Treatment of the Associated Ulnar-Sided Problems

  • Pier Paolo BorelliEmail author
  • Riccardo Luchetti


Ulnar impaction, ulnar styloid impaction (USI), ligamentous injury, chondral lesions, associated TFC tear (triangular fibrocartilage) with or without instability [18–20], and sigmoid fossa derangements can all be associated with a radius malunion (Fig. 13.1). Although it is true that treatment of the radius malunion itself might partially correct some of the problems, particularly those caused by axial shortening (USI), many other will remain unaddressed, and will be a source of pain and patient dissatisfaction. On the other hand, the isolated treatment of the associated injuries can be sufficient to ease the patient’s symptoms without addressing the radius, and a less involved postoperative course. Arthroscopic exploration allows the assessment of the impact that those associated injuries might have on the patient’s symptoms and the degree of improvement by the radius osteotomy itself, and also helps to evaluate if additional maneuvers (arthroscopic or open) are needed for addressing concomitant injuries.


Ulnar Collateral Ligament Ulnar Styloid Ulnar Head Ulnar Styloid Process Radioulnar Ligament 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Adams BD. Anatomic reconstruction of the distal radioulnar ligaments for DRUJ instability. Tech Hand Up Extrem Surg. 2000;4(3):154–60 CrossRefPubMedGoogle Scholar
  2. 2.
    Atzei A. New trend in arthroscopic management of type 1-B TFCC injuries with DRUJ instability. J Hand Surg Eur. 2009;20:1–10 Google Scholar
  3. 3.
    Atzei A, Luchetti R, Fairplay T. Arthroscopic foveal repair of triangular fibrocartilage complex peripheral lesion with distal radioulnar joint instability. Tech Hand Up Extrem Surg. 2008;12(4):226–35 CrossRefPubMedGoogle Scholar
  4. 4.
    Bain GI, Bidwell TA. Arthroscopic excision of ulnar styloid in stylocarpal impaction. Arthroscopy. 2006;22:677.e1–e3 CrossRefGoogle Scholar
  5. 5.
    Bain GI, Pourgiezis NP. Surgical approaches to the distal radioulnar joint. Tech Hand Up Extrem Surg. 2007;11(1): 51–6 CrossRefPubMedGoogle Scholar
  6. 6.
    Bernstein MA, Nagle DJ, Martinez A, Stogin JM, Wiedrich TA. A comparison of combined arthroscopic triangular fibrocartilage complex debridement and arthroscopic wafer distal ulna resection versus arthroscopic triangular fibrocartilage complex debridement and ulnar shortening osteotomy for ulnocarpal abutment syndrome. Arthroscopy. 2004;20: 392–401 CrossRefPubMedGoogle Scholar
  7. 7.
    Bickel KD. Arthroscopic treatment of ulnar impaction syndrome. J Hand Surg. 2008;33A:1420–3 Google Scholar
  8. 8.
    Cerezal L, del Piñal F, Abascal F, Garcia-Valtuille R, Pereda T, Canga A. Imaging findings in ulnar-sided wrist impaction syndromes. Radiographics 2002;22(1):105–20 Google Scholar
  9. 9.
    Chun S, Palmer AK. The ulnar impaction syndrome: follow-up of ulnar shortening osteotomy. J Hand Surg Am. 1993; 1818:46–53 CrossRefGoogle Scholar
  10. 10.
    del Piñal F. The 1-B “Constellation”: a sub-classification of TFCC tears. EWAS session, FEESH Poznam 2009 Google Scholar
  11. 11.
    del Piñal F, Garcia-Bernal FJ, Delgado J, Sammartçn M, Regaldo J, Cerezal L. Correction of malunited intra-articular distal radius fractures with an Inside-out osteotomy technique. J Hand Surg Am. 2006;31A:1029–34CrossRefGoogle Scholar
  12. 12.
    Del Piñal F, García-Bernal FJ, Studer A, Regalado J, Ayala H, Cagigal L. Sagittal rotational malunions of the distal radius: the role of pure derotational osteotomy. J Hand Surg Eur. 2009;34:160–5 Google Scholar
  13. 13.
    Feldon P, Terrono AL, Belsky MR. Wafer distal ulna resection for triangular fibrocartilage tears and/or ulna impaction syndrome. J Hand Surg. 1992;17A:731–7 Google Scholar
  14. 14.
    Fernandez DL. Correction of post-traumatic wrist deformity in adults by osteotomy, bone-grafting, and internal fixation. J Bone Joint Surg Am. 1982;64-A:1164–78 Google Scholar
  15. 15.
    Garcia-Elias M. Dorsal fractures of the triquetrum-avulsion or compression fractures? J Hand Surg Am. 1987;12:266–8 PubMedGoogle Scholar
  16. 16.
