We describe a modified metaphyseal ulnar osteotomy to treat ulnar impaction syndrome with a reverse oblique sigmoid notch. Based on a computational analysis of radiographs, a modified wedge metaphyseal ulnar osteotomy was devised with its apex positioned at the ulnar styloid base to avoid impaction between the sigmoid notch and ulnar head. Subsequently, nine patients with ulnar impaction syndrome and a reverse oblique sigmoid notch underwent this operation, combined with arthroscopic exploration and transosseous triangular fibrocartilage complex repair. The mean follow-up was 14 months. All patients achieved bone union within 5 weeks, with no degenerative changes being observed during the follow-up assessments. The final follow-up assessments revealed decreases in ulnar variance and in the scores for Visual Analogue Scale, Quick Disabilities of the Arm, Shoulder and Hand questionnaire and the Patient-Rated Wrist Evaluation. All patients achieved excellent or good grades on the Modified Mayo Wrist Score. This technique is effective in treating the ulnar impaction syndrome with a reverse oblique sigmoid notch.
BaekGHLeeHJGongHS, 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: 295–301.
2.
BainGIBidwellTA.Arthroscopic excision of ulnar styloid in stylocarpal impaction. Arthroscopy. 2006,
22: 677.e1–3.
3.
BeatonDEWrightJGKatzJN; Upper Extremity Collaborative Group.
Development of the QuickDASH: comparison of three item-reduction approaches. J Bone Joint Surg Am. 2005,
87: 1038–46.
4.
BenisSGoubauJFMermuysK, et al.
The oblique metaphyseal shortening osteotomy of the distal ulna: surgical technique and results of ten patients. J Wrist Surg. 2017,
6: 39–45.
5.
CooneyWPBusseyRDobynsJHLinscheidRL.Difficult wrist fractures. Perilunate fracture-dislocations of the wrist. Clin Orthop Relat Res. 1987,
214: 136–47.
6.
D’AgostinoPTownleyWALe VietDRoulotE.Oblique ulnar styloid osteotomy–a treatment for ulnar styloid impaction syndrome. J Hand Surg Am. 2011,
36: 1785–9.
7.
de RunzAPauchardNSorinTDapFDautelG.Ulna-shortening osteotomy: outcome and repercussion of the distal radioulnar joint osteoarthritis. Plast Reconstr Surg. 2016,
137: 175–84.
8.
FreyCSZhouJYShahKN, et al.
Distal metaphyseal ulnar shortening osteotomy fixation: a biomechanical analysis. J Hand Surg Am. 2023. doi: 10.1016/j.jhsa.2022.11.007.
9.
GreenbergJAWernerFWSmithJM.Biomechanical analysis of the distal metaphyseal ulnar shortening osteotomy. J Hand Surg Am. 2013,
38: 1919–24.
10.
GreybeDBolandMRWuTMithraratneK.A finite element model to investigate the effect of ulnar variance on distal radioulnar joint mechanics. Int J Numer Method Biomed Eng. 2017,
33. doi: 10.1002/cnm.2790.
11.
GriskaAFeldonP.Wafer resection of the distal ulna. J Hand Surg Am. 2015,
40: 2283–8.
HollevoetNVerdonkRVan MaeleG.The influence of articular morphology on non-traumatic degenerative changes of the distal radioulnar joint. A radiographic study. JHand Surg Br. 2006,
31: 221–5.
14.
HuangHKLeeSKHuangYCYinCYChangMCWangJP.Long-term radiographic outcomes and functional evaluation of ulnar shortening osteotomy in patients with ulnar impaction syndrome and reverse oblique sigmoid notch: a retrospective case series study. BMC Musculoskelet Disord. 2021,
22: 136.
15.
ImJHLeeJYKangHV.The combined procedure of ulnar metaphyseal shortening osteotomy with triangular fibrocartilage complex foveal knotless repair. J Hand Surg Am. 2021,
46: 822.e1–e7.
16.
