Top

Archives of Orthopaedic and Trauma Surgery

Published in:

01-01-2016 | Handsurgery

The distal radial decompression osteotomy for ulnar impingement syndrome

Authors: Hermann Krimmer, Frank Unglaub, Martin F. Langer, Christian K. Spies

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 1/2016

Abstract

Introduction

The decompression of the distal radioulnar joint (DRUJ) is performed by ulnar translation of the radial shaft proximal to the sigmoid notch, i.e. detensioning of the distal part of the interosseous membrane (DIOM) while containment of the DRUJ is achieved by closed wedge osteotomy of the radius. The osteotomy shortens the radius which entails detensioning of the triangular fibrocartilage complex (TFCC).

Surgical technique

Facilitating the modified Henry approach to the distal palmar radius a radial based wedge osteotomy is applied. The proximal osteotomy is proximal to the ulnar head and distal osteotomy is proximal to the sigmoid notch to prevent iatrogenic impingement. Ulnar translation of the radial shaft is performed to loosen the DIOM. The closed wedge osteotomy reduces radial inclination which will foster containment of the DRUJ.

Conclusion

Distal radial decompression osteotomy of the DRUJ preserves DRUJ function while relieving painful impingement. Further surgical interventions are not compromised in case of failure.

Krimmer H (2015) Decompression osteotomy DRUJ: indications and technique. Annual meeting of the German Society of Hand Surgeons, Ludwigsburg, 2015

Krimmer H (2012) Corrective osteotomy for treatment of the painful DRUJ in severe ulna minus. IWI Workshop held at the annual meeting of the American Society for Surgery of the Hand, Chicago, 2012

Ozer K (2015) Management of complications of distal radioulnar joint. Hand Clin 31(2):235–242. doi:10.1016/j.hcl.2014.12.003 PubMedCrossRef

Sotereanos DG, Papatheodorou LK, Williams BG (2014) Tendon allograft interposition for failed distal ulnar resection: 2- to 14-year follow-up. J Hand Surg Am 39(3):443–448. doi:10.1016/j.jhsa.2013.11.004 PubMedCrossRef

Moritomo H, Noda K, Goto A et al (2009) Interosseous membrane of the forearm: length change of ligaments during forearm rotation. J Hand Surg Am 34(4):685–691. doi:10.1016/j.jhsa.2009.01.015 PubMedCrossRef

Hagert CG (1994) Distal radius fracture and the distal radioulnar joint–anatomical considerations. Handchir Mikrochir Plast Chir 26(1):22–26PubMed

Kleinman WB (2007) Stability of the distal radioulna joint: biomechanics, pathophysiology, physical diagnosis, and restoration of function what we have learned in 25 years. J Hand Surg Am 32(7):1086–1106. doi:10.1016/j.jhsa.2007.06.014 PubMedCrossRef

Haugstvedt J, Berger RA, Nakamura T et al (2006) Relative contributions of the ulnar attachments of the triangular fibrocartilage complex to the dynamic stability of the distal radioulnar joint. J Hand Surg Am 31(3):445–451. doi:10.1016/j.jhsa.2005.11.008 PubMedCrossRef

Xu J, Tang JB (2009) In vivo changes in lengths of the ligaments stabilizing the distal radioulnar joint. J Hand Surg Am 34(1):40–45. doi:10.1016/j.jhsa.2008.08.006 PubMedCrossRef

10.

Schuind F, An KN, Berglund L et al (1991) The distal radioulnar ligaments: a biomechanical study. J Hand Surg Am 16(6):1106–1114PubMedCrossRef

11.

Kihara H, Short WH, Werner FW et al (1995) The stabilizing mechanism of the distal radioulnar joint during pronation and supination. J Hand Surg Am 20(6):930–936. doi:10.1016/S0363-5023(05)80139-X PubMedCrossRef

12.

Stuart PR, Berger RA, Linscheid RL et al (2000) The dorsopalmar stability of the distal radioulnar joint. J Hand Surg Am 25(4):689–699. doi:10.1053/jhsu.2000.9418 PubMedCrossRef

13.

Watanabe H, Berger RA, Berglund LJ et al (2005) Contribution of the interosseous membrane to distal radioulnar joint constraint. J Hand Surg Am 30(6):1164–1171. doi:10.1016/j.jhsa.2005.06.013 PubMedCrossRef

14.

Moritomo H (2015) The function of the distal interosseous membrane and its relevance to the stability of the distal radioulnar joint: an anatomical and biomechanical review. Handchir Mikrochir Plast Chir 47(5):277–280. doi:10.1055/s-0035-1545348 PubMedCrossRef

15.

Spies CK, Niehoff A, Unglaub F et al (2015) Biomechanical comparison of transosseous re-fixation of the deep fibres of the distal radioulnar ligaments versus deep and superficial fibres: a cadaver study. Int Orthop. doi:10.1007/s00264-015-2986-1

16.

