How to treat ulnar impingment syndrome in 2025?
Seance of wednesday 22 january 2025 (Chirurgie du poignet)
DOI number : 10.26299/50na-dg92/emem.2025.03.03
Abstract
Ulna impingement syndrome is a well-known and frequent cause of ulnar-sided wrist pain. Most often, ulnar impingement syndrome is the consequence of a relative excess of ulna length increasing ulnocarpal pressure, either congenital or following a radius fracture. An effective treatment consists in ulna shortening, as proposed by Milch, or an epiphyseal shortening better known as wafer procedure proposed by Feldon for open technique, and modified by Wnorowski for arthroscopy.
Those 2 main options are time-proven techniques, showing effectiveness for pain decrease, but despite several studies they remain competitors in surgeon’s choice. Indeed, clinical and radiographic outcomes, general complication rate remain similar for both options, but specific complications and secondary surgeries are more frequent in the osteotomy groups, mostly related to the plates used. Furthermore, implant removal expose patients to refracture of the ulna.
We expose our experience of a long oblique shortening osteotomy of the ulna, that seems to address most of the classical disadvantages of the classical plate-stabilized osteotomies. A retrospective study of our 14 first patients operated with this technique, was conducted between February 2019 and November 2022. Bone healing was achieved for all patients, with 2.46 months healing time, and a mean shortening of 4,43mm. All patients reported pain improvement, and complications were benign and uncommon. Two patients had implant removal, one of them related to psychological reasons. This technique allowed for an easy ulna shortening, reversible until screw fixation and without any specific device. Postoperatively, healing-time seemed optimal and fast, device non-intrusive, and implant removal could be done easily and without expected high-risk of refracture. We have now shifted our osteotomy technique exclusively toward this long oblique shortening technique.
However, ulna impingement syndrome treatment is not just a question of osteotomy-type. We propose to sum-up the different anatomic, pathologic and patient-related factors that influence our choice for decision-making.
Dr Thomas JAGER
Institut Européen de la Main, Hôpitaux Robert Schuman, Luxembourg
Those 2 main options are time-proven techniques, showing effectiveness for pain decrease, but despite several studies they remain competitors in surgeon’s choice. Indeed, clinical and radiographic outcomes, general complication rate remain similar for both options, but specific complications and secondary surgeries are more frequent in the osteotomy groups, mostly related to the plates used. Furthermore, implant removal expose patients to refracture of the ulna.
We expose our experience of a long oblique shortening osteotomy of the ulna, that seems to address most of the classical disadvantages of the classical plate-stabilized osteotomies. A retrospective study of our 14 first patients operated with this technique, was conducted between February 2019 and November 2022. Bone healing was achieved for all patients, with 2.46 months healing time, and a mean shortening of 4,43mm. All patients reported pain improvement, and complications were benign and uncommon. Two patients had implant removal, one of them related to psychological reasons. This technique allowed for an easy ulna shortening, reversible until screw fixation and without any specific device. Postoperatively, healing-time seemed optimal and fast, device non-intrusive, and implant removal could be done easily and without expected high-risk of refracture. We have now shifted our osteotomy technique exclusively toward this long oblique shortening technique.
However, ulna impingement syndrome treatment is not just a question of osteotomy-type. We propose to sum-up the different anatomic, pathologic and patient-related factors that influence our choice for decision-making.
Dr Thomas JAGER
Institut Européen de la Main, Hôpitaux Robert Schuman, Luxembourg