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- Most asymptomatic until adolescence
- Deformity: prominent ulnar styloid with volar subluxation of carpus
- Restricted supination, dorsiflexion, radial deviation
- Symptoms of ulnar impaction
- Median nerve irritation
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- Characteristic undergrowth of the volar, ulnar corner of radius with
- ↑ radial inclination
- ↑ volar tilt
- With dorsal radial bowing of distal radius
- Ulnar plus variance
- Ask for elbow XR - look for proximal synostosis
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- MRI to look for Vicker's ligament
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- Dyschondrosis of distal radius Ulnar volar physis with Premature fusion of volar and ulnar aspects of DR growth plateleading to:
- 1. Excessive radial inclination
- 2. Excessive volar tilt
- 3. Ulnar carpal impaction
- *Problem is the radius
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- Congenital - Vicker's ligament tethering (Radio-lunotriquetrial ligament)
- Post traumatic - a/w gymnasts with
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- Turner's syndrome, Ollier's, Maffucci, Achondroplasia
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- Depends on 4 factors - patient age and growth remaining, severity of deformity, severity of symptoms.
- Non Op - pain usually subsides by maturity
- Op - 3 main groups of surgery
- Vicker's ligament release with epiphysiodesis of unfused physis with fat interposition (of the radial dorsal aspect of distal radius)
- OR complete epiphysiodesis of the whole distal radius
- Radius osteotomy +/- address ulnar abutment
- Management of Chronic, Degenerative TFCC/ Unlar Abutment Syndrome?
- "Offloading procedures"
- < 2mm ulnar positive = Wafer procedure
- Removal of cartilage and bone under the TFCC
- > 2mm ulnar positive = ulnar shortening
- Salvage Procedures - if OA changes and pain
- Darrach, Sauve-kapandji, Bower’s hemiresection
- Resection of distal ulna - Darrach's
- Arthrodesis of DRUJ with proximal pseudoarthrosis- Suave Kapanji technique
- Wrist fusion
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