gms | German Medical Science

Objectives/Interrogation: Ulnar wrist pain is frequently caused by Ulnocarpal Impactation Syndrome (UIS) or Ulnocarpal Abutment. As an introduction we clarify the terminology, outline differential diagnosis. The purpose of our presentation to demonstrate our algorhythmical approach based on the experiences of the last four years.

Methods: Our treatment algorhythm will be shown as a flowchart with key points as follows: always conservative therapy at first, in case of DRUJ arthrosis/instability or limited pro/supination, consider Sauve-Kapandji procedure or DRUJ reconstruction, when having significant radius malalignment, consider corrective osteotomy, if only ulna plus is present and it exceeds 2-3 mm, consider extraarticular ulna shortening, otherwise arthroscopical/open wafer resection of the ulnar dome.

We didn't have early postoperative complications, however, implant removal was needed in 3 cases due to local sensitivity or allergic response to the metalwork inside. We had one non-union following extraarticular ulna shortening. Regarding to the 6 months outcome, based on the patients opinion, 0 bad, 1 acceptable, 5 good and 17 excellent results has been reported.

We demonstrate our algorhythm with solution of a rare case of UIS with DRUJ instability.

Results and Conclusions: When handling Ulnar Impactation Syndrome, the nonsurgical therapy should be considered as a first line of treatment. It is very important to exclude the other factors in ulnar wrist pain (e.g. ulnar impingement, TFCC pathology, ECU tenosynovitis etc.). Due to the difficult differential diagnosis one should use a well devised, reasoned algorhythmical thinking to get a better outcome.