpation over the ulnar side of his wrist joint and his pain is exacerbated with passive pronation and ulnar deviation. His grip strength is 75% of the opposite side. A neutral rotation posteroanterior radiograph of the wrist reveals cyst formation in the lunate and triquetrum as well as 1.5 mm of positive ulnar variance, which increased to 3 mm with a pronated grip view. Prior treatment consisting of activity modification, anti-inflammatory medication, splint immobilization, and 2 corticosteroid injections did not resolve his symptoms. He presents requesting surgical treatment. Educational Objectives •Define ulnocarpal impaction syndrome. •List the various causes of ulnocarpal impaction syndrome. •List the x-ray findings consistent with ulnocarpal impaction syndrome. •State the different osteotomy configurations used for ulnar shortening and explain the advantages and disadvantages. •Discuss the outcome studies that compare ulnar shortening osteotomy and wafer resection. Earn up to 2 hours of CME credit per JHS issue when you read the related articles and take the online test. To pay the $20 fee and take this month's test, visit http://www.assh.org/professionals/jhs. •Define ulnocarpal impaction syndrome. •List the various causes of ulnocarpal impaction syndrome. •List the x-ray findings consistent with ulnocarpal impaction syndrome. •State the different osteotomy configurations used for ulnar shortening and explain the advantages and disadvantages. •Discuss the outcome studies that compare ulnar shortening osteotomy and wafer resection. Earn up to 2 hours of CME credit per JHS issue when you read the related articles and take the online test. To pay the $20 fee and take this month's test, visit http://www.assh.org/professionals/jhs. Journal CME QuestionsJournal of Hand SurgeryVol. 35Issue 4Preview Full-Text PDF