Dorsal Translation of Ulnar Head after the Arthroscopic Wafer Procedure for Ulnar Impaction Syndrome

Yun,  Keonhee; Jung,  Ki Jin; Nho,  Jae Hwi; Cho,  WhiJe; Kim,  Byung Sung

doi:2019.24.4.303

Arch Hand Microsurg > Volume 24(4); 2019 > Article

Original Article

Archives of Hand and Microsurgery 2019;24(4):303-310.
Published online December 1, 2019.
DOI: https://doi.org/10.12790/ahm.2019.24.4.303

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. kbsos@schmc.ac.kr
²Department of Orthopedic Surgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.
³Department of Orthopedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea.

Received: 24 July 2019 • Revised: 16 September 2019 • Accepted: 22 September 2019

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.

Key Words: Ulnar head, Dorsal translation, Arthroscopy