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Zhou JY, Tuyishime H, Yao J. Arthroscopic-Assisted Repair of the Triangular Fibrocartilage Complex. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2024; 6:445-457. [PMID: 39166194 PMCID: PMC11331167 DOI: 10.1016/j.jhsg.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 03/18/2024] [Indexed: 08/22/2024] Open
Abstract
Triangular fibrocartilage complex (TFCC) injuries are a common cause of ulnar-side wrist pain and may progress to persistent pain, instability of the distal radioulnar joint, and arthritis if left untreated. Diagnosis and management of these injuries requires a nuanced understanding of features pertinent to the clinical presentation, imaging, and arthroscopic findings for accurate management. Arthroscopic-assisted repair techniques have revolutionized surgical management, providing detailed visualization and facilitating the repair of TFCC injuries and associated pathologies with minimally invasive techniques. In this review, we discuss the anatomy of the TFCC, history and examination of ulnar-sided pathology, imaging findings, and classification schemes and review surgical techniques for the treatment of TFCC injuries. We also touch on pearls and pitfalls of the techniques, complications, and results of treatment.
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Affiliation(s)
- Joanne Y. Zhou
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA
| | | | - Jeffrey Yao
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA
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Scigliano NM, McSweeny KF, Garcia Fleury I, Buckwalter JA. Ulnar Variance in Athletes: A Scoping Review. Sports Health 2024; 16:581-587. [PMID: 37681664 PMCID: PMC11195860 DOI: 10.1177/19417381231195527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023] Open
Abstract
CONTEXT Ulnar variance (UV) is a measurement of the relative locations of the radius and ulna that may become perturbed in athletic populations. Positive UV can be associated with wrist pathologies often treated conservatively or surgically and may result in interruption of sports participation. OBJECTIVE This scoping review aims to summarize diagnostic measures of UV in athletes, describe its relation to separate wrist conditions, and present treatment strategies for symptomatic UV. DATA SOURCES A systematic search was created and modified for PubMed, CINAHL, Embase, and SPORTDiscus including articles from inception until February 2, 2022. STUDY SELECTION Articles including UV characterization, imaging modality style, and an athletic population were searched across multiple databases. STUDY DESIGN A scoping review was designed to identify the methods for imaging UV in athletic populations following the PRISMA Extension for Scoping Reviews (PRISMA-ScR). LEVEL OF EVIDENCE Level 4. DATA EXTRACTION The specific athletic population, imaging modality, measurement style, wrist pathology association, and surgical management of UV were extracted. RESULTS A total of 4321 records were screened independently for eligibility: 22 met inclusion criteria. Eight sports comprised the analysis. All studies referenced conventional radiography to diagnose UV; 50% specified the posteroanterior, 18.2% anteroposterior, and 13.6% pronated, gripping radiographs. Hafner's method (7×), Palmer's technique (2×), and the method of perpendiculars (3×) were used to measure UV. Athletes displayed more positive UV than nonathletes and UV became more positive over time in longitudinal studies. Triangular fibrocartilage complex tears, focal lunate necrosis, and ulnar abutment were associated with positive UV. Ulnar shortening osteotomy was the most performed operation for positive UV. CONCLUSION Conventional radiography is the gold standard for imaging UV in athletes. Hafner's method is the most commonly used radiograph measurement technique. Wrist pathology in athletic populations may indicate positive UV in need for operative management.
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Affiliation(s)
- Noah M. Scigliano
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Kareena F. McSweeny
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Ignacio Garcia Fleury
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Joseph A. Buckwalter
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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Ravella KC, Yao J. Treatment of Hand and Wrist Cartilage Defects in Athletes. Sports Med Arthrosc Rev 2024; 32:104-112. [PMID: 38978204 DOI: 10.1097/jsa.0000000000000400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Cartilage injuries of the hand and wrist can be debilitating in the athlete. Diagnosis is difficult given the broad spectrum of presenting symptomatology. History and physical examination is crucial to achieve the correct diagnosis, and advanced imaging can offer helpful assistance to the clinician as well. TFCC injuries and ulnar impaction syndrome are among the most common conditions in athletes with hand and wrist pain. Treatment of these injuries is initially nonoperative, but elite athletes may elect to bypass nonoperative treatment in favor of earlier return to sport. Surgical treatment varies but can include open and arthroscopic methods. The clinician should tailor treatment plans to each athlete based on level of competition, type of sport, and individual preferences and goals.
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Affiliation(s)
- Krishna C Ravella
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
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Herzberg G, Burnier M, Ly L, Nakamura T, Piñal FD, Atzei A. A New Arthroscopic Classification of Triangular Fibrocartilage Complex Disorders. J Wrist Surg 2024; 13:2-8. [PMID: 38264139 PMCID: PMC10803146 DOI: 10.1055/s-0043-1769908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 05/09/2023] [Indexed: 01/25/2024]
Abstract
Introduction The use of wrist arthroscopy has become a prerequisite for diagnosis and treatment of triangular fibrocartilage complex (TFCC) disorders. Since Palmer's landmark paper, many new arthroscopic descriptions of TFCC tears have been published but there is no currently available updated comprehensive arthroscopic classification of TFCC lesions. Purpose We recently described the arthroscopic anatomy of the TFCC as viewed from a 3-4 portal. Our purpose was to propose a new TFCC disorders classification based on this new arthroscopic TFCC description. Methods We included all currently described TFCC disorders to the best of our knowledge into our arthroscopic, functional, and vascular anatomical concept. We also included patient's specific ulnar variance and distal radial ulnar joint coronal inclination as baseline treatment-oriented parameters. The fresh or chronic, reparable or nonreparable nature of some types of TFCC tears were considered as separate parameters. Results The proposed classification includes disc "D" (degenerative or traumatic), reins "R" (traumatic), and wall "W" (traumatic) lesions. Combined lesions of those three parts of the TFCC may be easily identified. This new classification should facilitate future analysis of isolated or combined TFCC disorders whether they are degenerative and/or traumatic. Discussion The authors present a new three-dimensional-three-part arthroscopic updated description of TFCC disorders with relevance to etiology and treatment principles.
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Affiliation(s)
- Guillaume Herzberg
- I-Trues Surgery Unit, Orthopedic Department, Clinique Parc Lyon, Lyon, France, Clinique Val Ouest, Lyon Ecully, France
| | - Marion Burnier
- I-Trues Surgery Unit, Department of Orthopedic, Institut Main Membre Supérieur, Villeurbanne, France
| | | | | | | | - Andrea Atzei
- Chirurgia Della Mano, Polso e Gomito, Microchirurgia Ricostruttiva MediLAB Sottoportico Teatro Dofin, Treviso, Italy
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Zhang L, Fu W. A comment on 'Ulnar shortening osteotomy vs. wafer resection for ulnar impaction syndrome: A systematic review and meta-analysis'. Int J Surg 2023; 109:4373-4374. [PMID: 37916929 PMCID: PMC10720770 DOI: 10.1097/js9.0000000000000722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 08/19/2023] [Indexed: 11/03/2023]
Affiliation(s)
| | - Weili Fu
- Sports Medicine Center, Department of Orthopedic Surgery/Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
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Buckwalter V JA, Scigliano NM, Fleury IG, Watson NAD, Dibbern KN, Glass NA, Goetz JE. Altered Ulnar Variance With Full-Body Weight-bearing During Handstands With Upper Extremity Weight-bearing CT. J Hand Surg Am 2023:S0363-5023(23)00502-6. [PMID: 37952145 DOI: 10.1016/j.jhsa.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/25/2023] [Accepted: 09/07/2023] [Indexed: 11/14/2023]
Abstract
PURPOSE Ulnar variance (UV) is a radiographic measurement relating the articular surface heights of the distal radius and ulna. Abnormal UV increases the risk for wrist pathology; however, it only provides a static measurement of an inherently dynamic bony relationship that changes with wrist position and loading. The purpose of this study was to investigate how full-body weight-bearing affects UV using weight-bearing computed tomography (WBCT). METHODS Ten gymnasts completed two 45-second scans inside a WBCT machine while performing a handstand on a flat platform (H) and parallettes (P). A non-weight-bearing CT scan was collected to match clinical practice (N). Differences in UV between weight-bearing conditions were evaluated separately for dominant and nondominant sides, and then, UV was compared between weight-bearing conditions on pooled dominant/nondominant data. RESULTS Pooled analyses comparing weight-bearing conditions revealed a significant increase in UV for H versus N (0.58 mm) and P versus N (1.00 mm), but no significant change in UV for H versus P (0.43 mm). Significant differences in UV were detected for H versus N, P versus N, and H versus P for dominant and nondominant extremities. The change from N to H was significantly greater in the dominant versus nondominant side, but greater in the nondominant side from N to P. CONCLUSIONS Ulnar variance changed with the application of load and position of the wrist. Differences in UV were found between dominant and nondominant extremities. CLINICAL RELEVANCE Upper extremity loading patterns are affected by hand dominance as defined by a cartwheel and suggest skeletal consequences from repetitive load on a dominantly used wrist. Although statistically significant, subtle changes detected in this investigational study do not necessarily bear clinical significance. Future WBCT research can lead to improved diagnostic measures for wrist pathologies affected by active loading and rotational wrist behavior.
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Affiliation(s)
- Joseph A Buckwalter V
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals & Clinics, Iowa City, IA.
| | - Noah M Scigliano
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals & Clinics, Iowa City, IA
| | - Ignacio Garcia Fleury
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals & Clinics, Iowa City, IA
| | - Nicole A D Watson
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals & Clinics, Iowa City, IA
| | - Kevin N Dibbern
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals & Clinics, Iowa City, IA
| | - Natalie A Glass
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals & Clinics, Iowa City, IA
| | - Jessica E Goetz
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals & Clinics, Iowa City, IA
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Zhou JY, Frey CS, Shah KN, Ostergaard PJ, Yao J. Antegrade Fixation of Distal Metaphyseal Ulnar Shortening Osteotomy. Tech Hand Up Extrem Surg 2023; 27:182-188. [PMID: 37185273 DOI: 10.1097/bth.0000000000000435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
The ulnar shortening osteotomy (USO) is a common procedure used to treat ulnar impaction syndrome secondary to static or dynamic ulnar-positive variance. There are many described techniques for the USO. The distal metaphyseal ulnar shortening osteotomy (DMUSO) with retrograde cannulated screw fixation was described to reduce complications seen with other techniques. Biomechanical analysis of fixation constructs demonstrates 2-screw constructs are significantly stiffer than 1 screw and antegrade constructs have similar or greater stiffness when compared with retrograde constructs. Here, we describe a technique of antegrade cannulated screw fixation for DMUSO that obviates the need for the disruption of the distal radioulnar joint for intra-articular exposure of the ulnar head. Similar to the traditional retrograde DMUSO technique, this construct may also decrease the risk of delayed union, symptomatic implants associated with diaphyseal osteotomies, and disruption of triangular fibrocartilaginous complex in wafer procedures.
