Abstract
Purpose: Ulnolunate disorders secondary to fracture of the radius generally result from inversion of the distal radioulnal index due to the relative shortening of the radius creating a conflict between the head of the ulna and the proximal anterior articular surface of the semilunate and cartilage impingement. Arthroscopy can often provide the diagnosis and minimally invasive treatment.
Material and methods: We reviewed a series of 32 patients, 15 men and 17 women, mean age 66 years (45–82). All presented sequelae of a fracture of the lower quarter of the radius with axial impaction. The ulnar variance was 2.7 mm (2–5). Time from initial fracture to arthroscopic resection was nine months (2–26). All patients presented pain, which was moderate and permanent in 19 and disabling in 13. Overall muscle force was reduced by 50% compared with the healthy side. Motion was limited due to the callus often associated with healing of these fractures. Patients underwent arthroscopy in an outpatient setting under locoregional anaesthesia. The arthroscope was introduced via a 3–4 radiocarpal portal allowing exploration of the joint space. Surgical treatment consisted in milling for partial distal resection of the ulnar head (6R radiocarpal portal). Wrist motion was restored in all cases.
Results: Mean follow-up was 39 months (18–54). Wrist motion was restored immediately in all cases. Pain at the radioulnar joint persisted in two patients. For 26 patients, the preoperative pain disappeared immediately. Muscle force improved compared with the preoperative level but did not reach the level of the healthy side.
Discussion: Arthroscopic treatment of ulnolunate impingement has proven efficacy and safety. It should however be reserved for cases with an inverted distal radioulnar index measuring less than 5 mm. If the ulnar variance is larger, we prefer ulnar osteotomy to shorten the bone. Other techniques are reserved for cases where the distal radioulnar joint is damaged.
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