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Management of Ulnar Impaction

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Wrist and Elbow Arthroscopy with Selected Open Procedures

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Abstract

The cornerstone of ulnar abutment syndrome is unloading the ulnocarpal joint by recession of the distal ulna. In the presence of a central perforation of the TFCC, it is possible to perform the recession arthroscopically. Arthroscopic wafer resection allows quicker recovery and avoids the morbidity and complications of ulnar shortening. Wafer resection, however, is limited to cases where only a few millimeters of ulna shortening is needed. Additionally, in the presence of advanced LT instability, diaphyseal shortening of the ulna may be preferable.

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References

  1. Palmer AK, Werner FW. Biomechanics of the distal radioulnar joint. Clin Orthop Relat Res. 1984;187:26–35.

    Article  Google Scholar 

  2. Palmer AK, Werner FW, et al. The triangular fibrocartilage complex of the wrist-anatomy and function. J Hand Surg [Am]. 1981;6:153–62.

    Article  CAS  Google Scholar 

  3. Palmer AK, Glisson RR, et al. Relationship between ulnar variance and triangular fibrocartilage complex thickness. J Hand Surg [Am]. 1984;9:681–2.

    Article  CAS  Google Scholar 

  4. Mikic ZD. Age changes in the triangular fibrocartilage of the wrist joint. J Anat. 1978;126(Pt 2):367–84.

    CAS  PubMed  PubMed Central  Google Scholar 

  5. Tolat AR, Sanderson PL, et al. The gymnast’s wrist: acquired positive ulnar variance following chronic epiphyseal injury. J Hand Surg [Br]. 1992;17:678–81.

    Google Scholar 

  6. Palmer AK. Fractures of the distal radius. In: Green DP, editor. Operative hand surgery. 3rd ed. New York: Churchill Livingstone; 1993. p. 861–928.

    Google Scholar 

  7. Bickel KD. Arthroscopic treatment of ulnar impaction syndrome. J Hand Surg [Am]. 2008;33(8):1420–3.

    Article  Google Scholar 

  8. Palmer AK. Triangular fibrocartilage complex lesions: a classification. J Hand Surg [Am]. 1989;14(4):594–606.

    Article  CAS  Google Scholar 

  9. Nakamura R, Horil E, Imaeda T, et al. The ulnocarpal stress test in the diagnosis of ulnar-sided wrist pain. J Hand Surg (Br). 1997;22(6):719–23.

    Article  CAS  Google Scholar 

  10. Lester B, Halbrecht J, Levy IM, et al. “Press Test” for office diagnosis of triangular fibrocartilage complex tears of the wrist. Ann Plast Surg. 1995;35:41–5.

    Article  CAS  Google Scholar 

  11. Sammer DM, Rizzo M. Ulnar impaction. Hand Clin. 2010;26:549–57.

    Article  Google Scholar 

  12. Tomaino MM. The importance of the pronated grip x-ray view in evaluating ulnar variance. J Hand Surg [Am]. 2000;25:352–7.

    Google Scholar 

  13. Imaeda T, Nakamura R, Shionoya K, et al. Ulnar impaction syndrome: MR imaging findings. Radiology. 1996;201(2):495–500.

    Article  CAS  Google Scholar 

  14. Weiss A-PC, Akelman E, Lambiase R. Comparison of the findings of triple-injection cinearthrography of the wrist with those of arthroscopy. J Bone Joint Surg Am. 1996;78:348–56.

    Article  CAS  Google Scholar 

  15. North ER, Meyer S. Wrist injuries: correlation of clinical and arthroscopic findings. J Hand Surg. 1990;15A:915–20.

    Article  Google Scholar 

  16. Tomaino MM, Weiser RW. Combined arthroscopic TFCC debridement and wafer resection of the distal ulna in wrists with triangular fibrocartilage complex tears and positive ulnar variance. J Hand Surg [Am]. 2001;26(6):1047–52.

    Article  CAS  Google Scholar 

  17. Wnorowski DC, Palmer AK, Werner FW, et al. Anatomic and biomechanical analysis of the arthroscopic wafer procedure. Arthroscopy. 1992;8(2):204–12.

    Article  CAS  Google Scholar 

  18. Palmar AK. Triangular fibrocartilage disorders: injury patterns and treatment. Arthroscopy. 1990;6:125–32.

    Article  Google Scholar 

  19. Pomerance J. Arthroscopic debridement and/or ulnar shortening osteotomy for TFCC tears. J Hand Surg [Am]. 2002;2(2):95–101.

    Article  Google Scholar 

  20. Palmer AK, Werner FW, Glisson RR, et al. Partial excision of the triangular fibrocartilage complex: an experimental study. J Hand Surg [Am]. 1988;13A:391–4.

    Article  Google Scholar 

  21. Minami A. Clinical results of treatment of triangular fibrocartilage complex tears by arthroscopic debridement. J Hand Surg [Am]. 1996;21(3):406–11.

    Article  CAS  Google Scholar 

  22. Feldon P, Terrono AL, Belsky MR. Wafer distal ulna resection for triangular fibrocartilage tears and/or ulna impaction syndrome. J Hand Surg [Am]. 1992;17:731–7.

    Article  CAS  Google Scholar 

  23. Deitch MA, Stern SJ. Ulnocarpal abutment: treatment options. Hand Clin. 1998;14(2):251–63.

    Article  CAS  Google Scholar 

  24. Bernstein MA, Nagel DJ, Martinez A, et al. A comparison of combined arthroscopic triangular fibrocartilage complex debridement and arthroscopic wafer distal ulna resection versus arthroscopic triangular fibrocartilage complex debridement and ulnar shortening osteotomy for ulnocarpal abutment syndrome. Arthroscopy. 2004;20(4):392–401.

    Article  Google Scholar 

  25. Nagel DJ. Arthroscopic treatment of degenerative tears of the triangular fibrocartilage. Hand Clin. 1994;10:615–24.

    Article  Google Scholar 

  26. Lee J, Nha KW, Lee GY, et al. Long-term outcomes of arthroscopic debridement and thermal shrinkage for isolated partial intercarpal ligament tears. Orthopedics. 2012;35(8):1204–9.

    Article  Google Scholar 

  27. DeSmet L, DeFerm A, Steenwerckx A, et al. Arthroscopic treatment of triangular fibrocartilage complex lesions of the wrist. Acta Orthop Belg. 1996;62:8–13.

    CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Loyola University Medical Center, Maywood, IL, USA

    Megan Anne Meislin

  2. Department of Orthopaedic Surgery, Griffith University School of Medicine, Gold Coast University Hospital, Southport, QLD, Australia

    Randy Bindra

Authors
  1. Megan Anne Meislin
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  2. Randy Bindra
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Editor information

Editors and Affiliations

  1. Division of Hand and Upper Extremity Surgery Section of Arthroscopic Surgery and Sports Medicine, Department of Orthopedic Surgery and Rehabilitation, University of Mississippi Medical Center, Jackson, MS, USA

    William B. Geissler

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Meislin, M.A., Bindra, R. (2022). Management of Ulnar Impaction. In: Geissler, W.B. (eds) Wrist and Elbow Arthroscopy with Selected Open Procedures. Springer, Cham. https://doi.org/10.1007/978-3-030-78881-0_10

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  • DOI: https://doi.org/10.1007/978-3-030-78881-0_10

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-78880-3

  • Online ISBN: 978-3-030-78881-0

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