Hagert E, Hagert C (2010) Understanding stability of the distal radioulnar joint through an understanding of its anatomy. Hand Clin 26(4):459–466. doi:10.1016/j.hcl.2010.05.002 PubMedCrossRef

17.

Spies CK, Prommersberger KJ, Langer M et al (2015) Instability of the distal radioulnar joint: treatment options for ulnar lesions of the triangular fibrocartilage complex. Unfallchirurg 118(8):701–717. doi:10.1007/s00113-015-0044-5 PubMedCrossRef

18.

Noda K, Goto A, Murase T et al (2009) Interosseous membrane of the forearm: an anatomical study of ligament attachment locations. J Hand Surg Am 34(3):415–422. doi:10.1016/j.jhsa.2008.10.025 PubMedCrossRef

19.

Kitamura T, Moritomo H, Arimitsu S et al (2011) The biomechanical effect of the distal interosseous membrane on distal radioulnar joint stability: a preliminary anatomic study. J Hand Surg Am 36(10):1626–1630. doi:10.1016/j.jhsa.2011.07.016 PubMedCrossRef

20.

Moritomo H, Omori S (2014) Influence of ulnar translation of the radial shaft in distal radius fracture on distal radioulnar joint instability. J Wrist Surg 3(1):18–21. doi:10.1055/s-0033-1364093 PubMedPubMedCentralCrossRef

21.

Arimitsu S, Moritomo H, Kitamura T et al (2011) The stabilizing effect of the distal interosseous membrane on the distal radioulnar joint in an ulnar shortening procedure: a biomechanical study. J Bone Joint Surg Am 93(21):2022–2030. doi:10.2106/JBJS.J.00411 PubMedCrossRef

22.

Doyle JR, Botte MJ (2003) Surgical anatomy of the hand and upper extremity. Lippincott Williams & Wilkins, Philadelphia

23.

Spies CK, Müller LP, Oppermann J et al (2014) Instability of the distal radioulnar joint—an overview of clinical and radiological procedures regarding their efficacies. Handchir Mikrochir Plast Chir 46(3):137–150. doi:10.1055/s-0033-1363662 PubMedCrossRef

24.

Bowers WH (1985) Distal radioulnar joint arthroplasty: the hemiresection-interposition technique. J Hand Surg Am 10(2):169–178PubMedCrossRef

25.

Kapandji IA (1986) The Kapandji-Sauvé operation. Its techniques and indications in non rheumatoid diseases. Ann Chir Main 5(3):181–193PubMedCrossRef

26.

Löw S, Mühldorfer-Fodor M, Pillukat T et al (2014) Ulnar shortening osteotomy for malunited distal radius fractures: results of a 7-year follow-up with special regard to the grade of radial displacement and post-operative ulnar variance. Arch Orthop Trauma Surg 134(1):131–137. doi:10.1007/s00402-013-1892-5 PubMedCrossRef

27.

van Schoonhoven J, Fernandez DL, Bowers WH et al (2000) Salvage of failed resection arthroplasties of the distal radioulnar joint using a new ulnar head prosthesis. J Hand Surg Am 25(3):438–446. doi:10.1053/jhsu.2000.6006 PubMedCrossRef

28.

Ahrens C, Unglaub F, Bruckner T et al (2014) Midterm functional outcome after dorsal capsular imbrication for posttraumatic instability of the distal radioulnar joint. Arch Orthop Trauma Surg 134(11):1633–1639. doi:10.1007/s00402-014-2092-7 PubMedCrossRef

29.

Unglaub F, Manz S, Bruckner T et al (2013) Dorsal capsular imbrication for dorsal instability of the distal radioulnar joint. Oper Orthop Traumatol 25(6):609–614. doi:10.1007/s00064-012-0223-2 PubMedCrossRef

30.

Löw S, Herold A, Eingartner C (2014) Standard wrist arthroscopy: technique and documentation. Oper Orthop Traumatol 26(6):539–546. doi:10.1007/s00064-014-0311-6 PubMedCrossRef

Title: The distal radial decompression osteotomy for ulnar impingement syndrome
Authors: Hermann Krimmer
Frank Unglaub
Martin F. Langer
Christian K. Spies
Publication date: 01-01-2016
Publisher: Springer Berlin Heidelberg
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 1/2016
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-015-2363-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The distal radial decompression osteotomy for ulnar impingement syndrome

Abstract

Introduction

Surgical technique

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Surgical technique

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2016

Validation of a German version of the International Hip Outcome Tool (G-iHOT33) according to the COSMIN checklist: how much improvement is clinically relevant?

Prognostic factors and therapeutic options for treatment of frozen shoulder: a systematic review

Development and initial evaluation of a point-of-care educational app on medical topics in orthogeriatrics

Unicompartmental knee arthroplasty in patients over 75 years: a definitive solution?

Dislocation is a risk factor for poor outcome after supination external rotation type ankle fractures

Recovery of subscapularis and shoulder function following arthroscopic treatment of isolated anterior and combined anterosuperior rotator cuff lesions