Original Article| Volume 28, ISSUE 2, P364-369, March 2023

Do triangular fibrocartilage complex foveal injuries affect the clinical outcome of ulnar shortening osteotomy for ulnar impaction syndrome?

Published:December 15, 2021DOI:



      Ulnar shortening osteotomy (USO), as its name implies, is used to shorten the ulna. It subsequently tightens the triangular fibrocartilage complex (TFCC) and ulnar wrist. TFCC foveal insertion is a primary stabilizer of the distal radioulnar joint. It is unclear whether USO is effective in TFCC foveal injuries. The purpose of this study was to review the clinical outcomes of ulnar shortening osteotomies with and without TFCC foveal injuries.


      We retrospectively reviewed patients with ulnar wrist pain treated with USO and wrist arthroscopy including the distal radioulnar joint (DRUJ). Sixty-five patients were included in this study. An algorithm was used to guide surgical decision-making. After arthroscopic confirmation of ulnar impaction syndrome, we performed USO with a locking compression plate (mean length of shortening, 2.7 mm; range, 1–7.5 mm). The flattened TFCC disc due to ulnar shortening was confirmed arthroscopically. If the DRUJ was unstable after USO, we repaired the TFCC foveal insertion.


      There were 32 post-traumatic and 33 idiopathic cases. We detected TFCC disc injuries in 34 wrists and TFCC foveal injuries in 33 wrists; both types were found in 15 wrists. TFCC foveal injuries were not significantly correlated with patient age, history of trauma, or clinical outcome. Most patients showed good clinical outcomes; 31 of 65 patients had preoperative DRUJ instability, with a significant number having foveal but not disc injuries.


