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DOI: 10.1055/s-0038-1668153
Changes in Ulnar Variance after a Triangular Fibrocartilage Complex Tear
Publikationsverlauf
17. Mai 2017
04. Juli 2018
Publikationsdatum:
17. August 2018 (online)
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Abstract
Purpose The relationship between triangular fibrocartilage complex (TFCC) tear and ulnar impaction syndrome has not been fully understood. We hypothesized that a TFCC tear could change the ulnar variance, which may be the cause of ulnar impaction syndrome.
Patients and Methods A total of 72 patients who underwent TFCC foveal repair between January 2011 and June 2016 were included in this retrospective study. Among them, 44 patients diagnosed with TFCC foveal tear with distal radioulnar joint instability and no ulnar impaction syndrome underwent TFCC foveal repair only (group A) and 28 patients diagnosed with TFCC foveal tear with ulnar impaction syndrome underwent TFCC foveal repair and ulnar shortening osteotomy simultaneously (group B). We measured their ulnar variances in preoperative, postoperative, and last follow-up plain radiography. We also compared them with the ulnar variance of the contralateral (uninjured) wrist. Postoperative clinical outcomes, such as range of motions of the wrist, the visual analog scale (VAS) for pain, grip strength, and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, were assessed.
Results Ulnar variance increased after TFCC tears compared with that on the uninjured side in both groups (group A: 0.98 vs. 0.52 mm, p = 0.013; group B: 2.71 vs. 2.13 mm, p = 0.001). Once the TFCC was repaired, ulnar variance decreased (group A: 0.98 to 0.01 mm, p < 0.01; group B: 2.71 to 0.64 mm, p < 0.01). However, it was increased on the last follow-up radiograph (group A: 0.01 to 0.81 mm, p < 0.01; group B: 0.64 to 1.05 mm, p = 0.004). There were no significant improvement of range of motion, except for pronation–supination motion (p = 0.04). Mean grip strength increased from 56.8 to 70.8% of the contralateral unaffected hand at the last assessment (p = 0.01). Mean VAS for pain decreased from 7.4 ± 2.5 preoperatively to 2.7 ± 2 postoperatively (p = 0.001). The QuickDASH score significantly improved from 45 to 9 (p = 0.001).
Conclusion Ulnar variance may be changed after a TFCC tear. In our study, it decreased after TFCC foveal repair. However, as time went on, the ulnar variance increased again, which could be one of the causes of ulnar impaction syndrome and ulnar-sided wrist pain.
Level of Evidence This is a therapeutic Level IV study.
Keywords
distal radioulnar joint - triangular fibrocartilage complex - ulnar impaction syndrome - ulnar shortening osteotomy - ulnar varianceNote
This work was performed at the Department of Orthopaedic Surgery, St. Vincent's Hospital, Catholic University of Korea, Seoul, South Korea.