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Affiliation(s)
- Joanne Y Zhou
- Department of Orthopaedic Surgery
- Hand and Upper Extremity Surgery, Stanford University, Redwood City
| | - Christopher S Frey
- Department of Orthopaedic Surgery
- Hand and Upper Extremity Surgery, Stanford University, Redwood City
| | - Kalpit N Shah
- Department of Orthopedic Surgery, Scripps Clinic, La Jolla, CA
| | | | - Jeffrey Yao
- Department of Orthopaedic Surgery
- Hand and Upper Extremity Surgery, Stanford University, Redwood City
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Flores DV, Umpire DF, Rakhra KS, Jibri Z, Belmar GAS. Distal Radioulnar Joint: Normal Anatomy, Imaging of Common Disorders, and Injury Classification. Radiographics 2023; 43:e220109. [DOI: 10.1148/rg.220109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Dyan V. Flores
- From the Department of Medical Imaging, Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F., K.S.R., Z.J.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); and Department of Radiology, Clínica Alemana de Santiago, Vitacura, Chile (G.A.S.B.)
| | - Darwin Fernández Umpire
- From the Department of Medical Imaging, Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F., K.S.R., Z.J.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); and Department of Radiology, Clínica Alemana de Santiago, Vitacura, Chile (G.A.S.B.)
| | - Kawan S. Rakhra
- From the Department of Medical Imaging, Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F., K.S.R., Z.J.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); and Department of Radiology, Clínica Alemana de Santiago, Vitacura, Chile (G.A.S.B.)
| | - Zaid Jibri
- From the Department of Medical Imaging, Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F., K.S.R., Z.J.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); and Department of Radiology, Clínica Alemana de Santiago, Vitacura, Chile (G.A.S.B.)
| | - Gonzalo A. Serrano Belmar
- From the Department of Medical Imaging, Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, Canada K1H 8L6 (D.V.F., K.S.R., Z.J.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); and Department of Radiology, Clínica Alemana de Santiago, Vitacura, Chile (G.A.S.B.)
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Shin EK. Impaction Syndromes About the Wrist. Curr Rev Musculoskelet Med 2022; 16:1-8. [PMID: 36435859 PMCID: PMC9839928 DOI: 10.1007/s12178-022-09809-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Impaction syndromes are frequently a source of ulnar-sided wrist pain and patient disability. Differentiating between these entities can be difficult due to significant overlap in their clinical presentations. This manuscript reviews the diagnosis and treatment of three different impaction syndromes: (1) ulnar impaction syndrome, (2) hamate arthrosis lunotriquetral ligament syndrome, and (3) triquetrohamate impaction syndrome. RECENT FINDINGS While non-operative treatment is always recommended upon initial presentation, the duration and extent of treatment are poorly defined. Diagnostic wrist arthroscopy usually confirms the clinical diagnosis and facilitates appropriate surgical management. Pain from ulnar impaction syndrome can be effectively treated with an ulnar shortening osteotomy, which unloads the ulnar aspect of the carpus, but complications have been reported secondary to hardware prominence and nonunion at the osteotomy site. Hamate arthrosis lunotriquetral ligament syndrome can be addressed by arthroscopically or openly excising the proximal pole of the hamate, while triquetrohamate impaction syndrome demands a debridement procedure with partial excision of the impinging triquetrum or hamate. In summary, impaction syndromes are underappreciated clinical entities but are known causes of ulnar-sided wrist pain. Maintaining a high index of suspicion will help to expedite appropriate non-operative and operative treatment. Surgical intervention-if needed-is often curative.
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Affiliation(s)
- Eon K Shin
- Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia Hand to Shoulder Center, 1203 Langhorne-Newtown Road, Suite 335, Langhorne, PA, 19047, USA.
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Moeller RT, Mentzel M, Vergote D, Bauknecht S. [Ulnar Shortening Osteotomy - Two Weeks of Immobilization Sufficient]. HANDCHIR MIKROCHIR P 2022; 54:434-441. [PMID: 36037818 DOI: 10.1055/a-1894-7149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Diaphyseal ulnar shortening osteotomy (USO) as surgical treatment of ulnar impaction syndrome is standardized nowadays with good to very good results. In contrast, a wide spectrum of different postoperative treatment regimens can be found in the current literature. The results after USO with modern, angular stable implants with immobilization for 2 weeks are presented. PATIENTS AND METHODS A retrospective database analysis identified 49 patients (31 women, 18 men, mean age 37.6 years) with a total of 51 USO over a 13-year period and were followed up for 73.5 (15.9-192.9). All USO were obliquely sawed and stabilized with palmar locking implants. The wrist was immobilized postoperatively in 30° extension in a dorsal forearm splint for 2 weeks. RESULTS All USO showed load-stable consolidation signs after an average of 7.0 (SD 1.9; 4.9-14.1) weeks. Wrist range of motion was significantly improved in extension/flexion from 107.6° (60-155) preoperatively to 123.7° (80-160) postoperatively and in ulnar/radial deviation from 55.1° (25-90) to 60.8° (30-90) (p<0.05). Pain level was significantly reduced from 3.2 (0-8) to 0.1 (0-2) at rest and from 7.3 (4-10) to 1.2 (0-9) under weight bearing (p<0.01). A total of 5 complications (9.8%) were noted. Nonunion was not found. CONCLUSION By using angular stable implants to stabilize a USO, the duration of immobilization can be reduced to 2 weeks without compromising bone healing.
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Affiliation(s)
- Richard-Tobias Moeller
- Universitätsklinikum Ulm, Klinik für Unfall-, Hand-, Plastische und Wiederherstellungschirurgie
| | - Martin Mentzel
- Universitätsklinikum Ulm, Klinik für Unfall-, Hand-, Plastische und Wiederherstellungschirurgie
| | - Daniel Vergote
- Universitätsklinikum Ulm, Klinik für Unfall-, Hand-, Plastische und Wiederherstellungschirurgie
| | - Simon Bauknecht
- Universitätsklinikum Ulm, Klinik für Unfall-, Hand-, Plastische und Wiederherstellungschirurgie
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Chinen S, Okubo H, Onaka K, Nakasone M, Kinjo M, Nishida K. Bone Morphology in Ulnar Impaction Syndrome: A Radiographic Evaluation. J Hand Surg Asian Pac Vol 2022; 27:491-498. [PMID: 35674259 DOI: 10.1142/s2424835522500497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Positive ulnar variance (UV) may be associated with a higher incidence of ulnar impaction syndrome (UIS). However, neutral and/or negative UV has also been associated with the development of UIS; therefore, other risk factors may be involved. The purpose of this study was to compare radiological bone morphology in patients with UIS and asymptomatic controls. Methods: Between 2009 and 2018, posteroanterior wrist radiographs of 47 wrists in 45 patients diagnosed with UIS were compared with those of 163 wrists in 93 asymptomatic patients from the control group. The following parameters were obtained: ulnar variance (UV); ulnar head top-fovea distance (UTFD); capitate-triquetrum distance (CTD); radio-lunate distance (RLD) and lunate coverage ratio (LCR). The morphology of the lunate was classified based on the absence (type I) or presence (type II) of a medial facet that articulates with the hamate. The radiographic parameters and lunate types were compared between the two groups. We then divided the groups into two subgroups: the positive UV subgroup and the neutral/negative UV subgroup. In each subgroup, the radiographic parameters and lunate types were compared between the UIS and control groups. Results: In the UIS group, the UV and UTFD were significantly increased compared to those in the control group. The proportion of type II lunates was significantly higher in the UIS group than in the control group. In addition, the type II lunate was more common in the UIS group in both the positive UV and negative UV groups. Conclusions: Our study suggests that in addition to positive UV, ulnar head morphology with an increased UTFD and type II lunate morphology may be associated with the development of ulnar impaction syndrome. Level of Evidence: Level III (Diagnostic).
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Affiliation(s)
- Shuko Chinen
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Hirotaka Okubo
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Keiko Onaka
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Motoko Nakasone
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Masaki Kinjo
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Kotaro Nishida
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
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Abstract
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.
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Long-term outcome after arthroscopic debridement of Palmer type 2C central degenerative lesions of the triangular fibrocartilage complex. Arch Orthop Trauma Surg 2021; 141:1807-1814. [PMID: 33932158 DOI: 10.1007/s00402-021-03918-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 04/17/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose of this study was to report long-term objective and patient-reported outcome after arthroscopic debridement of central degenerative triangular fibrocartilage complex (TFCC) lesions. METHODS A total of 17 patients with central degenerative TFCC (Palmer type 2C) lesions and ulnar positive variance who were treated by arthroscopic debridement were retrospectively reviewed. Mean follow-up was 8.8 years. Assessment facilitating the Modified Mayo Wrist score (MMWS), the Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH score), recording of pain level and of patient satisfaction, and radiological examination were done. RESULTS Patients reached a pain level of 1.7 VAS, MMW score of 92, and DASH score of 22. No significant differences could be detected between the operated and the contralateral extremity regarding range of motion and grip strength for all patients. No perioperative complications occurred. CONCLUSION Arthroscopic debridement of central degenerative TFCC lesions is safe, reliable, and efficacious even for ulnar positive variance. LEVEL OF EVIDENCE Therapeutic IV.
