Guidelines for the Diagnosis and Treatment of Ulnar Impaction Syndrome (2024)_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 Asian Pacific Wrist Association Specialist Guideline Group on Diagnosis and Treatment of Ulnar Impaction Syndrome

Corresponding?author：

Asian Pacific Wrist Association Specialist Guideline Group on Diagnosis and Treatment of Ulnar Impaction Syndrome, Email: wendongxu@fudan.edu.cn

Keywords：

Ulnar impaction syndrome; diagnosis; treatment; guidelines

DOI：

10.7507/1002-1892.202607068

Video：

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Abstract Full text Figures/Tables Video References Cited by

Ulnar impaction syndrome (UIS), also known as ulnar impaction or ulnar abutment, is a degenerative condition causing pain on the ulnar side of the wrist. It can lead to wrist bone necrosis, resulting in wrist joint stability disruption and a significant wrist function impairment. The global understanding of this condition varies, contributing to substantial differences in clinical outcomes. In collaboration with the Asian Pacific Wrist Association (APWA), a team of experts from various fields within the Hand Surgery Department at Huashan Hospital Fudan University has collectively formulated the “Guidelines for the Diagnosis and Treatment of Ulnar Impaction Syndrome (2024)”. The development process adhered to the guidelines outlined in the World Health Organization (WHO)’s handbook for guideline development. The Guidelines forms 10 key questions and 21 recommendations, provides recommendations for UIS diagnosis, criteria for selecting conservative or surgical interventions, options for surgical procedures, and address various related issues, aiming to guide clinicians in their diagnostic and therapeutic approaches.

Citation： Asian Pacific Wrist Association Specialist Guideline Group on Diagnosis and Treatment of Ulnar Impaction Syndrome. Guidelines for the Diagnosis and Treatment of Ulnar Impaction Syndrome (2024). Chinese Journal of Reparative and Reconstructive Surgery, 2026, 40(9): 1325-1335. doi: 10.7507/1002-1892.202607068 Copy