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References
- 1 Spies CK, Müller LP, Unglaub F, Hahn P, Klum M, Oppermann J. Anatomical transosseous fixation of the deep and superficial fibers of the radioulnar ligaments. Arch Orthop Trauma Surg 2014; 134 (12) 1783-1788
- 2 Palmer AK, Werner FW. Biomechanics of the distal radioulnar joint. Clin Orthop Relat Res 1984; (187) 26-35
- 3 Friedman SL, Palmer AK, Short WH, Levinsohn EM, Halperin LS. The change in ulnar variance with grip. J Hand Surg Am 1993; 18 (04) 713-716
- 4 Onishi T, Omokawa S, Iida A. , et al. Biomechanical study of distal radioulnar joint ballottement test. J Orthop Res 2017; 35 (05) 1123-1127
- 5 Shen J, Papadonikolakis A, Garrett JP, Davis SM, Ruch DS. Ulnar-positive variance as a predictor of distal radioulnar joint ligament disruption. J Hand Surg Am 2005; 30 (06) 1172-1177
- 6 Smith AM, Urbanosky LR, Castle JA, Rushing JT, Ruch DS. Radius pull test: predictor of longitudinal forearm instability. J Bone Joint Surg Am 2002; 84-A (11) 1970-1976
- 7 Kim JP, Park MJ. Assessment of distal radioulnar joint instability after distal radius fracture: comparison of computed tomography and clinical examination results. J Hand Surg Am 2008; 33 (09) 1486-1492
- 8 Sammer DM, Rizzo M. Ulnar impaction. Hand Clin 2010; 26 (04) 549-557
- 9 Nakamura R, Horii E, Imaeda T, Nakao E, Kato H, Watanabe K. The ulnocarpal stress test in the diagnosis of ulnar-sided wrist pain. J Hand Surg [Br] 1997; 22 (06) 719-723
- 10 Steyers CM, Blair WF. Measuring ulnar variance: a comparison of techniques. J Hand Surg Am 1989; 14 (04) 607-612
- 11 Shrout PE, Fleiss JL. Intraclass correlations: uses in assessing rater reliability. Psychol Bull 1979; 86 (02) 420-428
- 12 Friedman SL, Palmer AK. The ulnar impaction syndrome. Hand Clin 1991; 7 (02) 295-310
- 13 Chun S, Palmer AK. The ulnar impaction syndrome: follow-up of ulnar shortening osteotomy. J Hand Surg Am 1993; 18 (01) 46-53
- 14 Darrow Jr JC, Linscheid RL, Dobyns JH, Mann III JM, Wood MB, Beckenbaugh RD. Distal ulnar recession for disorders of the distal radioulnar joint. J Hand Surg Am 1985; 10 (04) 482-491
- 15 Minami A, Kato H. Ulnar shortening for triangular fibrocartilage complex tears associated with ulnar positive variance. J Hand Surg Am 1998; 23 (05) 904-908
- 16 Inoue G, Tamura Y. Treatment of chronic dislocation or subluxation of the distal radioulnar joint. Nippon Seikeigeka Gakkai Zasshi 1993; 67 (05) 399-407
- 17 Köppel M, Hargreaves IC, Herbert TJ. Ulnar shortening osteotomy for ulnar carpal instability and ulnar carpal impaction. J Hand Surg Eur Vol 1997; 22B: 451-456
- 18 Nishiwaki M, Nakamura T, Nakao Y, Nagura T, Toyama Y. Ulnar shortening effect on distal radioulnar joint stability: a biomechanical study. J Hand Surg Am 2005; 30 (04) 719-726
- 19 Tomaino MM, Elfar J. Ulnar impaction syndrome. Hand Clin 2005; 21 (04) 567-575
- 20 Palmer AK. Triangular fibrocartilage complex lesions: a classification. J Hand Surg Am 1989; 14 (04) 594-606
- 21 Boulas HJ, Milek MA. Ulnar shortening for tears of the triangular fibrocartilaginous complex. J Hand Surg Am 1990; 15 (03) 415-420
- 22 Minami A, Ishikawa J, Suenaga N, Kasashima T. Clinical results of treatment of triangular fibrocartilage complex tears by arthroscopic debridement. J Hand Surg Am 1996; 21 (03) 406-411
- 23 Hulsizer D, Weiss AP, Akelman E. Ulna-shortening osteotomy after failed arthroscopic debridement of the triangular fibrocartilage complex. J Hand Surg Am 1997; 22 (04) 694-698
- 24 Trumble TE, Gilbert M, Vedder N. Ulnar shortening combined with arthroscopic repairs in the delayed management of triangular fibrocartilage complex tears. J Hand Surg Am 1997; 22 (05) 807-813
- 25 Van Sanden S, De Smet L. Ulnar shortening after failed arthroscopic treatment of triangular fibrocartilage complex tears. Chir Main 2001; 20 (05) 332-336
- 26 Kawanishi Y, Moritomo H, Omori S, Kataoka T, Murase T, Sugamoto K. A comparison of 3-D computed tomography versus 2-D radiography measurements of ulnar variance and ulnolunate distance during forearm rotation. J Hand Surg Eur Vol 2014; 39 (05) 526-532