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Kwon YW, Choi IC, Park JH, Nam JJ, Roh SH, Park JW. Influence of TFCC foveal tear on the location of lunate chondromalacia in ulnar impaction syndrome. Skeletal Radiol 2021; 50:1855-1861. [PMID: 33725169 DOI: 10.1007/s00256-021-03757-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/06/2021] [Accepted: 03/07/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this study was to identify the location of lunate chondromalacia and to compare the difference in location according to presence or absence of triangular fibrocartilage complex (TFCC) foveal tear, which induces distal radioulnar joint (DRUJ) instability. METHODS We performed a retrospective study of 97 patients (102 wrists) who were diagnosed with and treated for idiopathic ulnar impaction syndrome (UIS) between 2014 and 2018. Subjects were divided into two groups according to presence or absence of TFCC foveal tear with DRUJ instability. Group I had UIS without a TFCC foveal tear (52 wrists, mean age of 43.2 years), while Group II had UIS with a TFCC foveal tear (50 wrists, mean age of 45.3 years). There was no significant difference in age, sex, or duration of symptoms between the two groups. All patients underwent wrist MR Arthrography (MRA) in the same gantry, and all scanned coronal sections of the lunate were standardized into 10 slices, including the whole anteroposterior width of the lunate. Each slice was sequentially numbered from dorsal to volar side, and the location of chondromalacia was marked in each numbered section. Radiological parameters including ulnar variance and ulnolunate distance (ULD), which indicated the distance between the ulnar head and lunate, were measured in the wrist series. RESULTS The most frequent location of lunate chondromalacia was slightly to the volar side of the lunate in both groups. Group I showed a higher frequency of chondromalacia in the volar side of the lunate. In Group II, chondromalacia was identified with high frequency not only on the volar side of the lunate but also on the dorsal side. In other words, Group II showed broader chondromalacia in the lunate. There was no significant difference in ulnar variance (Group I, 3.19 ± 1.42 mm; Group II, 2.76 mm ± 1.67 mm) or ulnolunate distance (Group I, 1.66 ± 0.94 mm; Group II, 2.05 mm ± 0.87 mm). The average ULD decreased during radial deviation but increased during ulnar deviation. CONCLUSION This study showed that lunate chondromalacia associated with idiopathic ulnar impaction syndrome occurs more frequently on the volar side of the lunate. Also, TFCC foveal tear, which causes DRUJ instability, leads to broader lunate chondromalacia in idiopathic ulnar impaction syndrome. Therefore, further analysis of the pattern of lunate chondromalacia can provide a clue for DRUJ instability.
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Affiliation(s)
- Young Woo Kwon
- Department of Orthopaedic Surgery, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu, South Korea
| | - In Cheul Choi
- Department of Orthopaedic Surgery, College of Medicine, Korea University Anam Hospital, 73, Inchon-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Ji Hun Park
- Department of Orthopaedic Surgery, College of Medicine, Korea University Anam Hospital, 73, Inchon-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Jae Jun Nam
- Department of Orthopaedic Surgery, College of Medicine, Korea University Anam Hospital, 73, Inchon-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Sang-Hoon Roh
- Department of Orthopaedic Surgery, Nowon Eulji Medical Center, Seoul, South Korea
| | - Jong Woong Park
- Department of Orthopaedic Surgery, College of Medicine, Korea University Anam Hospital, 73, Inchon-ro, Seongbuk-gu, Seoul, 02841, South Korea.
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Roulet S, Gubbiotti L, Lakhal W, Chaves C, Marteau E, Laulan J, Bacle G. Ulna shortening osteotomy for ulnar impaction syndrome: Impact of distal radioulnar joint morphology on clinical outcome. Orthop Traumatol Surg Res 2021; 107:102970. [PMID: 34052512 DOI: 10.1016/j.otsr.2021.102970] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/02/2020] [Accepted: 09/14/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Treatment of ulnar impaction syndrome (UIS) is based on ulnocarpal decompression, which may be achieved by ulna shortening osteotomy. The aim is to restore zero or negative ulnar variance. Tolat et al. described 3 distal radioulnar joint (DRUJ) morphologic types: vertical, oblique and reverse. Joint type has been thought to influence the clinical result of shortening, especially in the reverse type. HYPOTHESIS DRUJ type does not influence clinical results in ulna shortening osteotomy. MATERIAL AND METHODS Twenty-nine wrists were operated on in 27 patients: 13 female, 14 male; mean age at surgery, 43 years (range, 18-72 years). In 20 cases, UIS was idiopathic and in 7 post-traumatic. Mean preoperative ulnar variance was 3.6mm (range, 2-18mm). The osteotomy was fixed by screwed plate. RESULTS Twenty-five patients (27 wrists) were assessed at a mean 64 months (range, 18 months to 13 years). There were no cases of infection or hematoma. DRUJ was type 1 (vertical) in 6 cases (22%), type 2 (oblique) in 14 (52%) and type 3 (reverse) in 7 (26%). Mean postoperative pain score on VAS was 0.7/10 (range, 0-4); 9 wrists remained painful. Mean Quick-DASH was 16.9 (range, 0-48) and mean PRWE 21.9 (range, 16.9-59). Thirteen patients were very satisfied, 11 satisfied, 1 moderately satisfied, and 2 dissatisfied. Mean postoperative ulnar variance was -0.1mm (range, -4 to +8mm). Three wrists developed osteoarthritis, all following traumatic UIS. There were no significant correlations between DRUJ type and other clinical or radiological parameters. DISCUSSION Ulna shortening osteotomy has proven efficacy in UIS. The literature reports excellent or good results in 75% of cases. In the present study, 96% of patients considered themselves cured or improved by surgery, and none reported worsening. Ulna shortening osteotomy can be used in all 3 DRUJ types; DRUJ coronal morphology does not impact clinical result. LEVEL OF EVIDENCE IV-retrospective study.
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Affiliation(s)
- Steven Roulet
- Département de chirurgie orthopédique, chirurgie de la main et des nerfs périphériques-centre Hospitalo-Universitaire Tours-université de médecine de Tours François Rabelais, Avenue de la République, 37000 Tours, France.
| | - Laura Gubbiotti
- Département de chirurgie orthopédique, chirurgie de la main et des nerfs périphériques-centre Hospitalo-Universitaire Tours-université de médecine de Tours François Rabelais, Avenue de la République, 37000 Tours, France
| | - Walid Lakhal
- Département de chirurgie orthopédique, chirurgie de la main et des nerfs périphériques-centre Hospitalo-Universitaire Tours-université de médecine de Tours François Rabelais, Avenue de la République, 37000 Tours, France
| | - Camilo Chaves
- Département de chirurgie orthopédique, chirurgie de la main et des nerfs périphériques-centre Hospitalo-Universitaire Tours-université de médecine de Tours François Rabelais, Avenue de la République, 37000 Tours, France
| | - Emilie Marteau
- Département de chirurgie orthopédique, chirurgie de la main et des nerfs périphériques-centre Hospitalo-Universitaire Tours-université de médecine de Tours François Rabelais, Avenue de la République, 37000 Tours, France
| | - Jacky Laulan
- Département de chirurgie orthopédique, chirurgie de la main et des nerfs périphériques-centre Hospitalo-Universitaire Tours-université de médecine de Tours François Rabelais, Avenue de la République, 37000 Tours, France
| | - Guillaume Bacle
- Département de chirurgie orthopédique, chirurgie de la main et des nerfs périphériques-centre Hospitalo-Universitaire Tours-université de médecine de Tours François Rabelais, Avenue de la République, 37000 Tours, France
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16
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Ou Yang O, McCombe DB, Keating C, Maloney PP, Berger AC, Tham SKY. Ulnar-sided wrist pain: a prospective analysis of diagnostic clinical tests. ANZ J Surg 2021; 91:2159-2162. [PMID: 34459533 DOI: 10.1111/ans.17169] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 07/15/2021] [Accepted: 07/23/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Identifying the cause of pain on the ulnar side of the wrist can be challenging. The outcome and recovery following surgery can be unpredictable. The aim of this study was to document and analyse the clinical tests used to evaluate the cause of ulnar-sided wrist pain and determine their diagnostic relevance. METHODS This is a prospective evaluation of 110 patients who presented with pain on the ulnar side of the wrist. The clinical evaluation and results from radiological investigations were documented and analysed. RESULTS There were 17 different diagnoses. Eighty-five percent of the diagnoses were triangular fibrocartilage complex (TFCC) injuries, ulnocarpal abutment syndrome (UCAS), pisotriquetral arthritis (PTA), triquetral fracture or non-union, distal radioulnar joint arthritis (DRUJ OA) and extensor carpi ulnaris (ECU) pathology. The ulnocarpal stress test and ulnar foveal sign were positive in several diagnoses. The ulnar foveal sign had a sensitivity and specificity of 89% and 48% for TFCC injuries, and 85% and 37% for UCAS, respectively. The sensitivity and specificity of pisotriquetral shear test for PTA was 100% and 92%, respectively. Patients with PTA or ECU pathology localised their pain better on the patient's pain localisation chart. CONCLUSION Diagnosis of TFCC injuries, UCAS, DRUJ OA and ECU injuries are challenging as the clinical symptoms and signs for the four diagnoses were similar and required either magnetic resonance imaging or computed tomography for diagnostic confirmation after clinical examination. The ulnocarpal stress test and the ulnar foveal sign were not sufficiently specific.
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Affiliation(s)
- Owen Ou Yang
- Victorian Hand Surgery Associates, Fitzroy, Victoria, Australia.,Department of Plastic and Hand Surgery, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - David B McCombe
- Victorian Hand Surgery Associates, Fitzroy, Victoria, Australia.,Department of Plastic and Hand Surgery, St Vincent's Hospital, Fitzroy, Victoria, Australia.,Hand and Wrist Biomechanics Laboratory, O'Brien Institute/St Vincent's Institute, Fitzroy, Victoria, Australia.,Department of Paediatrics, Royal Children's Hospital, University of Melbourne, Flemington, Victoria, Australia
| | - Cameron Keating
- Victorian Hand Surgery Associates, Fitzroy, Victoria, Australia
| | - Peter P Maloney
- Victorian Hand Surgery Associates, Fitzroy, Victoria, Australia.,Department of Plastic and Hand Surgery, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Anthony C Berger
- Victorian Hand Surgery Associates, Fitzroy, Victoria, Australia.,Department of Plastic and Hand Surgery, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Stephen K Y Tham
- Victorian Hand Surgery Associates, Fitzroy, Victoria, Australia.,Department of Plastic and Hand Surgery, St Vincent's Hospital, Fitzroy, Victoria, Australia.,Hand and Wrist Biomechanics Laboratory, O'Brien Institute/St Vincent's Institute, Fitzroy, Victoria, Australia
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17
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Samade R, Farrell N, Zaki O, Farrar N, Goyal KS. Outcomes following Distal Radius Fractures with Preexisting Ulnocarpal Abutment. J Wrist Surg 2021; 10:329-334. [PMID: 34381637 PMCID: PMC8328551 DOI: 10.1055/s-0041-1726294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 02/03/2021] [Indexed: 10/21/2022]
Abstract
Background Due to the commonality of distal radius fractures (DRFs), the potential impact of ulnocarpal abutment (UA) on patient outcomes is significant, whether it developed after or prior to injury. It is, therefore, important to consider whether preexisting UA has any impact on outcomes after an acute DRF. Questions/Purpose The aims of this study were to determine if differences were present in (1) pain at final follow-up, (2) complications, and (3) unintended operations in patients with DRFs and either without or with preexisting radiographic UA. Methods A single institution retrospective cohort study comparing patients treated either nonoperatively (43 patients) or operatively (473 patients) for DRFs between 5/1/2008 to 5/1/2018 was performed. Data included demographics, prior wrist pain or surgery, ulnar variance, select treatment data, and presence of pain, complication, or unintended operation by final follow-up. Statistical testing used Fisher's exact test and chi-squared test, with a significance level of 0.05. Results The prevalence of preexisting UA was 14.0 and 15.6% in the nonoperatively- and operatively treated groups, respectively. In nonoperatively treated patients without or with UA, no differences in pain (37.8 vs. 33.3%, p = 1.00) or complications were seen (13.5 vs. 50.0%, p = 0.07). A higher unintended operation rate for nonoperatively treated DRFs with UA, compared with those without, UA was seen (5.4 vs. 50.0%, p = 0.01). No differences in pain, complications, or unintended operations were seen between those without and with UA in the operatively treated group. Conclusion Preexisting UA is not associated with pain, complications, or unintended operations after operative treatment of DRFs. Prospective studies further evaluating outcomes in nonoperatively treated DRFs with UA may be beneficial.