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1. Milch H. Cuff resection of the ulna for malunited Colles’ fracture[J]. J Bone Joint Surg (Am), 1941, 23: 311-313.
2. Sammer DM, Rizzo M. Ulnar impaction[J]. Hand Clin, 2010, 26(4): 549-557.
3. Isa AD, Mcgregor ME, Padmore CE, et al. An in vitro study to determine the effect of ulnar shortening on distal forearm loading during wrist and forearm motion: implications in the treatment of ulnocarpal impaction[J]. J Hand Surg (Am), 2019, 44(8): 669-679.
4. WHO. WHO handbook for guideline development[M]. 2nd ed. Geneva: WHO Press, 2014.
5. Brouwers MC, Kerkvliet K, Spithoff KAGREE Next Steps Consortium. The AGREE Reporting Checklist: a tool to improve reporting of clinical practice guidelines[J/OL]. BMJ, 2016, 354: i4852. doi: 10.1136/bmj.i4852.
6. Chen YL, Yang KH, Marusic A, et al. A Reporting Tool for Practice Guidelines in Health Care: The RIGHT Statement[J]. Ann Intern Med, 2017, 166(2): 128-132.
7. Oxford Centre for Evidence-Based Medicine: Levels of Evidence (March 2009) [Z/OL]. [2023-10-08]. https://www.cebm.ox.ac.uk/resources/levels-of-evidence/oxford-centre-for-evidence-based-medicine-levels-of-evidencemarch-2009.
8. Jawed A, Ansari MT, Gupta V. TFCC injuries: How we treat? [J]. J Clin Orthop Trauma, 2020, 11(4): 570-579.
9. Skalski MR, White EA, Patel DB, et al. The traumatized TFCC: An illustrated review of the anatomy and injury patterns of the triangular fibrocartilage complex[J]. Curr Probl Diagn Radiol, 2016, 45(1): 39-50.
10. Palmer AK. Triangular fibrocartilage complex lesions: a classification[J]. J Hand Surg (Am), 1989, 14(4): 594-606.
11. Tomaino MM, Elfar J. Ulnar impaction syndrome[J]. Hand Clin, 2005, 21(4): 567-575.
12. Yu H, Wang T, Wang Y, et al. Ulnar shortening osteotomy vs. wafer resection for ulnar impaction syndrome: A systematic review and meta-analysis[J/OL]. Int J Surg, 2022, 104: 106725. doi: 10.1016/j.ijsu.2022.106725.
13. Afekenstam FW, Palmer AK, Glisson RR. The load on the radius and ulna in different positions of the wrist and forearm. A cadaver study[J]. Acta Orthop Scand, 1984, 55(3): 363-365.
14. Cardoso ANP, Viegas R, Gamelas P, et al. Ulnar shortening osteotomy: our experience[J]. Rev Bras Ortop (Sao Paulo), 2020, 55(5): 612-619.
15. Nakamura R, Horii E, Imaeda T, et al. The ulnocarpal stress test in the diagnosis of ulnar-sided wrist pain[J]. J Hand Surg (Br), 1997, 22(6): 719-723.
16. Sachar K. Ulnar-sided wrist pain: evaluation and treatment of triangular fibrocartilage complex tears, ulnocarpal impaction syndrome, and lunotriquetral ligament tears[J]. J Hand Surg (Am), 2012, 37(7): 1489-1500.
17. Shin EK. Impaction syndromes about the wrist[J]. Curr Rev Musculoskelet Med, 2023, 16(1): 1-8.
18. Dasilva MF, Goodman AD, Gil JA, et al. Evaluation of ulnar-sided wrist pain[J/OL]. J Am Acad Orthop Surg, 2017, 25(8): E150-E156.
19. Friedman SL, Palmer AK. The ulnar impaction syndrome[J]. Hand Clin, 1991, 7(2): 295-310.
20. Imaeda T, Nakamura R, Shionoya K, et al. Ulnar impaction syndrome: MR imaging findings[J]. Radiology, 1996, 201(2): 495-500.
21. Cerezal L, Del pi?al F, Abascal F. MR imaging findings in ulnar-sided wrist impaction syndromes[J]. Magn Reson Imaging Clin N Am, 2004, 12(2): 281-299, vi.
22. Tomaino MM. Ulnar impaction syndrome in the ulnar negative and neutral wrist. Diagnosis and pathoanatomy[J]. J Hand Surg (Br), 1998, 23(6): 754-757.
23. Roh YH, Kim S, Gong HS, et al. Prognostic value of clinical and radiological findings for conservative treatment of idiopathic ulnar impaction syndrome[J/OL]. Sci Rep, 2018, 8(1): 9891. doi: 10.1038/s41598-018-28060-2.
24. Ikeda M, Kobayashi Y, Saito I, et al. Conservative treatment using a newly designed custom-made wrist splint for ulnocarpal abutment syndrome[J]. Prosthet Orthot Int, 2015, 39(6): 496-501.
25. Terzis A, Koehler S, Sebald J, et al. Ulnar shortening osteotomy as a treatment of symptomatic ulnar impaction syndrome after malunited distal radius fractures[J]. Arch Orthop Trauma Surg, 2020, 140(5): 681-695.
26. Cha S, Shin H, Kim K, et al. Ulnar shortening for adolescent ulnar impaction syndrome: radiological and clinical outcomes[J]. J Hand Surg (Am), 2012, 37(12): 2462-2467.
27. Roulet S, Gubbiotti L, Lakhal W, et al. Ulna shortening osteotomy for ulnar impaction syndrome: Impact of distal radioulnar joint morphology on clinical outcome[J/OL]. Orthop Traumatol Surg Res, 2021, 107(5): 102970. doi: 10.1016/j.otsr.2021.102970.
28. Im J, Lee J, Kang H. The combined procedure of ulnar metaphyseal shortening osteotomy with triangular fibrocartilage complex foveal knotless repair [J/OL]. J Hand Surg (Am), 2021, 46(9): 822.e1-822.e7. doi: 10.1016/j.jhsa.2021.01.021.
29. Nishiwaki M, Nakamura T, Nakao Y, et al. Ulnar shortening effect on distal radioulnar joint stability: a biomechanical study[J]. J Hand Surg (Am), 2005, 30(4): 719-726.
30. Auzias P, Delarue R, Camus EJ, et al. Ulna shortening osteotomy versus arthroscopic wafer procedure in the treatment of ulnocarpal impingement syndrome[J]. Hand Surg Rehabil, 2021, 40(2): 156-161.
31. Feldon P, Terrono AL, Belsky MR. The “Wafer” procedure. Partial distal ulnar resection[J]. Clin Orthop Relat Res, 1992, (275): 124-129.
32. Sagerman SD, Zogby RG, Palmer AK, et al. Relative articular inclination of the distal radioulnar joint: a radiographic study[J]. J Hand Surg (Am), 1995, 20(4): 597-601.
33. 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]. J Hand Surg (Br), 1996, 21(5): 587-594.
34. Owens J, Compton J, Day M, et al. Nonunion rates among ulnar-shortening osteotomy for ulnar impaction syndrome: a systematic review[J/OL]. J Hand Surg (Am), 2019, 44(7): 612.e1-612.e12. doi: 10.1016/j.jhsa.2018.08.018.
35. Baek GH, Lee HJ, Gong HS, et al. Long-term outcomes of ulnar shortening osteotomy for idiopathic ulnar impaction syndrome: at least 5-years follow-up[J]. Clin Orthop Surg, 2011, 3(4): 295-301.
36. Megerle K, Hellmich S, Germann G, et al. Hardware location and clinical outcome in ulna shortening osteotomy[J/OL]. Plast Reconstr Surg Glob Open, 2015, 3(10): e549. doi: 10.1097/GOX.0000000000000521.
37. Constantine KJ, Tomaino MM, Herndon JH, et al. Comparison of ulnar shortening osteotomy and the wafer resection procedure as treatment for ulnar impaction syndrome[J]. J Hand Surg (Am), 2000, 25(1): 55-60.
38. Loh YC, Van den abbeele K, Stanley JK, et al. The results of ulnar shortening for ulnar impaction syndrome[J]. J Hand Surg (Br), 1999, 24(3): 316-320.
39. Darrow JC, Linscheid RL, Dobyns JH, et al. Distal ulnar recession for disorders of the distal radioulnar joint[J]. J Hand Surg (Am), 1985, 10(4): 482-491.
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