- 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 KJ Constanine MD et al (Journal of Hand Surg. Vol 25A. No 1. Jan 2000. p 57), 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;
