Combined ulnar shortening osteotomy and elastic suspended fixation in treatment of ulnar impaction syndrome_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHENG Muxin ¹ , LIN Xiaodong ¹ , XU Shuchai ² ,  LIU Hongliang ² , LIU Jian ¹ , HUANG Zexin ²

1. The Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China;
2. The 4th Department of Orthopeadics, Guangdong Provincial Traditional Chinese Medical Hospital Affiliated to Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 520105, P.R.China;

Corresponding author：

LIU Hongliang, Email: 174257711@qq.com

Keywords：

Wrist joint; ulnar impaction syndrome; ulnar osteotomy; elastic suspended fixation

DOI：

10.7507/1002-1892.201802058

Video：

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Objective To investigate the effectiveness of ulnar shortening osteotomy combined with elastic suspension fixation for ulnar impaction syndrome caused by relatively long ulna. Methods Between October 2015 and August 2016, 3 cases of ulnar impaction syndrome were treated. One patient was male and 2 patients were females. The age was 32, 29, and 59 years, respectively. One patient was dislocation and impaction of distal radioulnar joint for more than 1 year after internal fixation due to ulnar and radial open fractures. Other patients had no trauma and surgery, but long-term manual history. The visual analogue scale (VAS) scores were 7, 5, and 5, respectively. Cooney wrist function scores were rated as poor. Preoperative X-ray measurements of the ulnar variance was 12.7, 9.0, and 8.7 mm, respectively. The ulna was transversely osteotomy and fixed with plate and screws. The distal radioulnar joint was elastic suspension fixed with mini plate. Results Postoperative X-ray film showed that the matching of the distal radioulnar joint had no significant difference compared with the contralateral side. All the incisions healed by first intention without complication such as neurovascular injury, infection, and dislocation of the distal radioulnar joint. The patients were followed up 27, 17, and 23 months, respectively. At last follow-up, X-ray film showed that all osteotomy segments achieved bony union without internal fixation failure. The VAS scores were 2, 0, and 1, respectively, and the Cooney wrist function scores were rated as excellent. Conclusion The ulnar shortening osteotomy combined with elastic suspension fixation can correct the ulna variation, avoid the instability of the distal radioulnar joint caused by the extensive dissection of the tissue around the ulnar, and avoid stiffness of the joints caused by rigid fixation. It is an ideal treatment for ulna impaction syndrome.

Citation： ZHENG Muxin, LIN Xiaodong, XU Shuchai, LIU Hongliang, LIU Jian, HUANG Zexin. Combined ulnar shortening osteotomy and elastic suspended fixation in treatment of ulnar impaction syndrome. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(8): 993-996. doi: 10.7507/1002-1892.201802058 Copy

1.	Gelberman RH, Salamon PB, Jurist JM, et al. Ulnar variance in Kienböck’s disease. J Bone Joint Surg (Am), 1975, 57(5): 674-676.
2.	Pillukat T, Van Schoonhoven J, Lanz U. Ulnar instability of the carpus. Orthopade, 2004, 33(6): 676-684.
3.	Löw S, Herold A, Unglaub F, et al. Treatment of ulnar impaction syndrome with and without central TFC lesion. J Wrist Surg, 2018, 7(2): 133-140.
4.	史瑞明. 尺骨撞击综合征的诊断和治疗进展. 医学理论与实践, 2016, 29(9): 1144-1145.
5.	Bell MJ, Hill RJ, McMurtry RY. Ulnar impingement syndrome. J Bone Joint Surg (Br), 1985, 67(1): 126-129.
6.	刘健, 夏威夷, 许树柴, 等. 远侧尺桡关节脱位的治疗进展. 中华创伤骨科杂志, 2017, 19(10): 915-920.
7.	Wijffels M, Brink P, Schipper I. Clinical and non-clinical aspects of distal radioulnar joint instability. Open Orthop J, 2012, 6: 204-210.
8.	Stockton DJ, Pelletier ME, Pike JM. Operative treatment of ulnar impaction syndrome: a systematic review. J Hand Surg (Eur Vol), 2015, 40(5): 470-476.
9.	Noureldin M, Kakar S. Extensor carpi ulnaris instability following ulnar shortening osteotomy. J Wrist Surg, 2017, 6(2): 144-147.
10.	荣艳波, 田光磊, 陈山林. 深层桡尺远侧韧带对桡尺远侧关节稳定作用的生物力学研究. 北京大学学报 (医学版), 2017, 49(3): 518-521.
11.	陈轶腾, 吕一, 谢跃鹏, 等. 改良尺骨截骨矫形术治疗陈旧性下尺桡关节脱位疗效观察. 浙江中西医结合杂志, 2017, 27(4): 326-327.
12.	Teodoro RL, Nishimi AY, Pascarelli L, et al. Surgical treatment of acromioclavicular dislocation using the endobutton. Acta Ortop Bras, 2017, 25(3): 81-84.
13.	Eguchi A, Ochi M, Adachi N, et al. Mechanical properties of suspensory fixation devices for anterior cruciate ligament reconstruction: comparison of the fixed-length loop device versus the adjustable-length loop device. Knee, 2014, 21(3): 743-748.
14.	Petre BM, Smith SD, Jansson KS, et al. Femoral cortical suspension devices for soft tissue anterior cruciate ligament reconstruction: a comparative biomechanical study. Am J Sports Med, 2013, 41(2): 416-422.
15.	de Vries EN, Walenkamp MM, Mulders MA, et al. Minimally invasive stabilization of the distal radioulnar joint: a cadaveric study. J Hand Surg (Eur Vol), 2017, 42(4): 363-369.
16.	Kam CC, Jones CM, Fennema JL, et al. Suture-button construct for interosseous ligament reconstruction in longitudinal radioulnar dissociations: a biomechanical study. J Hand Surg (Am), 2010, 35(10): 1626-1632.
17.	Sang L, Liu H, Liu J, et al. A case report of distal radioulnar joint dislocation fixed by using mini-plate-button. Int J Surg Case Rep, 2017, 34: 69-73.
18.	Teodoro RL, Nishimi AY, Pascarelli L, et al. Surgical treatment of acromioclavicular dislocation using the endobutton. Acta Ortop Bras, 2017, 25(3): 81-84.