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Affiliation(s)
- Richard Samade
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Nolan Farrell
- College of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Omar Zaki
- College of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Nicholas Farrar
- College of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Kanu S. Goyal
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
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18
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Open and Arthroscopic Triangular Fibrocartilage Complex (TFCC) Repair. J Am Acad Orthop Surg 2021; 29:518-525. [PMID: 34078841 DOI: 10.5435/jaaos-d-20-00998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 01/25/2021] [Indexed: 02/01/2023] Open
Abstract
Triangular fibrocartilage complex (TFCC) tears, whether acute or chronic, can result in persistent ulnar-sided wrist pain. Although diagnosis and nonsurgical management of TFCC tears is well described, there remains ongoing discussion about the optimal surgical technique, specifically open or arthroscopic. This article reviews the most up-to-date literature regarding TFCC injury including demographics, risk factors for TFCC injury, classification of acute and chronic TFCC tears, history and physical examination, appropriate diagnostic imaging, surgical indications, pertinent surgical anatomy, open and arthroscopic TFCC repair, fixation biomechanics and techniques, postoperative rehabilitation, and clinical outcomes.
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19
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[What does the hand surgeon expect from the radiologist in diagnostic imaging of the hand?]. Radiologe 2021; 61:335-342. [PMID: 33659998 DOI: 10.1007/s00117-021-00827-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND For hand surgeons, in addition to anamnesis and clinical examination, imaging is the essential component in diagnostics and the basis for therapy planning. The focus on the special field of the "hand" and the adjacent joints is limited with regard to the anatomical extent, but with regard to the possible clinical pictures it encompasses the entire range of pathological changes. CLINICAL ISSUE Which imaging techniques support the goal of maintaining the functionality of the hand? PERFORMANCE The carpal bones can be represented by computer tomography without superimposition. The navicular (scaphoid) should be evaluated sagittally in its longitudinal axis. MRI imaging is useful, for example, when assessing possible ligament injuries or ulnar-carpal complaints on the triangular disc. Stress images prove additional information in the case of of dynamic ligament or joint instabilities. ACHIEVEMENTS Imaging with conventional X‑rays is the basis of radiological diagnostics of the hand. In addition, the small structures of the hand and fingers to be assessed must be specifically visualized. PRACTICAL RECOMMENDATION In order to enable precise assessment of the fine and complex structures on the hand in relation to the clinical complaints, close communication of the anamnesis and questions with the radiologist is desirable.
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20
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Yamazaki T, Matsuura Y, Nimura A, Horiuchi S, Suzuki T, Ohtori S. Prediction of Stress Distribution Applied to the Triangular Fibrocartilage Complex: A Finite Element Analysis. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2021; 3:94-98. [PMID: 35415536 PMCID: PMC8991935 DOI: 10.1016/j.jhsg.2020.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 12/08/2020] [Indexed: 11/15/2022] Open
Abstract
Purpose The triangular fibrocartilage complex (TFCC) is an important tissue stabilizer for the distal radioulnar joint, but stress distribution on the TFCC is not clear. The purpose of this study was to report the stress distribution of the TFCC using finite element analysis (FEA). Methods Pathological specimens of the wrist joint from an 80-year-old man were imported into a finite element analysis software package, and regions of interest including bone, soft tissue, and TFCC were extracted to create a 3-dimensional model. The material properties were obtained from previous research using cadaver specimens. To allow large deformations, we used hyperelastic elements to model the TFCC and soft tissue. Bone was defined as a uniform tissue that did not break. With the carpals and radius constrained, the rotation axis was set at the center of the ulnar head and a force was applied to move the ulnar head in pronation and supination. Under these boundary conditions, the behavior of the TFCC was extracted as a moving image. The average value of the maximum principal stress for each component of the TFCC was extracted and graphed. Results In the supinated position, the maximum principal stress was found on the palmar side of the TFCC (eg, on the tension side). In pronation, the maximum principal stress was found on the dorsal side. Conclusions This study clearly showed the 3-dimensional structure of the TFCC and analyzed its stress distribution under load. In supination, mean values of the maximum principal stress were greater on the palmar fibers than the dorsal fibers. In pronation, mean maximum principal stress was greater on the dorsal fibers than the palmar fibers. Clinical relevance Knowing the distribution of stresses in the TFCC is an important factor in developing treatment strategies for a pathologic TFCC.
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Affiliation(s)
- Takahiro Yamazaki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yusuke Matsuura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Akimoto Nimura
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Saya Horiuchi
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takane Suzuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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21
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Affiliation(s)
- David M Brogan
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Richard A Berger
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Sanjeev Kakar
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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22
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Serfaty A, Costa HP, Foelker CE, Filho ENK, Souza FF, Bordalo-Rodrigues M. Evaluation of ulnar variance on wrist MR imaging: is it a reliable measure? Skeletal Radiol 2020; 49:723-730. [PMID: 31807873 DOI: 10.1007/s00256-019-03339-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 10/25/2019] [Accepted: 11/04/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine if ulnar variance can be evaluated by magnetic resonance (MR) imaging and if this measure can be used as a reliable indicator when correlated to the gold standard technique, conventional radiography (CR). MATERIALS AND METHODS From January to July 2018, the MR images of 64 participants, comprising 66 wrists (mean age 34.9 years; 33 females; 31 males), were obtained. Among those, 29 were referred for evaluation of the wrist for different medical reasons and 35 were asymptomatic volunteers from our radiology group. All subjects had a plain radiography of the wrist in a posteroanterior view with a mean interval between images of 1 day. Local ethics committee approved the study and written informed consent was obtained from all patients. Two musculoskeletal radiologists evaluated the images. Correlation coefficients and a linear regression model were used for statistical analyses. RESULTS Intra- and inter-observer analyses were performed for both diagnostic methods with results showing concordance (intra-observer: kappa score: MR 0.915/CR 0.931; p < 0.05; inter-observer: kappa score: MR 0.857/CR 0.931; p < 0.05). The intraclass correlations of MR and CR to evaluate agreement between the radiologists was slightly higher for radiologist #1 (0.771) than for radiologist #2 (0.659). A linear regression model showed good model fit indicating that MR does correlate with the ulnar variance as measured by CR (CR = 0.554 + 0.897 × MR, R2 = 0.665). CONCLUSION Although CR is the gold standard method for the evaluation of ulnar variance, our study demonstrated that MR can be used as a reliable qualitative option.
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Affiliation(s)
- Aline Serfaty
- Department of Radiology, Faculty of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil. .,Medscanlagos Radiology, rua Manoel Francisco Valentim, 57, Cabo Frio, RJ, 28906220, Brazil.
| | - Hugo Pereira Costa
- Radiology Institute (INRAD), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC/FMUSP), São Paulo, SP, Brazil
| | - Conrado Eduardo Foelker
- Radiology Institute (INRAD), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC/FMUSP), São Paulo, SP, Brazil
| | - Eduardo Noda Kihara Filho
- Radiology Institute (INRAD), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC/FMUSP), São Paulo, SP, Brazil
| | - Felipe Ferreira Souza
- Radiology Institute (INRAD), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC/FMUSP), São Paulo, SP, Brazil
| | - Marcelo Bordalo-Rodrigues
- Radiology Institute (INRAD), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC/FMUSP), São Paulo, SP, Brazil
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23
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Cardoso ANP, Viegas R, Gamelas P, Falcão P, Baptista C, Silva FS. Ulnar Shortening Osteotomy: Our Experience. Rev Bras Ortop 2020; 55:612-619. [PMID: 33093726 PMCID: PMC7575385 DOI: 10.1055/s-0040-1702959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 11/29/2019] [Indexed: 11/02/2022] Open
Abstract
Objective The objective of the present study was to evaluate the clinical and radiographic results of our series regarding ulnar shortening osteotomy, as well as to briefly review the pathology, indications and surgical options of ulnocarpal conflict. Methods We performed a retrospective analysis of consecutive patients who were treated with ulnar shortening osteotomy between January 2012 and June 2017 at our hospital. We clinically evaluated pain, articular range of motion, grip strength and functional outcomes using the quick-DASH questionnaire. We radiographically measured the pre- and postoperative ulnar variance and the shortening performed. Results We identified eight operated patients, and it was possible to evaluate seven of them. Pain decreased in this population (visual analogue scale [VAS] score changed from 7 to 2.6, p < 0.05), there was a decrease in quick-DASH (64 to 28, p < 0.05) and we found a decrease in the articular amplitude ∼ 7° for flexion ( p = 0.2), and of 5.5° for supination ( p = 0.3), as well as decreasing grip strength to about 86% on the contralateral side ( p = 0.07). The ulnar variance changed from a mean of + 5.5 mm to - 1.1 mm ( p < 0.05). Two out of 8 patients (25%) presented plaque-related symptoms and one of them underwent a new intervention to extract the material. Conclusions Ulnar shortening osteotomy is an effective surgical procedure both in the treatment of ulnocarpal conflict and in the discharge of the ulna. The results presented agreement with other results published in the literature, with good clinical and radiographic results.
