Katsuyuki Iwatsuki1, Masahiro Tatebe2, Michiro Yamamoto2, Takaaki Shinohara2, Ryogo Nakamura2, Hitoshi Hirata2. 1. Department of Hand Surgery, Nagoya University Graduate School of Medicine; Hand Surgery Center, Chunichi Hospital, Nagoya; Department of Orthopaedic Surgery, Anjo Kosei Hospital, Anjo, Japan. Electronic address: kiwatsuki@med.nagoya-u.ac.jp. 2. Department of Hand Surgery, Nagoya University Graduate School of Medicine; Hand Surgery Center, Chunichi Hospital, Nagoya; Department of Orthopaedic Surgery, Anjo Kosei Hospital, Anjo, Japan.
Abstract
PURPOSE: We hypothesized that most patients with ulnar impaction syndrome have degenerative changes of the proximal lunotriquetral (LT) membrane and that ulnar-shortening osteotomy is an effective procedure in these patients. METHODS: We retrospectively reviewed 50 wrists of 49 patients with idiopathic ulnar impaction syndrome who underwent an arthroscopic evaluation at the time of ulnar-shortening osteotomy, and subsequently at plate removal. Based on the Geissler classification, patients were divided into group A, normal, and group B, grades I to IV. The degree of degeneration of the proximal LT membrane at first-look arthroscopy was compared with that at second-look arthroscopy. RESULTS: After ulnar-shortening osteotomy, both groups improved significantly in wrist range of motion and grip strength. According to the Mayo wrist score, 29, 18, and 3 patients showed excellent, good, and fair results, respectively. Of the 50 wrists, 25 had degenerative changes (group B) in the proximal LT membrane at the time of first-look arthroscopy. Of the 25 wrists in group B, 11 wrists improved based on the Geissler grade, 9 wrists showed no changes, and 2 wrists became worse. Clinically, patients demonstrated improvement after ulnar-shortening osteotomy regardless of the degree of degenerative LT ligament changes. CONCLUSIONS: Degenerative LT membrane changes that were seen in about half of our patients were mostly of a mild nature, and the clinical outcomes of ulnar-shortening osteotomy were acceptable. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
PURPOSE: We hypothesized that most patients with ulnar impaction syndrome have degenerative changes of the proximal lunotriquetral (LT) membrane and that ulnar-shortening osteotomy is an effective procedure in these patients. METHODS: We retrospectively reviewed 50 wrists of 49 patients with idiopathic ulnar impaction syndrome who underwent an arthroscopic evaluation at the time of ulnar-shortening osteotomy, and subsequently at plate removal. Based on the Geissler classification, patients were divided into group A, normal, and group B, grades I to IV. The degree of degeneration of the proximal LT membrane at first-look arthroscopy was compared with that at second-look arthroscopy. RESULTS: After ulnar-shortening osteotomy, both groups improved significantly in wrist range of motion and grip strength. According to the Mayo wrist score, 29, 18, and 3 patients showed excellent, good, and fair results, respectively. Of the 50 wrists, 25 had degenerative changes (group B) in the proximal LT membrane at the time of first-look arthroscopy. Of the 25 wrists in group B, 11 wrists improved based on the Geissler grade, 9 wrists showed no changes, and 2 wrists became worse. Clinically, patients demonstrated improvement after ulnar-shortening osteotomy regardless of the degree of degenerative LT ligament changes. CONCLUSIONS: Degenerative LT membrane changes that were seen in about half of our patients were mostly of a mild nature, and the clinical outcomes of ulnar-shortening osteotomy were acceptable. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
Authors: Joris S Teunissen; Sanharib Al Shaer; Brigitte P A van der Heijden; Ruud W Selles; Steven E R Hovius; Oliver T Zöphel Journal: J Hand Surg Eur Vol Date: 2022-04-11