American Society for Peripheral Nerve

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Isolated Lunotriquetral Ligament Tears Treated with Ulnar Shortening Osteotomy
Ather Mirza, MD; Justin B. Mirza, DO
Ather Mirza, Smithtown, NY

Introduction: Isolated injuries to the lunotriquetral interosseous ligament (LTL) are relatively uncommon injuries of the carpus, which may be easily missed. These difficult-to-diagnose injuries are almost always of traumatic etiology, although not usually from high energy trauma. Patients often do not seek acute care for these injuries, with a reported delay to diagnosis of 1.2 yrs in one study (Shin 2001). The most widely reported surgical treatments require arthrotomy and report moderate to high rate of complication. In contrast, ulnar-shortening osteotomy (USO) carries the benefit of not violating the wrist joint, instead reducing lunotriquetral motion by tightening the relevant extrisic ligaments. This study aims to assess the outcomes of isolated lunotriquetral interosseous ligament (LTL) tears treated with ulnar shortening osteotomy (USO).

Materials & Methods: This study includes 62 cases of arthroscopically verified isolated LTL tears (Geissler type II to IV) treated with a USO technique between October 1992 and April 2010 with minimum one year follow-up (range, 1 to 10.6 y). Surgical outcomes were assessed using pre- and post-operative measurements of grip strength and active range of motion (AROM) as well as objective and subjective data graded using Chun and Palmer’s modified Gartland Werley wrist grading system.

Results: Preoperatively, all cases were graded fair (29.0%, n=18) or poor (56.5%, n=35), with insufficient data to calculate grades in nine cases. At final follow-up, the majority of patients exhibited excellent (48.4%, n=30) or good (30.6%, n = 19) scores, some fair (16.1%, n=10) and no poor scores, with insufficient data to calculate scores in two cases. All subjective and objective variables significantly improved at final follow-up. Mean grip strength increased from a value of 22.4 kg before surgery to 31.8 kg at final follow-up, a 9.4 kg (41.8%) increase. Ulnar variance was reduced from a preoperative mean of 0.94 mm (range, -2 to +3.5 mm) to a postoperative mean of -1.04 mm (range, -5 to 0.5). The mean bone healing time was 18.6 weeks (range, 8 to 37 weeks) post osteotomy. There were no non-unions, infections, or other complications. Osteotomy plates were removed in most cases (87.0%, n=54) at a mean of 16.9 months, upon persistent tenderness in the plate area that was unresponsive to conservative management.

Conclusions: Ulnar shortening osteotomy reduced symptoms of posttraumatic isolated LTL tears in this single-surgeon series.

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