- Discussion:
- impingement of distal ulna on carpi which may arise from positive ulnar variance or non union of distal ulnar frx;
- positive ulnar varience leads to loading of the ulnocarpal joint and resultant LT disruption, lunate chondral lesion, and TFCC tears;
- diff dx: (ulnar sided wrist pain) distral radio-ulnar DJD, pisotriquetral DJD, or ECU tendonitis;
- Exam Findings:
- positive ulnar stress test;
- tenderness with direct palpation of the ulnar carpal joint;
- Radiographs:
- radiographic findings may be subtle;
- may show flattening, subchondral sclerosis, and/or lytic changes in lunate and/or triquetrum with similar changes seen over the distal ulna;
- patients may have increased ulnar variance;
- in subtle cases, a pronation grip radiograph may demonstrate ulnar variance;
- bone scan may be positive;
- Treatment:
- Waffer Procedure;
- in the report by Constanine KJ, et al (2000), the authors compared ulnar shortening osteotomy vs the wafer procedure;
- 22 patients were followed over a 6 year period (11 patients in each group);
- 9 patients w/ ulnar shortening osteotomy had a good to excellent result vs 8 patients w/ good to excellent results in the wafer procedure group;
- 5 out of 11 patients required a secondary operative procedure (for either painful hardware or for non union);
- ulnar shortening osteotomy
- hemiresection arthroplasty
- along w/ distal ulnar osteotomy or hemiresection arthroplasty, injury to the TFCC should be addressed w/ repair or debridement
- Comparison of ulnar shortening osteotomy and the wafer resection procedure as treatment for ulnar impaction syndrome.