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Ulnar shortening after TFCC suture repair of Palmer type 1B lesions

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Purpose

The objective of this study was to determine functional and subjective outcomes of an ulnar shortening procedure elected by patients who experienced persistent ulno-carpal symptoms following arthroscopic suture repair of a Palmer type 1B lesion. All patients had a dynamic ulna positive variance.

Methods

Five patients (3 males and 2 females) with arthroscopic repair of Palmer type 1B tears who subsequently underwent ulnar shortening were reviewed. At the time of the arthroscopic repair the patients’ average age was 37 ± 13 years (range 16–52 years). Average time to follow-up was 14 ± 6 months (range 10–23 months). The average age was 38 ± 14 years (range 17–53 years) when the ulnar shortening was performed. The second follow-up took place 7 ± 2 months (range 5–9 months) after ulnar shortening. During the follow-ups, range of motion, grip strength, pain, Modified Mayo Wrist Score, DASH Score, and ulnar length were evaluated. Citing persistent ulno-carpal symptoms, the patients elected ulnar shortening an average of 17 ± 7months (range 13–29 months) following the arthroscopic repair. Prior to ulnar shortening the average static ulnar variance was 0.2 ± 1.3 mm (range −1 to 2 mm), the average dynamic ulnar variance was 1.4 ± 0.5 mm (range 1 to 2 mm).

Results

Ulnar shortening brought about further reduction in pain after the arthroscopic repair of the triangular fibrocartilage complex (TFCC) had already reduced it. As measured by a visual analogue scale, the average value after ulnar shortening was 2.2 ± 2.1 (range 0.7−5.0). The average static ulnar variance was −3.4 ± 2 mm (range −5 to −1 mm). Patients were very satisfied with the results of the ulnar shortening and four out of five indicated that it had significantly improved their symptoms and they would elect ulnar shortening again. Postoperative range of motion as a percentage of the contralateral side averaged 90% for the extension/flexion arc, 80% for the radial/ulnar deviation arc, and 100% for the pronation/supination arc of motion. In addition, there was an improvement in grip strength. The Modified Mayo Wrist Score was rated excellent in three patients, and fair in two patients. The average DASH score was 22 ± 22 (range 0–53).

Conclusions

Patients who have a dynamic ulna positive variance and experience persistent ulno-carpal symptoms following arthroscopic suture repair of a Palmer type 1B lesion, benefit from an ulnar shortening procedure. Shortening the ulna can improve these patients’ symptoms of pain, range of motion, and grip strength.

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Authors and Affiliations

  1. Handsurgery, Vulpius Klinik, Bad Rappenau, Germany

    Maya B. Wolf, Andreas Reiter, Peter Hahn & Frank Unglaub

  2. Department of Orthopaedic Surgery, Kantonsspital, Saint Gall, Switzerland

    Markus W. Kroeber

  3. Department of Plastic and Hand Surgery, University of Erlangen, Krankenhausstrasse 12, 91054, Erlangen, Germany

    Susanne B. Thomas, Raymund E. Horch & Frank Unglaub

Authors
  1. Maya B. Wolf
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  2. Markus W. Kroeber
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  3. Andreas Reiter
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  4. Susanne B. Thomas
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  5. Peter Hahn
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  6. Raymund E. Horch
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  7. Frank Unglaub
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Corresponding author

Correspondence to Frank Unglaub.

Additional information

M. B. Wolf and M. W. Kroeber have contributed equally to this work.

The study was supported by the ELAN Fonds, University of Erlangen. All authors have no financial interest at the time of submission.

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Wolf, M.B., Kroeber, M.W., Reiter, A. et al. Ulnar shortening after TFCC suture repair of Palmer type 1B lesions. Arch Orthop Trauma Surg 130, 301–306 (2010). https://doi.org/10.1007/s00402-008-0719-2

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  • DOI: https://doi.org/10.1007/s00402-008-0719-2

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