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 Hand Surg Am. 2019 Aug;44(8):669-679. doi: 10.1016/j.jhsa.2019.04.007. Epub 2019 Jun 3.

Abstract

Purpose: To evaluate the effect of ulnar shortening on distal forearm loading following simulated dynamic motion.

Methods: Ulnar shortening was simulated using a custom-built adjustable implant to simulate up to 4 mm of ulnar shortening (-4 mm) in 9 cadaveric extremities. Load cells were placed in the distal ulna and radius to quantify axial loading. Using a wrist and forearm motion simulator, absolute and percentage loads were measured during dynamic flexion, ulnar deviation (UD), flexion dart throw (DT), and pronation.

Results: There was a significant decrease in absolute and percentage distal ulnar loads at each interval of ulnar shortening during flexion, UD, DT, and pronation. The distal ulna bore no compressive loads, and in fact, tensile loads were measured in the ulna at 2 mm of ulnar shortening during DT and pronation, at 3 mm during flexion, and at 4 mm during UD.

Conclusions: A progressive decrease in distal ulnar loads with generation of tensile loads was observed with sequential ulnar shortening.

Clinical relevance: Ulnar shortening greater than 2 mm can result in tensile loading in the distal ulna. When managing ulnar impaction syndrome, excessive shortening may not be required to provide relief of symptoms.

Keywords: Forearm load sharing; ulnar-shortening osteotomy; ulnocarpal impaction; wrist biomechanics.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Biomechanical Phenomena
  • Cadaver
  • Carpal Joints / physiopathology*
  • Carpal Joints / surgery
  • Forearm / physiopathology
  • Humans
  • In Vitro Techniques
  • Middle Aged
  • Orthopedic Procedures
  • Osteotomy
  • Prostheses and Implants
  • Range of Motion, Articular
  • Stress, Mechanical
  • Syndrome
  • Ulna / physiopathology*
  • Ulna / surgery*
  • Weight-Bearing
  • Wrist Joint / physiopathology
  • Wrist Joint / surgery