IwasakiNIshikawaJKatoHMinamiMMinamiA.Factors affecting results of ulnar shortening for ulnar impaction syndrome. Clin Orthop Relat Res. 2007,
465: 215–9.
LapnerPCPoitrasPBackmanDGiachinoAAConwayAF.The effect of the wafer procedure on pressure in the distal radioulnar joint. J Hand Surg Am. 2004,
29: 80–4.
21.
LuCWangPZhangL, et al.
Clinical study of wrist arthroscopy combined with oblique ulnar shortening osteotomy in the treatment of ulnar impaction syndrome. Orthop Surg. 2022,
14: 2947–54.
22.
MacDermidJC.Development of a scale for patient rating of wrist pain and disability. J Hand Ther. 1996,
9: 178–83.
23.
MinamiAKatoH.Ulnar shortening for triangular fibrocartilage complex tears associated with ulnar positive variance. J Hand Surg Am. 1998,
23: 904–8.
24.
NishiwakiMNakamuraTNaguraTToyamaYIkegamiH.Ulnar-shortening effect on distal radioulnar joint pressure: a biomechanical study. J Hand Surg Am. 2008,
33: 198–205.
25.
NunezFABarnwellJLiZNunezFASr.Metaphyseal ulnar shortening osteotomy for the treatment of ulnocarpal abutment syndrome using distal ulna hook plate: case series. J Hand Surg Am. 2012,
37: 1574–9.
26.
OhWTKangHJChunYMKohIHAnHMChoiYR.Arthroscopic wafer procedure versus ulnar shortening osteotomy as a surgical treatment for idiopathic ulnar impaction syndrome. Arthroscopy. 2018,
34: 421–30.
27.
RheeSMLeeJYSongKSLeeGYLeeJS.Lunate subchondral cysts: Are there specific radiologic findings for patients with symptomatic ulnocarpal impaction?J Orthop Sci. 2019,
24: 636–42.
28.
RohYHKimSGongHSBaekGH.Prognostic value of clinical and radiological findings for conservative treatment of idiopathic ulnar impaction syndrome. Sci Rep. 2018,
8: 9891.
29.
Ross.MWiemann.MPeters.SEBenson.RCouzensGB.The influence of cartilage thickness at the sigmoid notch on inclination at the distal radioulnar joint. Bone Joint J. 2017,
99: 369–75.
30.
SagermanSDZogbyRGPalmerAKWernerFWFortinoMD.Relative articular inclination of the distal radioulnar joint: a radiographic study. J Hand Surg Am. 1995,
20: 597–601.
31.
SennwaldGDella SantaDBeaulieuJY.A comparison of diaphyseal and metaphyseal techniques of ulna shortening. J Hand Surg Eur. 2013,
38: 542–9.
32.
SeoJBKimJPYiHSParkKH.The outcomes of arthroscopic repair versus debridement for chronic unstable triangular fibrocartilage complex tears in patients undergoing ulnar-shortening osteotomy. J Hand Surg Am. 2016,
41: 615–23.
33.
SladeJFGillonTJ.Osteochondral shortening osteotomy for the treatment of ulnar impaction syndrome: a new technique. Tech Hand Up Extrem Surg. 2007,
11: 74–82.
TolatARSandersonPLDe SmetLStanleyJK.The gymnast’s wrist: acquired positive ulnar variance following chronic epiphyseal injury. J Hand Surg Br. 1992,
17: 678–81.
37.
TolatARStanleyJKTrailIA.A cadaveric study of the anatomy and stability of the distal radioulnar joint in the coronal and transverse planes. J Hand Surg Br. 1996,
21: 587–94.
TrousdaleRTAmadioPCCooneyWPMorreyBF.Radio-ulnar dissociation. A review of twenty cases. J Bone Joint Surg Am. 1992,
74: 1486–97.
40.
YangHQiWZhangF, et al.
Comparison of diaphyseal and metaphyseal ulnar shortening osteotomies for the treatment of ulnar impaction syndrome. BMC Musculoskelet Disord. 2023,
24: 10.
