Arch Hand Microsurg 2019; 24(4): 303-310  
Dorsal Translation of Ulnar Head after the Arthroscopic Wafer Procedure for Ulnar Impaction Syndrome
Keonhee Yun1, Ki Jin Jung2, Jae-Hwi Nho3, WhiJe Cho1, Byung Sung Kim1
1Department of Orthopedic Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
2Department of Orthopedic Surgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
3Department of Orthopedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
Correspondence to: Byung Sung Kim
Department of Orthopedic Surgery, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon 14584, Korea
TEL: +82-32-621-5262, FAX: +82-32-621-5018, E-mail: kbsos@schmc.ac.kr, ORCID: https://orcid.org/0000-0002-4984-6918
Received: July 24, 2019; Revised: September 16, 2019; Accepted: September 22, 2019; Published online: December 1, 2019.
© Korean Society for Surgery of the Hand, Korean Society for Microsurgery, and Korean Society for Surgery of the Peripheral Nerve. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Purpose: The purpose of this study was to evaluate the results of the arthroscopic wafer procedure (AWP) for ulnar impaction syndrome (UIS) and identify preoperative factors and degree of distal radioulnar joint (DRUJ) translation that could assist in predicting outcomes.
Methods: We retrospectively reviewed the medical records of 9 patients (11 wrists) who underwent AWP for UIS. Among these, 5 cases were converted to secondary ulnar shortening osteotomy and were categorized to group A and the remaining 6 cases were categorized to group B. The ulnar variance (UV), radioulnar ratio (RUR) by computed tomography or magnetic resonance imaging (MRI), MRI evidence of mechanical impaction in the ulnar or lunate, grip power, Disability of Shoulder, Arm and Hand (DASH) score, and Mayo wrist score were examined before and after AWP.
Results: The MRI evidence did not differ significantly between groups A and B (p>0.05). The average UV and RUR changed from 1.6±0.7 mm and 0.68±0.17 before AWP to –1.5±0.9 mm and 0.54±0.10 after AWP, respectively. The difference between the preoperative RUR (0.65) and postoperative RUR in group B (0.49) was significant (p=0.027, Pearson correlation coefficient=0.862). The grip strength, DASH score, and Mayo wrist score improved from 77.1%, 47.6, and 69.1 to 85.2%, 16.8, and 85.5, respectively.
Conclusion: If patients have persisting pain and DRUJ dorsal translation is not reduced after wafer procedure, secondary ulnar shortening osteotom may be required.
Keywords: Ulnar head, Dorsal translation, Arthroscopy


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