1. Gelberman RH, Salamon PB, Jurist JM, et al. Ulnar variance in Kienböck’s disease. J Bone Joint Surg (Am), 1975, 57(5): 674-676.
2. Pillukat T, Van Schoonhoven J, Lanz U. Ulnar instability of the carpus. Orthopade, 2004, 33(6): 676-684.
3. Löw S, Herold A, Unglaub F, et al. Treatment of ulnar impaction syndrome with and without central TFC lesion. J Wrist Surg, 2018, 7(2): 133-140.
4. 史瑞明. 尺骨撞击综合征的诊断和治疗进展. 医学理论与实践, 2016, 29(9): 1144-1145.
5. Bell MJ, Hill RJ, McMurtry RY. Ulnar impingement syndrome. J Bone Joint Surg (Br), 1985, 67(1): 126-129.
6. 刘健, 夏威夷, 许树柴, 等. 远侧尺桡关节脱位的治疗进展. 中华创伤骨科杂志, 2017, 19(10): 915-920.
7. Wijffels M, Brink P, Schipper I. Clinical and non-clinical aspects of distal radioulnar joint instability. Open Orthop J, 2012, 6: 204-210.
8. Stockton DJ, Pelletier ME, Pike JM. Operative treatment of ulnar impaction syndrome: a systematic review. J Hand Surg (Eur Vol), 2015, 40(5): 470-476.
9. Noureldin M, Kakar S. Extensor carpi ulnaris instability following ulnar shortening osteotomy. J Wrist Surg, 2017, 6(2): 144-147.
10. 荣艳波, 田光磊, 陈山林. 深层桡尺远侧韧带对桡尺远侧关节稳定作用的生物力学研究. 北京大学学报 (医学版), 2017, 49(3): 518-521.
11. 陈轶腾, 吕一, 谢跃鹏, 等. 改良尺骨截骨矫形术治疗陈旧性下尺桡关节脱位疗效观察. 浙江中西医结合杂志, 2017, 27(4): 326-327.
12. Teodoro RL, Nishimi AY, Pascarelli L, et al. Surgical treatment of acromioclavicular dislocation using the endobutton. Acta Ortop Bras, 2017, 25(3): 81-84.
13. Eguchi A, Ochi M, Adachi N, et al. Mechanical properties of suspensory fixation devices for anterior cruciate ligament reconstruction: comparison of the fixed-length loop device versus the adjustable-length loop device. Knee, 2014, 21(3): 743-748.
14. Petre BM, Smith SD, Jansson KS, et al. Femoral cortical suspension devices for soft tissue anterior cruciate ligament reconstruction: a comparative biomechanical study. Am J Sports Med, 2013, 41(2): 416-422.
15. de Vries EN, Walenkamp MM, Mulders MA, et al. Minimally invasive stabilization of the distal radioulnar joint: a cadaveric study. J Hand Surg (Eur Vol), 2017, 42(4): 363-369.
16. Kam CC, Jones CM, Fennema JL, et al. Suture-button construct for interosseous ligament reconstruction in longitudinal radioulnar dissociations: a biomechanical study. J Hand Surg (Am), 2010, 35(10): 1626-1632.
17. Sang L, Liu H, Liu J, et al. A case report of distal radioulnar joint dislocation fixed by using mini-plate-button. Int J Surg Case Rep, 2017, 34: 69-73.
18. Teodoro RL, Nishimi AY, Pascarelli L, et al. Surgical treatment of acromioclavicular dislocation using the endobutton. Acta Ortop Bras, 2017, 25(3): 81-84.

Chinese Journal of Reparative and Reconstructive Surgery

Combined ulnar shortening osteotomy and elastic suspended fixation in treatment of ulnar impaction syndrome

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