      USO achieved reasonable outcomes, even in patients with TFCC foveal injuries. In cases demonstrating ulnar impaction, USO should be prioritized over TFCC repair.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Orthopaedic Science
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Palmer A.K.
        The distal radioulnar joint.
        Orthop Clin N Am. 1984 Apr; 15: 321-335
        • Sachar K.
        Ulnar-sided wrist pain: evaluation and treatment of triangular fibrocartilage complex tears, ulnocarpal impaction syndrome, and lunotriquetral ligament tears.
        J Hand Surg Am. 2012 Jul; 37: 1489-1500
        • Nakamura R.
        • Horii E.
        • Imaeda T.
        • Nakao E.
        • Kato H.
        • Watanabe K.
        The ulnocarpal stress test in the diagnosis of ulnar-sided wrist pain.
        J Hand Surg Br. 1997 Dec; 22: 719-723
        • Haugstvedt J.R.
        • Langer M.F.
        • Berger R.A.
        Distal radioulnar joint: functional anatomy, including pathomechanics.
        J Hand Surg Eur. 2017 May; 42: 338-345
        • Chan J.J.
        • Teunis T.
        • Ring D.
        Prevalence of triangular fibrocartilage complex abnormalities regardless of symptoms rise with age: systematic review and pooled analysis.
        Clin Orthop Relat Res. 2014 Dec; 472: 3987-3994
        • Tatebe M.
        • Shinohara T.
        • Okui N.
        • Yamamoto M.
        • Hirata H.
        • Imaeda T.
        Clinical, radiographic, and arthroscopic outcomes after ulnar shortening osteotomy: a long-term follow-up study.
        J Hand Surg Am. 2012 Dec; 37: 2468-2474
        • Milch H.
        Cuff resection of the ulna for malunited Colles' fracture.
        J Bone Joint Surg Am. 1941; 23: 311-313
        • Moritomo H.
        The distal interosseous membrane: current concepts in wrist anatomy and biomechanics.
        J Hand Surg Am. 2012 Jul; 37: 1501-1507
        • Nishiwaki M.
        • Nakamura T.
        • Nakao Y.
        • Nagura T.
        • Toyama Y.
        Ulnar shortening effect on distal radioulnar joint stability: a biomechanical study.
        J Hand Surg Am. 2005 Jul; 30: 719-726
        • Tatebe M.
        • Horii E.
        • Nakao E.
        • Shinohara T.
        • Imaeda T.
        • Nakamura R.
        • Hirata H.
        Repair of the triangular fibrocartilage complex after ulnar-shortening osteotomy: second-look arthroscopy.
        J Hand Surg Am. 2007 Apr; 32: 445-449
        • Darrow Jr., J.C.
        • Linscheid R.L.
        • Dobyns J.H.
        • Mann 3rd, J.M.
        • Wood M.B.
        • Beckenbaugh R.D.
        Distal ulnar recession for disorders of the distal radioulnar joint.
        J Hand Surg Am. 1985 Jul; 10: 482-491
        • Boulas H.J.
        • Milek M.A.
        Ulnar shortening for tears of the triangular fibrocartilaginous complex.
        J Hand Surg Am. 1990 May; 15: 415-420
        • Mirza A.
        • Mirza J.B.
        • Shin A.Y.
        • Lorenzana D.J.
        • Lee B.K.
        • Izzo B.
        Isolated lunotriquetral ligament tears treated with ulnar shortening osteotomy.
        J Hand Surg Am. 2013 Aug; 38: 1492-1497
        • Tatebe M.
        • Nishizuka T.
        • Hirata H.
        • Nakamura R.
        Ulnar shortening osteotomy for ulnar-sided wrist pain.
        J Wrist Surg. 2014 May; 3: 77-84
        • Nishizuka T.
        • Tatebe M.
        • Hirata H.
        • Shinohara T.
        • Yamamoto M.
        • Iwatsuki K.
        Simple debridement has little useful value on the clinical course of recalcitrant ulnar wrist pain.
        Bone Joint J. 2013 Dec; 95-B: 1687-1696
      1. Wolfe S.W. Pederson W.C. Kozin S.H. Greens operative hand surgery. 6th. Elsevier Churchill, Philadelphia, Pennsylvania2010
        • Nakamura R.
        • Tanaka Y.
        • Imaeda T.
        • Miura T.
        The influence of age and sex on ulnar variance.
        J Hand Surg Br. 1991 Feb; 16: 84-88
        • Moriya T.
        • Aoki M.
        • Iba K.
        • Ozasa Y.
        • Wada T.
        • Yamashita T.
        Effect of triangular ligament tears on distal radioulnar joint instability and evaluation of three clinical tests: a biomechanical study.
        J Hand Surg Eur. 2009 Apr; 34: 219-223
        • Suzuki M.
        • Kurimoto S.
        • Shinohara T.
        • Tatebe M.
        • Imaeda T.
        • Hirata H.
        Development and validation of an illustrated questionnaire to evaluate disabilities of the upper limb.
        J Bone Joint Surg Br. 2010 Jul; 92: 963-969
        • Nakamura R.
        • Hori M.
        • Imamura T.
        • Horii E.
        • Miura T.
        Method for measurement and evaluation of carpal bone angles.
        J Hand Surg Am. 1989 Mar; 14: 412-416
        • Yamamoto M.
        • Koh S.
        • Tatebe M.
        • Shinohara T.
        • Shionoya K.
        • Hirata H.
        • Nakamura R.
        Importance of distal radioulnar joint arthroscopy for evaluating the triangular fibrocartilage complex.
        J Orthop Sci. 2010 Mar; 15: 210-215
        • Rayhack J.M.
        Ulnar shortening.
        Tech Hand Up Extrem Surg. 2003 Jun; 7: 52-60
        • Tatebe M.
        • Nakamura R.
        • Horii E.
        • Nakao E.
        Results of ulnar shortening osteotomy for ulnar impaction syndrome in wrists with neutral or negative ulnar variance.
        J Hand Surg Br. 2005 May; 30: 129-132
        • Stockton D.J.
        • Pelletier M.E.
        • Pike J.M.
        Operative treatment of ulnar impaction syndrome: a systematic review.
        J Hand Surg Eur. 2015 Jun; 40: 470-476
        • Baek G.H.
        • Chung M.S.
        • Lee Y.H.
        • Gong H.S.
        • Lee S.
        • Kim H.H.
        Ulnar shortening osteotomy in idiopathic ulnar impaction syndrome.
        J Bone Joint Surg Am. 2005 Dec; 87: 2649-2654
        • Iwasaki N.
        • Ishikawa J.
        • Kato H.
        • Minami M.
        • Minami A.
        Factors affecting results of ulnar shortening for ulnar impaction syndrome.
        Clin Orthop Relat Res. 2007 Dec; 465 (PMID: 17906587): 215-219
        • Fricker R.
        • Pfeiffer K.M.
        • Troeger H.
        Ulnar shortening osteotomy in posttraumatic ulnar impaction syndrome.
        Arch Orthop Trauma Surg. 1996; 115: 158-161
        • Constantine K.J.
        • Tomaino M.M.
        • Herndon J.H.
        • Sotereanos D.G.
        Comparison of ulnar shortening osteotomy and the wafer resection procedure as treatment for ulnar impaction syndrome.
        J Hand Surg Am. 2000 Jan; 25: 55-60
        • Adams B.D.
        Distal radioulnar joint instability.
        in: Wolfe S.W. Hotchkiss R.N. Pederson W.C. Kozin S.H. Operative hand surgery. 6th ed. Churchill Livingstone, New York2011: 523-560