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Affiliation(s)
| | - Rui Viegas
- Departamento de Ortopedia e Traumatologia, Hospital Beatriz Ângelo, Loures, Portugal
| | - Patrícia Gamelas
- Departamento de Ortopedia e Traumatologia, Hospital Beatriz Ângelo, Loures, Portugal
| | - Pedro Falcão
- Departamento de Ortopedia e Traumatologia, Hospital Beatriz Ângelo, Loures, Portugal
| | - Carolina Baptista
- Departamento de Ortopedia e Traumatologia, Hospital Beatriz Ângelo, Loures, Portugal
| | - Filipa Santos Silva
- Departamento de Ortopedia e Traumatologia, Hospital Beatriz Ângelo, Loures, Portugal
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Abstract
Ulnar abutment (ulnocarpal impaction) syndrome may be a source of ulnar-sided wrist pain in the athlete. This condition results from excessive load transfer across the triangular fibrocartilage complex and ulnocarpal joints with characteristic degenerative changes. It frequently occurs in patients with either static or dynamic ulnar positive variance. Treatment is tailored to the athlete and their sporting demands. Surgical treatment focuses on addressing ulnar variance to unload the ulnocarpal joint, with multiple surgical options, including the metaphyseal closing wedge osteotomy achieving this goal. This review focuses on the presentation, biomechanics, and treatment options for ulnar abutment syndrome in the athlete.
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Affiliation(s)
- Thomas R Acott
- The Core Institute, 9321 W Thomas Road, Suite 205, Phoenix, AZ 85037
| | - Jeffrey A Greenberg
- Indiana Hand to Shoulder Center, 8501 Harcourt Road, Indianapolis, IN 46260, USA.
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Moser TP, Martinez AP, Andoulsi S, Jeantroux J, Cardinal É. Radiographic/MR Imaging Correlation of the Wrist. Magn Reson Imaging Clin N Am 2019; 27:601-623. [PMID: 31575396 DOI: 10.1016/j.mric.2019.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In this review article, the authors discuss the imaging features of the most common pathologic conditions of the wrist by putting the emphasis on radiographic and MR imaging correlations. A topographic approach based on the 3 functional columns of the wrist (radial, central, and ulnar) serves as a framework. The pathologic conditions are classified, based on the structures involved, as fractures, ligament injuries, arthropathies, bone abnormalities, and tendinopathies. The authors describe and evaluate classic radiographic signs and explain how they correlate with MR imaging. The advantages and limitations of each technique are thoroughly discussed as well as other imaging modalities.
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Affiliation(s)
- Thomas P Moser
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, 1000, rue Saint-Denis, Montréal, Québec H2X 0C1, Canada.
| | - Adriana P Martinez
- Department of Orthopedic Surgery, University of Ottawa, The Ottawa Hospital Civic Campus, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada
| | - Sooheib Andoulsi
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, 1000, rue Saint-Denis, Montréal, Québec H2X 0C1, Canada
| | - Jérémy Jeantroux
- Service d'Imagerie Médicale, Clinique St-François, 1-5, rue Colomé, Haguenau 67502, France
| | - Étienne Cardinal
- Medvue, 5811 Côte-des-Neiges Road, Montreal, Québec H3S 1Z2, Canada
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Isa AD, Mcgregor ME, Padmore CE, Langohr DG, Johnson JA, King GJW, Suh N. An In Vitro Study to Determine the Effect of Ulnar Shortening on Distal Forearm Loading During Wrist and Forearm Motion: Implications in the Treatment of Ulnocarpal Impaction. J Hand Surg Am 2019; 44:669-679. [PMID: 31171375 DOI: 10.1016/j.jhsa.2019.04.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 02/12/2019] [Accepted: 04/05/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the effect of ulnar shortening on distal forearm loading following simulated dynamic motion. METHODS Ulnar shortening was simulated using a custom-built adjustable implant to simulate up to 4 mm of ulnar shortening (-4 mm) in 9 cadaveric extremities. Load cells were placed in the distal ulna and radius to quantify axial loading. Using a wrist and forearm motion simulator, absolute and percentage loads were measured during dynamic flexion, ulnar deviation (UD), flexion dart throw (DT), and pronation. RESULTS There was a significant decrease in absolute and percentage distal ulnar loads at each interval of ulnar shortening during flexion, UD, DT, and pronation. The distal ulna bore no compressive loads, and in fact, tensile loads were measured in the ulna at 2 mm of ulnar shortening during DT and pronation, at 3 mm during flexion, and at 4 mm during UD. CONCLUSIONS A progressive decrease in distal ulnar loads with generation of tensile loads was observed with sequential ulnar shortening. CLINICAL RELEVANCE Ulnar shortening greater than 2 mm can result in tensile loading in the distal ulna. When managing ulnar impaction syndrome, excessive shortening may not be required to provide relief of symptoms.
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Affiliation(s)
| | | | | | | | - James A Johnson
- University of Western Ontario, London, Ontario, Canada; Roth McFarlane Hand & Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada
| | - Graham J W King
- University of Western Ontario, London, Ontario, Canada; Roth McFarlane Hand & Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada
| | - Nina Suh
- University of Western Ontario, London, Ontario, Canada; Roth McFarlane Hand & Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada.
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27
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Farr S. Commentary on Trehan et al. Arthroscopic treatment of triangular fibrocartilage complex injuries in paediatric and adolescent patients. J Hand Surg Eur Vol 2019; 44:587-588. [PMID: 31210601 DOI: 10.1177/1753193419828925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Sebastian Farr
- Department of Pediatric Orthopaedics and Adult Foot and Ankle Surgery, Orthopaedic Hospital Speising, Vienna, Austria
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28
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Terzis A, Neubrech F, Sebald J, Sauerbier M. [Surgical treatment of ulnar impaction syndrome : Ulnar shortening osteotomy through the ulnopalmar approach using a low-profile, locking plate]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2019; 31:547-556. [PMID: 31172214 DOI: 10.1007/s00064-019-0613-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 05/30/2018] [Accepted: 06/08/2018] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Extra-articular shortening of the distal ulna in order to decompress the ulnocarpal joint. INDICATIONS Congenital or posttraumatic, symptomatic ulnar impaction syndrome. CONTRAINDICATIONS Osteoarthritis or deformation of the distal radioulnar joint. SURGICAL TECHNIQUE Exactly defined oblique osteotomy in the distal third of the ulna using the saw guide, closing of the osteotomy gap using the compression spindle, osteosynthesis with the locking plate. POSTOPERATIVE MANAGEMENT Palmar forearm thermoplastic cast or splint for 3 weeks, load bearing after bony union. RESULTS Between June 2016 and March 2018 ulnar shortening was performed in 17 patients using the new locking plate. In all, 15 patients were reevaluated with complete follow-up data. Postoperatively patients experienced significant pain reduction (Visual Analog Scale 0-10) by 65% (7 before and 2.5 after surgery; p < 0.05) and a significant improvement of function (Disabilities of Arm, Shoulder and Hand 0-100) by 49% (47 before and 24 after surgery; p < 0.05). Bony union was observed in all patients after a mean time of 4 months. Overall patient satisfaction was high.
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Affiliation(s)
- A Terzis
- Abteilung für Plastische, Hand- und Rekonstruktive Chirurgie, BG Unfallklinik Frankfurt am Main, Akademisches Lehrkrankenhaus, Goethe-Universität Frankfurt am Main, Friedberger Landestr. 430, 60389, Frankfurt am Main, Deutschland.
| | - F Neubrech
- Abteilung für Plastische, Hand- und Rekonstruktive Chirurgie, BG Unfallklinik Frankfurt am Main, Akademisches Lehrkrankenhaus, Goethe-Universität Frankfurt am Main, Friedberger Landestr. 430, 60389, Frankfurt am Main, Deutschland
| | - J Sebald
- Abteilung für Plastische, Hand- und Rekonstruktive Chirurgie, BG Unfallklinik Frankfurt am Main, Akademisches Lehrkrankenhaus, Goethe-Universität Frankfurt am Main, Friedberger Landestr. 430, 60389, Frankfurt am Main, Deutschland
| | - M Sauerbier
- Abteilung für Plastische, Hand- und Rekonstruktive Chirurgie, BG Unfallklinik Frankfurt am Main, Akademisches Lehrkrankenhaus, Goethe-Universität Frankfurt am Main, Friedberger Landestr. 430, 60389, Frankfurt am Main, Deutschland
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Kim J, Cho J, Lee YH, Oh S, Gong HS, Baek GH. Distal radioulnar joint configurations in three-dimensional computed tomography in patients with idiopathic ulnar impaction syndrome. J Hand Surg Eur Vol 2019; 44:488-495. [PMID: 30799668 DOI: 10.1177/1753193419828330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
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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Affiliation(s)
- Jihyeung Kim
- Department of Orthopaedic Surgery, Seoul National University, College of Medicine Jongno-gu, Seoul, Republic of Korea
| | - Jaewoo Cho
- Department of Orthopaedic Surgery, Seoul National University, College of Medicine Jongno-gu, Seoul, Republic of Korea
| | - Yo-Han Lee
- Department of Orthopaedic Surgery, Seoul National University, College of Medicine Jongno-gu, Seoul, Republic of Korea
| | - Sohee Oh
- Department of Orthopaedic Surgery, Seoul National University, College of Medicine Jongno-gu, Seoul, Republic of Korea
| | - Hyun Sik Gong
- Department of Orthopaedic Surgery, Seoul National University, College of Medicine Jongno-gu, Seoul, Republic of Korea
| | - Goo Hyun Baek
- Department of Orthopaedic Surgery, Seoul National University, College of Medicine Jongno-gu, Seoul, Republic of Korea
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Mwaturura T, Daneshvar P, Pike J, Goetz TJ. Clinical and Radiographic Correlates for the Treatment of Ulnocarpal Impaction. J Wrist Surg 2019; 8:192-197. [PMID: 31192039 PMCID: PMC6546495 DOI: 10.1055/s-0038-1677534] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 12/03/2018] [Indexed: 10/27/2022]
Abstract
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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Affiliation(s)
- Tendai Mwaturura
- Department of Orthopaedic Surgery, University of British Columbia, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Parham Daneshvar
- Department of Orthopaedic Surgery, University of British Columbia, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Jeffrey Pike
- Department of Orthopaedic Surgery, University of British Columbia, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Thomas Joseph Goetz
- Department of Orthopaedic Surgery, University of British Columbia, St Paul's Hospital, Vancouver, British Columbia, Canada
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Shin SH, Lee YS, Choi KY, Kwak DS, Chung YG. During forearm rotation the three-dimensional ulnolunate distance is affected more by translation of the ulnar head than change in ulnar variance. J Hand Surg Eur Vol 2019; 44:517-523. [PMID: 30176749 DOI: 10.1177/1753193418795638] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Ulnolunate abutment has been thought to be aggravated by pronation because of an increase in ulnar variance. We hypothesized that the ulnolunate distance might be greater in pronation because the ulnar head is dorsally translated. Twenty-one three-dimensional reconstructions of computed tomographic scans of wrists taken in supination and pronation were investigated. The ulnolunate distance was measured in each position, and the change in ulnolunate distance from supination to pronation was calculated. The changes in ulnar variance from supination to pronation and the amount of translation of the ulnar head were measured directly by superimposing three-dimensional reconstructions. The mean ulnolunate distance in pronation was significantly greater than in supination. There was no significant correlation between the changes in ulnolunate distance and in the ulnar variance. The change in ulnolunate distance had a significant positive linear relationship with the amount of translation of the ulnar head. The change in ulnolunate distance during forearm rotation is determined by the amount of translation of the ulnar head rather than by change in ulnar variance. Level of evidence: IV.
