Question About Ulnar Impaction Surgery

[tdsd84]

My brother complained of wrist pain and decreased grip strength. He went to a doctor who then did surgery in Nov 2010 for Ulnar impaction. About 3 weeks ago, he showed me a picture of his xray that he had done at his last appt. His doctor told him he was doing good. But the picture of the xray shows a slice of the ulnar bone removed and now there is a gap. At the wrist, there is a thin brace that connects the radius and the ulnar bone but there is nothing that stablizes the cut ulnar bone to the other end of the ulnar bone. This doesn't look normal to me. The doctor had not indicated that more surgery would be needed to stabilize this. If this is a common thing, please explain how the bone will heal together when the ends don't even touch. I am afraid for him. I have a picture of the xray that I can email if you would like to see it.

[mtomaino]

It sounds as though your brother had an ulnar shortening osteotomy. This usually requires the use of a plate and screws for stabilization. There certainly is a risk of delayed healing or even nonunion. If possible, reply to this post---and scroll down to where it says "mamage attachments". You should be able to upload xray pics if you have them.

[tdsd84]

Thank you for your time. I appreciate your feedback

[mtomaino]

The xray you provided shows that your brother had a fusion between the distal ulna and the radius, as well as creation of a more proximal ulnar pseudarthrosis to provide forearm rotation. This is called the "Suave Kapanji" procedure.

Ordinarily this is one of several options for treating DRUJ (distal radioulnar joint) arthritis. But, as in your brother's case, it can be used to treat ulnar impaction syndrome--so long as the length of the ulna is shortened prior to performing the fusion. The "gap" in the ulna is intentional--to allow for forearm rotation.

I have attached 2 pictures which may be easier to see for future Forum viewers.

[tdsd84]

Will he be able to return to work? He has a physically demanding job. His doctor said that he may not even be able to use a hammer or ride a motorcycle. This was an elective surgery and was not something he would have had done if it was going to disable him. This surgery was not explained. When he first saw his xray, he thought he had broken his arm. Was there a more conserative treatment for wrist pain that could have been attempted?

Thank you so much for sharing your expertise.

[mtomaino]

I am sure that his Doctor took into consideration the etiology of his pain, and utilized a surgical option that he/she was familiar with. This is a well known option, but does mean, potentially, that there may be some activity limitations.

This, all too often, is the reality after wrist surgery---just like after low back surgery. You and your brother should remain patient and optimistic. And, if some "adaptation" is needed down the road, embrace the fact that his wrist was limiting him, and that this may have been among the best possible solutions.

Best of luck!