The management of this condition with tenodesis of the ulnar stump results in a short term relief, specially in heavy manual workers. Usually the tenodesis stretches out with time and the ulnocarpal impingement recurs. Moreover the possibility of soft tissue reconstruction is very limited, since patients have usually had more than one reconstructive procedure at the distal radioulnar joint level.
The surgical option described here aims at restoring ulnar continuity with an ulnar head prosthesis. The spherical head articulates with a socket reamed in the proximal area of the fused ulnar head. Removal of the fused head and insertion of a conventional ulnar head prosthesis is not recommendable since both the bone support to the TFCC as well as the origins of the ulnocarpal ligaments are destroyed. Furthermore, since most of these patients have had multiple previous surgeries, the probability of finding a well preserved extensor retinaculum and dorsal capsule to stabilize the conventional prosthesis are diminished.
Indication
Revision following failed Sauve-Kapandji procedures (ulnoradial impingement)
Preoperative Planning
The extent of ulnar and/or carpal instability and the soft tissue condition should be assessed by careful clinical examination. Accurate length planning (using x-ray templates and taking 90°/90° x-rays of both forearms) is of particular importance. This allows the surgeon to determine the optimal resection level and the size of the required spherical head and stem.
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