Ulnar shortening oblique osteotomy combined with arthroscopy technique for ulnar impaction syndrome / 中华骨科杂志

ABSTRACT

Objective:To introduce ulnar shortening oblique osteotomy combined with arthroscopy technique for ulnar impaction syndrome and to evaluate the outcomes.Methods:From August 2012 to January 2015, data of 25 cases with ulnar impaction syndrome who were treated in our hospital with oblique osteotomy of the ulna and internal fixation were retrospectively analyzed. There were 14 males and 11 females with an average age of 32.5±4.9 years old (range, 18-62 years). All 25 cases had wrist triangular fibrocartilage complex (TFCC) injuries. Intraoperative arthroscopy was conducted to investigate the pathologic changes of the articular disk of the triangular fibrocartilage complex (TFCC), chondromalacia of the lunate and triquetrum, and tears of the lunotriquetral interosseous ligament (LTIL), debridement of the synovial membrane and the free edge of the central perforation of TFCC, to remove the cartilage from the lunate and triangular bone, and to perform oblique osteotomy of the ulna and internal fixation after repairing of TFCC ulnar tear. We evaluated the outcomes by means of comparing the postoperative values of modified Mayo and visual analogue scale (VAS).Results:There were 5 cases of IB, 5 of IIA, 7 of IIB, 4 of IIC, 4 of IID according to Palmer's classification. All 25 cases were followed-up for 24.6±1.9 months (range, 12-46 months). All patients achieved bone healing with an average of 14.0±1.9 weeks (range, 12-20 weeks). The mean value of preoperative ulnar variation was 3.8 ±1.5 mm which decreased to -1.5±0.5 mm after operation. The preoperative VAS was 7.8±0.7 which decreased to 1.3±1.5 at the latest follow-up. The modified Mayo value increased from 52.8±15.8 to 83.0±11.2. There were 19 cases with excellent wrist function, 5 good and 1 fair. The excellent-good rate was 96% (24/25). Grip strength value increased from 6.3±1.5 kg preoperative to 12.3±1.9 kg postoperative. There was no postoperative infection, delayed or nonunion of bone, but irritation of steel plate appeared in 10 patients, which disappeared after the removal of the steel plate.Conclusion:Arthroscopy combined with ulnar shortening oblique osteotomy technique for ulnar impaction syndrome can reduce wrist pain, increase hand grip strength, improve the activity of the wrist joint, and the clinical effect is positive.