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Affiliation(s)
- Seung-Han Shin
- 1 Department of Orthopedic Surgery, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong-Suk Lee
- 1 Department of Orthopedic Surgery, The Catholic University of Korea, Seoul, Republic of Korea
| | - Keun-Young Choi
- 1 Department of Orthopedic Surgery, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dai-Soon Kwak
- 2 Catholic Institute for Applied Anatomy/Department of Anatomy, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yang-Guk Chung
- 1 Department of Orthopedic Surgery, The Catholic University of Korea, Seoul, Republic of Korea
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Masouros PT, Apergis EP, Babis GC, Pernientakis SS, Igoumenou VG, Mavrogenis AF, Nikolaou VS. Essex-Lopresti injuries: an update. EFORT Open Rev 2019; 4:143-150. [PMID: 31057951 PMCID: PMC6491950 DOI: 10.1302/2058-5241.4.180072] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Reconstruction of the central band of the interosseous membrane is an emerging procedure implemented in the treatment of longitudinal radioulnar dissociation (LRUD), usually in its chronic setting, after Essex-Lopresti injuries of the forearm. There are no sufficient clinical data to support reconstruction of the central band of the interosseous membrane in acute LRUD injuries. Clinical and cadaveric studies comparing autografts (palmaris longus, flexor carpi radialis and bone-patellar-bone), allografts (Achilles tendon) and synthetic ligaments have not shown superiority of one technique versus another; however, they have shown special concerns with respect to the use of synthetic grafts. Latrogenic fracture, decrease of rotational range of movement, iatrogenic nerve injury (superficial radial and median nerve), donor site morbidity with autografts and recurrent instability are the complications reported in literature after interosseous membrane reconstruction.
Cite this article: EFORT Open Rev 2019;4:143-150. DOI: 10.1302/2058-5241.4.180072
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Affiliation(s)
| | | | - George C Babis
- Second Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | | | - Vasilios G Igoumenou
- First Department of Orthopaedics, National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasileios S Nikolaou
- Second Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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Dunn J, Polmear M, Daniels C, Shin E, Nesti L. Arthroscopically Assisted Transosseous Triangular Fibrocartilage Complex Foveal Tear Repair in the United States Military. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2019. [DOI: 10.1016/j.jhsg.2019.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Outcomes of Operative Treatment of Triangular Fibrocartilage Tears in Pediatric and Adolescent Athletes. J Pediatr Orthop 2018; 38:e618-e622. [PMID: 30134350 DOI: 10.1097/bpo.0000000000001243] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Triangular fibrocartilage complex (TFCC) tears have been treated with increasing frequency in pediatric and adolescent patients over the past decade. There is little information on these injuries in young athletes and a scarcity of data regarding their ability to return to preinjury levels of athletic participation. The purpose of this study was to review the outcomes of pediatric and adolescent athletes with operatively treated TFCC tears with or without a concurrent ulnar shortening osteotomy and to determine their ability to return to their preoperative level of activity. METHODS A retrospective chart review was performed for all patients who underwent operative treatment of TFCC tears between 2006 and 2012 within one Upper Extremity practice. Patients were included if they were high-level athletes, unable to participate in their sport secondary to wrist pain and desired to return to their sport. All operative patients had imaging studies and clinical findings consistent with TFCC injury as the primary source of their activity-limiting pain and had failed nonoperative management prior to surgery. Patients without at least 3 months of documented postoperative follow up were excluded. RESULTS In total, 22 patients were included in the chart review with 20 patients willing to participate in a telephone survey and PODCI. Eighty percent of patients returned to their sport following operative treatment of their injury at an average of 4.8 months. Seven of the 22 patients underwent a concurrent ulnar shortening osteotomy for ulnar positive variance. All 20 patients reported satisfaction with the outcomes of their surgery and treatment. CONCLUSIONS Operative treatment of TFCC injuries in adolescent and pediatric athletes after failure of conservative treatment allowed return to sport at the previous level of participation. Concurrent ulnar shortening osteotomy in the setting of ulnar positive variance did not prohibit return to high-level athletic participation. LEVEL OF EVIDENCE Level IV.
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Zhu AF, Burns G, Siljander B, Waljee JF, Ozer K. The Role of Triangular Fibrocartilage Complex in Axial Stability of the Forearm. J Wrist Surg 2018; 7:404-408. [PMID: 30349754 PMCID: PMC6196086 DOI: 10.1055/s-0038-1666977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 06/04/2018] [Indexed: 10/28/2022]
Abstract
Background The triangular fibrocartilage complex (TFCC) provides stability to the wrist and disruption of this complex can result in axial instability which can lead to ulnocarpal abutment. Purpose This article determines the individual contributions of the volar radioulnar ligament (VRUL), dorsal radioulnar ligament (DRUL), and foveal attachment of the TFCC to longitudinal stability of the forearm under axial load. Materials and Methods Eighteen cadaveric specimens were randomly assigned into three groups representing the component of the TFCC to be initially transected: VRUL, DRUL, and foveal attachment. Prior to transection, posterioranterior radiographs of the wrist were obtained at 0, 44.5, and 90 N of axial load. Serial transection of the TFCC components were performed with radiographs obtained at each of the aforementioned loads. Ulnar variance was assessed with two-way repeated measures analysis of variance and paired t -tests. Results Transection of the foveal attachment demonstrated a significant change in ulnar variance of 1.5 and 0.6 mm under 45 and 90 N of load, respectively. At 0 N of load, there was no significant change in ulnar variance between an intact wrist and a wrist with all three ligaments transected; however, a significant change in ulnar variance, 1.0 mm, was observed under 90 N of load. Conclusion The foveal attachment of the TFCC provides the largest contribution to axial stability. Clinical Relevance The TFCC provides axial stability to the wrist and disruption of the TFCC may result in change in ulnar variance observed on an axial loaded wrist radiograph.
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Affiliation(s)
- Andy F. Zhu
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Geoffrey Burns
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Breana Siljander
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | | | - Kagan Ozer
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
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The Parallelogram Effect: The Association Between Central Band and Positive Ulnar Variance. J Hand Surg Am 2018; 43:827-832. [PMID: 29804695 DOI: 10.1016/j.jhsa.2018.03.058] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 02/14/2018] [Accepted: 03/30/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE Ulnar impaction syndrome is a poorly understood degenerative wrist condition characterized by symptoms of pain thought to be caused by increased loads between the ulnar head and the carpals. Radiographic evaluation often reveals an ulnar-positive wrist. We hypothesize that progressive elongation of the central band of the forearm interosseous ligaments changes the longitudinal radial-ulnar relationships, resulting in an ulnar-positive wrist. The objective of the study was to identify a relationship between the loss of integrity of the forearm interosseous ligaments and increased ulnar variance. METHODS Six cadaveric human forearms were used to measure displacement of the radius relative to the ulna during axial loading of the lunate fossa of the radius. Radial heights were measured in supination and pronation under a 5-lbF (22-N) preload. Gradual axial loads were applied up to 50 lbF (222N); the resultant axial displacement was measured in supination and pronation. All measurements were evaluated with the interosseous ligament intact and repeated with the central band cut. RESULTS With an applied 5-lbF preload, cutting the central band increased ulnar variance by 3.02 ± 0.80 mm in supination and by 2.15 ± 0.79 mm in pronation. In supination, when the loads were increased from the 5-lbF preload to 50 lbF, the radius displaced 2.1 times further after the central band was cut (3.00 mm) compared with the group with the intact forearm construct (1.41 mm). In pronation, when the loads were increased from the 5-lbF preload to 50 lbF, the radius displaced 1.8 times further when the central band was cut (2.84 mm) than with the intact forearm construct (1.57 mm). CONCLUSIONS Because of a parallelogram effect, the radius shifted proximally under a 5-lbF preload, creating an ulnar-positive wrist relationship. Dynamic loading of the forearm after ligament excision resulted in significant additional radial displacement relative to the intact forearm. CLINICAL RELEVANCE Deficiency in the ligamentous restraints of the central band leads to positive ulnar variance, which could be a factor (among others) that contributes to idiopathic ulnar impaction syndrome.
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Shin SH, Lee YS, Kang JW, Noh DY, Jung JY, Chung YG. Where Is the Ulnar Styloid Process? Identification of the Absolute Location of the Ulnar Styloid Process Based on CT and Verification of Neutral Forearm Rotation on Lateral Radiographs of the Wrist. Clin Orthop Surg 2018; 10:80-88. [PMID: 29564051 PMCID: PMC5851858 DOI: 10.4055/cios.2018.10.1.80] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 10/22/2017] [Indexed: 11/16/2022] Open
Abstract
Background The location of the ulnar styloid process can be confusing because the radius and the hand rotate around the ulna. The purpose of this study was to identify the absolute location of the ulnar styloid process, which is independent of forearm pronation or supination, to use it as a reference for neutral forearm rotation on lateral radiographs of the wrist. Methods Computed tomography (CT) images of 23 forearms taken with elbow flexion of 70° to 90° were analyzed. The axial CT images were reconstructed to be perpendicular to the distal ulnar shaft. The absolute location of the ulnar styloid process in this study was defined as the position of the ulnar styloid process on the axial plane of the ulnar head relative to the long axis of the humeral shaft with the elbow set in the position for standard lateral radiographs of the wrist. To identify in which direction the ulnar styloid is located on the axial plane of the ulnar head, the angle between “the line of humeral long axis projected on the axial plane of the ulna” and “the line passing the center of the ulnar head and the center of the ulnar styloid” was measured (ulnar styloid direction angle). To identify how volarly or dorsally the ulnar styloid should appear on the true lateral view of the wrist, the ratio of “the volar-dorsal diameter of the ulnar head” and “the distance between the volar-most aspect of the ulnar head and the center of the ulnar styloid” was calculated (ulnar styloid location ratio). Results The mean ulnar styloid direction angle was 12° dorsally. The mean ulnar styloid location ratio was 1:0.55. Conclusions The ulnar styloid is located at nearly the ulnar-most (the opposite side of the humerus with the elbow flexed) and slightly dorsal aspects of the ulnar head on the axial plane. It should appear almost midway (55% dorsally) from the ulnar head on the standard lateral view of the wrist in neutral forearm rotation. These location references could help clinicians determine whether the forearm is in neutral or rotated position on an axial CT/magnetic resonance imaging scan or a lateral radiograph of the wrist.
