- Discussion:
- indications are essentially the same as for radial shortening;
- advocates of ulnar lengthening for Kienbock's dz base their theorem
on the fact that an ulnar lengthening procedure decreases the load
across the radiolunate joint;
- this procedure is ideally suited for pts w/ ulnar minus variance;
- success have been reported even for pts w/ a lunate collapse;
- because of impingement on ulnar side of wrist, reduction in ulnar
deviation is not uncommon;
- pts may also have postoperative pain following procedure, because of
alteration of the distal radioulnar joint;
- advocates of this procedure feel that there is less surgery involved
w/ this procedure than w/ radial shortening, eventhough a bone
graft is not required;
- Technique:
- ulnar incision is used;
- 4-hole slotted plate is fixed to ulna to allow lengthening w/in slots;
- thru central cut, appropriate lengthening is accomplished by extending
distal ulna until x-rays confirm that equal length has been obtained;
- deficit is filled by iliac bone graft, & plate is compressed;
- because this procedure requires a bone graft, pts do better w/ strict
immobilization which is provided by internal plate fixation;
- Complications:
- 15 % nonunion;
- ulnar impingement syndrome;
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Ulnar lengthening in the treatment of Kienbock's disease.