    Garcia-Elias M. Soft-tissue anatomy and relationships about the distal ulna. Hand Clin. 1998;14:165–76 PubMedGoogle Scholar
  17. 17.
    Giachino AA, McIntyre AI, Gui KJ, Conway AF. Ulnar styloid triquetral impaction. Hand Surg. 2007;12(2):123–34 CrossRefPubMedGoogle Scholar
  18. 18.
    Lindau T. Cartilage injuries in distal radial fractures. Acta Orthop Scand. 2003;74(3):327–31 CrossRefPubMedGoogle Scholar
  19. 19.
    Lindau T, Adlercreutz C, Aspenberg P. Peripheral TFCC tears and instability of the distal radioulnar joint after distal radial fractures. J Hand Surg. 2000;22A:464–8 Google Scholar
  20. 20.
    Lindau TR, Arner M, Hagberg L. Intra-articular lesions in distal radius fractures in young adults: a descriptive, arthroscopic study in 50 patients. J Hand Surg [Br]. 1997; 22-B(5):639–43 Google Scholar
  21. 21.
    Loftus JB. Arthroscopic wafer for ulnar impaction syndrome. Tech Hand Up Extrem Surg. 2000;4:182–8 CrossRefPubMedGoogle Scholar
  22. 22.
    Loh YC, Den Abbellek V, Stanley JK, et al. The results of ulnar shortening for ulnar impaction syndrome. J Hand Surg Br. 1999;24:316–20 CrossRefPubMedGoogle Scholar
  23. 23.
    Luchetti R, Borelli PP, Atzei P. Moderni orientamenti nel trattamento delle fratture. Il trattamento delle fratture di polso. In: AIOD Sezione Italiana, OTC Sezione Italiana, editors. Moderni orientamenti nel trattamento delle fratture. Italia, Milano: Springer. Stryker Italia Education Program. 2008. p. 519–88 Google Scholar
  24. 24.
    Mathoulin C, Pagnotta A. Resection arthroscopique distale de l’ulna dans les conflits. Chir Main. 2006;25S:202–8 CrossRefGoogle Scholar
  25. 25.
    Nakamura T, Makita A. The proximal ligamentous component of the triangular fibrocartilage complex: functional anatomy and three-dimensional changes in length of the radioulnar ligament during pronation-supination. J Hand Surg Br. 2000;25:479–86 PubMedGoogle Scholar
  26. 26.
    Nakamura T, Nakao Y, Ikegami H, Sato K, Takayama S. Open repair of the ulnar disruption of the triangular fibrocartilage complex with double three-dimensional mattress suturing technique. Tech Hand Up Extrem Surg. 2004;8:116–23 CrossRefPubMedGoogle Scholar
  27. 27.
    Palmer AK. Triangular fibrocartilage complex lesions: a classification. J Hand Surg. 1989;14A:594–606 Google Scholar
  28. 28.
    Sachar K. Ulnar-sided wrist pain: evaluation and treatment of triangular fibrocartilage complex tears, ulnocarpal impaction syndrome, and lunotriquetral ligament tears. J Hand Surg. 2008;33A:1669–79 Google Scholar
  29. 29.
    Scheker LR, Ozer K. Ligamentous stabilization of the distal radioulnar joint. Tech Hand Up Extrem Surg. 2004;8:239–46 CrossRefPubMedGoogle Scholar
  30. 30.
    Slutsky DJ. Distal radioulnar joint arthroscopy and the volar ulnar portal. Tech Hand Upper Extrem Surg. 2007; 11(1): 38–44 CrossRefGoogle Scholar
  31. 31.
    Scheker LR, Slutsky OK, Tay SC DJ, Tomita K, Berger RA. The “ulnar fovea sign” for defining ulnar wrist pain: an analysis of sensitivity and specificity. J Hand Surg Am. 2007;32: 438–44 CrossRefGoogle Scholar
  32. 32.
    Tolat AR, Stanley JK, Trail IA. A cadaveric study of the anatomy and stability of the distal radioulnar joint in the coronal and transverse planes. J Hand Surg Br. 1996;21:587–94 CrossRefPubMedGoogle Scholar
  33. 33.
    Tolat AR, Stanley JK, Tomaino TIA, MM EJ. Ulnar impaction syndrome. Hand Clin. 2005;21:567–75 CrossRefGoogle Scholar
  34. 34.
    Tolat AR, Stanley JK, Tomaino TIA, MM EJ, Topper SM, Wood MB, et al. Ulnar styloid impaction syndrome. J Hand Surg Am. 1997;22:699–704 CrossRefGoogle Scholar
  35. 35.
    Tolat AR, Stanley JK, Tomaino TIA, MM EJ, Topper SM, Wood MB, et al. Force transmission through the distal ulna: effect of ulnar variance, lunate fossa angulation, and radial and palmar tilt of the distal radius. J Hand Surg Am. 1992;17: 423–8CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2010

Authors and Affiliations

  1. 1.Wrist and Hand Surgery Service 1st Division of Orthopaedic and Trauma Center Spedali Civili of BresciaBresciaItaly
  2. 2.Rimini Hand Surgery & Rehabilitation Center, Rimini Multimedica Policlinic, MilanoRiminiItaly

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