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Affiliation(s)
- Seung-Han Shin
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong-Suk Lee
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin-Woo Kang
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong-Young Noh
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joon-Yong Jung
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yang-Guk Chung
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Editorial Commentary: Wrist Ulnar Impaction Syndrome: When I Use the Wafer Procedure and When I Do Not. Arthroscopy 2018; 34:431-432. [PMID: 29413189 DOI: 10.1016/j.arthro.2017.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 11/10/2017] [Accepted: 11/10/2017] [Indexed: 02/02/2023]
Abstract
Ulnar impaction syndrome is fundamentally a clinical diagnosis, which can be confirmed by magnetic resonance imaging. All palmer stages are amenable to surgical treatment with either arthroscopic wafer procedure (AWP) or ulnar shortening osteotomy, and neither the absence of a triangular fibrocartilage complex perforation nor neutral or negative variance contraindicate either. Because of its minimally invasive value proposition and likely success, there are few clinical scenarios for which I do not perform AWP preferentially. Furthermore, AWP is always preferable in smokers and in wrists in which a divergent orientation of the sigmoid notch and ulnar articular surfaces portend arthritic complication after ulnar shortening.
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Park JH, Jang WY, Kwak DH, Park JW. Lunate morphology as a risk factor of idiopathic ulnar impaction syndrome. Bone Joint J 2017; 99-B:1508-1514. [PMID: 29092991 DOI: 10.1302/0301-620x.99b11.bjj-2016-1238.r2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 05/15/2017] [Indexed: 02/06/2023]
Abstract
AIMS Positive ulnar variance is an established risk factor for idiopathic ulnar impaction syndrome (UIS). However, not all patients with positive ulnar variance develop symptomatic UIS and other factors, including the morphology of the lunate, may be involved. The aim of this study was to clarify the relationship between lunate morphology and idiopathic UIS. PATIENTS AND METHODS A cohort of 95 patients with idiopathic UIS (UIS group) was compared with 95 asymptomatic controls with positive ulnar variance. The shape of the lunate was measured using the capitate-triquetrum distance (CTD), ulnar coverage ratio (UCR), radiolunate distance and radiolunate angle. The association of radiographic parameters and lunate types with the development of UIS was investigated in univariable and multivariable analyses. Receiver operating characteristic curves were used to estimate a cutoff for any statistically significant variables. RESULTS The proportion of type II lunates, which have a medial hamate facet, were significantly higher in the UIS group than in the control group in the univariable analysis (p = 0.001). CTD (odds ratio (OR) 1.52; 95% confidence interval (CI) 1.11 to 2.06; p = 0.008) and UCR (OR 44.78; 95% CI 5.35 to 374.90; p = 0.002) showed a positive association with UIS in the multivariable analysis. Estimated cutoff values were 2.5 mm for the CTD (area under the curve (AUC) = 0.65) and 0.4 for the UCR (AUC = 0.64). CONCLUSION The proportion of type II lunates was greater in the UIS group than in the control group. A large UCR, which represents the broad base of the lunate, was positively associated with the development of idiopathic UIS. Cite this article: Bone Joint J 2017;99-B:1508-14.
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Affiliation(s)
- J H Park
- Korea University College of Medicine, 73, Inchon-ro, Sungbuk-gu, Seoul 06334, South Korea
| | - W Y Jang
- Korea University College of Medicine, 73, Inchon-ro, Sungbuk-gu, Seoul 06334, South Korea
| | - D H Kwak
- Korea University College of Medicine, 73, Inchon-ro, Sungbuk-gu, Seoul 06334, South Korea
| | - J W Park
- Korea University College of Medicine, 73, Inchon-ro, Sungbuk-gu, Seoul 06334, South Korea
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Abstract
PURPOSE OF REVIEW The goal of this manuscript is to review key historic and recent literature regarding extensor carpi ulnaris (ECU), triangular fibrocartilage complex (TFCC) and distal radioulnar joint (DRUJ) injuries, particularly in athletes. RECENT FINDINGS Many recent studies examining the ECU focus on clinical and radiographic diagnosis. Several physical exam findings are described in addition to the use of MRI and US. Imaging studies must be clinically correlated due to high incidence of findings in asymptomatic patients. In regard to the TFCC/DRUJ, there are numerous recent studies that support the use of MRA as an adjunctive diagnostic study. There are also a number of repair constructs that are described for the various different kinds of TFCC pathology reviewed here. In summary, there are a number of options for the diagnosis and treatment of ulnar-sided wrist pain. Patient factors, especially in the athletic population, must be taken into account when approaching any patient with these pathologies.
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Greybe D, Boland MR, Wu T, Mithraratne K. A finite element model to investigate the effect of ulnar variance on distal radioulnar joint mechanics. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2017; 33:e02790. [PMID: 27021471 DOI: 10.1002/cnm.2790] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 03/14/2016] [Accepted: 03/19/2016] [Indexed: 06/05/2023]
Abstract
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.
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Affiliation(s)
- Desney Greybe
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Michael R Boland
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - Tim Wu
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Kumar Mithraratne
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
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Abstract
Gymnastics is a unique sport, which loads the wrist and arms as weight-bearing extremities. Because of the load demands on the wrist in particular, stress fractures, physeal injury, and overuse syndromes may be observed. This spectrum of injury has been termed "gymnast's wrist," and incorporates such disorders as wrist capsulitis, ligamentous tears, triangular fibrocartilage complex tears, chondromalacia of the carpus, stress fractures, distal radius physeal arrest, and grip lock injury.
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Affiliation(s)
- Megan R Wolf
- Department of Orthopaedic Surgery, University of Connecticut Health Center, 263 Farmington Avenue, MARB4-ORTHO, Farmington, CT 06030-4037, USA
| | - Daniel Avery
- Department of Orthopaedic Surgery, University of Connecticut Health Center, 263 Farmington Avenue, MARB4-ORTHO, Farmington, CT 06030-4037, USA
| | - Jennifer Moriatis Wolf
- Department of Orthopaedic Surgery and Rehabilitation, University of Chicago Hospitals, 5841 South Maryland Avenue, MC 3079, Chicago, IL 60637, USA.
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Papatheodorou LK, Baratz ME, Bougioukli S, Ruby T, Weiser RW, Sotereanos DG. Long-Term Outcome of Step-Cut Ulnar Shortening Osteotomy for Ulnar Impaction Syndrome. J Bone Joint Surg Am 2016; 98:1814-1820. [PMID: 27807114 DOI: 10.2106/jbjs.15.01111] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Extra-articular ulnar shortening osteotomy is a common procedure for the surgical treatment of ulnar impaction syndrome. Several techniques for this osteotomy have been developed to avoid the morbidity associated with a standard transverse osteotomy. However, these techniques require special instrumentation and are expensive. The purpose of this study was to evaluate the outcome of step-cut ulnar shortening osteotomy without special jigs for ulnar impaction syndrome. METHODS A retrospective study of 164 consecutive patients who underwent step-cut ulnar shortening osteotomy between 2000 and 2010 was performed. The long arm of the step-cut osteotomy was oriented in the coronal plane parallel to the long axis of the ulna. The short arms of the osteotomy were perpendicular to the long axis in the axial plane. Fixation was performed with a palmar 3.5-mm standard neutralization plate and a lag screw. The goal of the osteotomy was to reduce ulnar variance, which was assessed in all patients with pronated grip-view radiographs preoperatively and postoperatively. Preoperative ulnar variance ranged from +1 to +6 mm. RESULTS All patients were followed for at least 24 months. Union of the osteotomy site was achieved at a mean of 8.2 weeks. The union rate was 98.8%. There were 2 cases of nonunion, which required additional surgery. The mean postoperative ulnar variance was +0.2 mm (range, -1 to +1.5 mm) after a mean overall ulnar shortening of 2.5 mm. All patients returned to their previous work, in a mean of 4 months. The plate was removed from 12 patients because of plate-related symptoms. No other complications were encountered. CONCLUSIONS The step-cut ulnar shortening osteotomy provides ample bone-to-bone contact and simplifies control of rotation. Stable internal fixation with standard techniques allowed an early return to functional activities. Palmar placement of the plate diminishes the need for plate removal. This is a simple and less expensive technique for ulnar shortening that does not require the use of special instrumentation in patients with ulnar impaction syndrome. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | - Mark E Baratz
- University of Pittsburgh, Orthopaedic Specialists-UPMC, Pittsburgh, Pennsylvania
| | - Sofia Bougioukli
- University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Tyler Ruby
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Robert W Weiser
- University of Pittsburgh, Orthopaedic Specialists-UPMC, Pittsburgh, Pennsylvania
| | - Dean G Sotereanos
- University of Pittsburgh, Orthopaedic Specialists-UPMC, Pittsburgh, Pennsylvania
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Avery DM, Rodner CM, Edgar CM. Sports-related wrist and hand injuries: a review. J Orthop Surg Res 2016; 11:99. [PMID: 27633260 PMCID: PMC5025579 DOI: 10.1186/s13018-016-0432-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 08/28/2016] [Indexed: 12/15/2022] Open
Abstract
Background Hand and wrist injuries are common during athletics and can have a significant impact especially if initially disregarded. Due to their high level of physical demand, athletes represent a unique subset of the population. Main body The following is an overview of hand and wrist injuries commonly seen in athletics. Information regarding evaluation, diagnosis, conservative measures, and surgical treatment are provided. Conclusion Knowledge of these entities and special consideration for the athlete can help the team physician effectively treat these players and help them achieve their goals.
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Affiliation(s)
- Daniel M Avery
- University of Connecticut Musculoskeletal Institute, 263 Farmington Avenue, Farmington, CT, 06030-4037, USA.
| | - Craig M Rodner
- University of Connecticut Musculoskeletal Institute, 263 Farmington Avenue, Farmington, CT, 06030-4037, USA
| | - Cory M Edgar
- University of Connecticut Musculoskeletal Institute, 263 Farmington Avenue, Farmington, CT, 06030-4037, USA
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Tiedeken NC, Baratz ME. Ulnocarpal Impingement and Triangular Fibrocartilage Complex Tears. OPER TECHN SPORT MED 2016. [DOI: 10.1053/j.otsm.2015.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Seo JB, Kim JP, Yi HS, Park KH. 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. [PMID: 27039349 DOI: 10.1016/j.jhsa.2016.02.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 01/24/2016] [Accepted: 02/16/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this study was to compare the results of arthroscopic peripheral repair (AR) and arthroscopic debridement (AD) for the treatment of chronic unstable triangular fibrocartilage complex (TFCC) tears in ulnar-positive patients undergoing ulnar-shortening osteotomy (USO). METHODS A total of 31 patients who underwent arthroscopic treatments combined with USO for unstable TFCC tears and were followed-up at a minimum of 24 months were included in this retrospective cohort study. Fifteen patients were treated with AR, and 16 patients were treated with AD while at the same time undergoing a USO. Outcome measures included wrist range of motion, grip strength, Disabilities of the Arm, Shoulder, and Hand (DASH) and Patient-Rated Wrist Evaluation (PRWE) scores, and overall outcomes according to the modified Mayo wrist scoring system. In addition, a stress test to assess distal radioulnar joint (DRUJ) stability was performed before and after surgery to compare the 2 cohorts. RESULTS Both respective cohorts showed significant improvements in grip strength and subjective scores at the final follow-up. Grip strength, DASH, and PRWE scores were better in the AR group than in the AD group. The recovery rate from DRUJ instability observed during the preoperative examination was superior in the AR group. CONCLUSIONS Both AD and AR of the TFCC combined with USO are reliable procedures with satisfactory clinical outcomes for unstable TFCC tears in ulnar-positive patients. However, AR of the TFCC is suggested if DRUJ stability is concomitantly compromised. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Joong-Bae Seo
- Department of Orthopedic Surgery, College of Medicine, Dankook University, Cheonan, Korea; Department of Kinesiology and Medical Science, Graduate School, Dankook University, Cheonan, Korea
| | - Jong-Pil Kim
- Department of Orthopedic Surgery, College of Medicine, Dankook University, Cheonan, Korea; Department of Kinesiology and Medical Science, Graduate School, Dankook University, Cheonan, Korea.
| | - Hyung-Suk Yi
- Department of Orthopedic Surgery, College of Medicine, Dankook University, Cheonan, Korea
| | - Kwang-Hee Park
- Department of Orthopedic Surgery, College of Medicine, Dankook University, Cheonan, Korea
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Kirchberger MC, Unglaub F, Mühldorfer-Fodor M, Pillukat T, Hahn P, Müller LP, Spies CK. Update TFCC: histology and pathology, classification, examination and diagnostics. Arch Orthop Trauma Surg 2015; 135:427-37. [PMID: 25575720 DOI: 10.1007/s00402-015-2153-6] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Indexed: 02/09/2023]
Abstract
The TFCC is a crucial stabilizer of the DRUJ. Based on its superficial and deep fibers, the TFCC guarantees unrestricted pronation and supination which is essential for performing sophisticated tasks. The ability to perform complex movements is of uppermost importance for hand function. Therefore, a functional intact TFCC is a prerequisite in this context. The articular disc of the TFCC is a fibrocartilaginous extension of the superficial zone of hyaline articular cartilage which arises from the radius. The peripheral 10-40 % of the TFC is vascularized. Degeneration of the articular disc is common with increasing age. Even though the central part of the articular disc is avascular, potential regeneration of lesions could be detected. The Palmer and Atzei classifications of TFCC lesions are complementary. TFCC innervation is based on different nerves. There is a high variability. A diligent clinical examination facilitates specific tests which help to allocate symptoms to the pathology. Therefore, a thorough clinical examination is not dispensable. Wrist arthroscopy remains the "gold standard" for diagnosing TFCC pathologies despite technical progress in imaging modalities. MR arthrography may have the potential to become a real alternative to wrist arthroscopy for diagnosing TFCC pathologies with technical progress in the future.
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Affiliation(s)
- Michael C Kirchberger
- Department of Hand Surgery, Vulpius Klinik, Vulpiusstraße 29, 74906, Bad Rappenau, Germany
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Pidgeon TS, Waryasz G, Carnevale J, DaSilva MF. Triangular Fibrocartilage Complex: An Anatomic Review. JBJS Rev 2015; 3:01874474-201501000-00001. [PMID: 27501024 DOI: 10.2106/jbjs.rvw.n.00053] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Tyler S Pidgeon
- University Orthopedics, 2 Dudley Street, Suite 200, Providence, RI 02905
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Parker AS, Nguyen M, Minard CG, Guffey D, Willis MH, Reichel LM. Measurement of ulnar variance from the lateral radiograph: a comparison of techniques. J Hand Surg Am 2014; 39:1114-21. [PMID: 24810937 DOI: 10.1016/j.jhsa.2014.03.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 03/18/2014] [Accepted: 03/19/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the reliability of measuring ulnar variance on lateral wrist radiographs and to compare this technique with previously described methods. METHODS Ulnar variance was measured in 100 normal wrist radiographs using the methods of perpendiculars, central reference point, and the lateral radiograph by 3 surgeons on 2 occasions. Intraobserver repeatability and agreement between raters and methods were assessed and compared. RESULTS Intra- and interobserver reliability and agreement were both excellent using all 3 methods within a ± 1.0-mm cutoff. However, there was substantial pairwise disagreement in measures of ulnar variance between all 3 methods. CONCLUSIONS This study demonstrates that, for measurement of ulnar variance, the methods of perpendiculars, central reference point, and lateral radiographic measurement each have clinically acceptable intraobserver repeatability and interobserver agreement. Despite their independent reliability, each method of radiographic determination of ulnar variance had considerable disagreement with the other methods, indicative of inherent inaccuracies in the techniques. The lateral radiograph uniquely allows for visualization of the amount of ulnar head protruding proximal or distal to the concave lunate facet and allows for a rapid estimation of pronosupination, which is known to affect ulnar variance. CLINICAL RELEVANCE Determination of ulnar variance can be an important component of surgical decision making in various pathological conditions of the hand and wrist. Traditionally, it has been measured through methods using the posteroanterior wrist radiograph, but there are potential shortcomings with these methods, and use of the lateral radiograph may provide a more clinically relevant picture of ulnar variance. This study shows that measurement from the lateral radiograph provides similar reliability to previously accepted techniques.
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Affiliation(s)
- Andrew S Parker
- Department of Orthopedic Surgery, Baylor College of Medicine, Ben Taub General Hospital, Houston, TX; Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX; Department of Radiology, Baylor College of Medicine, Houston, TX
| | - Minh Nguyen
- Department of Orthopedic Surgery, Baylor College of Medicine, Ben Taub General Hospital, Houston, TX; Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX; Department of Radiology, Baylor College of Medicine, Houston, TX
| | - Charles G Minard
- Department of Orthopedic Surgery, Baylor College of Medicine, Ben Taub General Hospital, Houston, TX; Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX; Department of Radiology, Baylor College of Medicine, Houston, TX
| | - Danielle Guffey
- Department of Orthopedic Surgery, Baylor College of Medicine, Ben Taub General Hospital, Houston, TX; Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX; Department of Radiology, Baylor College of Medicine, Houston, TX
| | - Marc H Willis
- Department of Orthopedic Surgery, Baylor College of Medicine, Ben Taub General Hospital, Houston, TX; Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX; Department of Radiology, Baylor College of Medicine, Houston, TX
| | - Lee M Reichel
- Department of Orthopedic Surgery, Baylor College of Medicine, Ben Taub General Hospital, Houston, TX; Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX; Department of Radiology, Baylor College of Medicine, Houston, TX.
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50
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Chang CY, Huang AJ, Bredella MA, Kattapuram SV, Torriani M. Association between distal ulnar morphology and extensor carpi ulnaris tendon pathology. Skeletal Radiol 2014; 43:793-800. [PMID: 24595441 DOI: 10.1007/s00256-014-1845-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 01/20/2014] [Accepted: 02/05/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the association between distal ulnar morphology and extensor carpi ulnaris (ECU) tendon pathology. MATERIALS AND METHODS We retrospectively reviewed 71 adult wrist MRI studies with ECU tendon pathology (tenosynovitis, tendinopathy, or tear), and/or ECU subluxation. Subjects did not have a history of trauma, surgery, infection, or inflammatory arthritis. MRI studies from 46 subjects without ECU tendon pathology or subluxation were used as controls. The following morphological parameters of the distal ulna were measured independently by two readers: ulnar variance relative to radius, ulnar styloid process length, ECU groove depth and length. Subjects and controls were compared using Student's t test. Inter-observer agreement (ICC) was calculated. RESULTS There was a significant correlation between negative ulnar variance and ECU tendon pathology (reader 1 [R1], P = 0.01; reader 2 [R2], P < 0.0001; R1 and R2 averaged data, P < 0.0001) and ECU tendon subluxation (P = 0.001; P = 0.0001; P < 0.0001). In subjects with ECU tendon subluxation there was also a trend toward a shorter length (P = 0.3; P <0.0001; P = 0.001) and a shallower ECU groove (P = 0.01; P = 0.03; P = 0.01; R1 and R2 averaged data with Bonferroni correction, P = 0.08). ECU groove depth (P = 0.6; P = 0.8; P = 0.9) and groove length (P = 0.1; P = 0.4; P = 0.7) showed no significant correlation with ECU tendon pathology, and length of the ulnar styloid process showed no significant correlation with ECU tendon pathology (P = 0.2; P = 0.3; P = 0.2) or subluxation (P = 0.4; P = 0.5; P = 0.5). Inter-observer agreement (ICC) was >0.64 for all parameters. CONCLUSION Distal ulnar morphology may be associated with ECU tendon abnormalities.
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Affiliation(s)
- Connie Y Chang
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts, General Hospital and Harvard Medical School, Boston, MA, USA,
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