An experience of recessional osteotomy of the ulna for ulnocarpal impingement syndrome.

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We report on the Milch procedure which was performed in 4 patients with ulnocarpal impingement syndrome achieving favorable clinical results.Two cases had TFCC tears, and partial resection was done before ulnar recession. One case had malunion after fracture of the distal radius. The last was a chronic case of ESSEX LOPRESTI fracture.The average ulnar variance was corrected from plus 4.3mm to minus 0.8mm. The range of motion was improved to become almost equal to that of the opposite side. Two cases had slight pain on movement of the ulnocarpal joint. According to the evaluation using Darrow's criteria, three cases were classified as good and one case was fair.Milch's procedure has four mechanical effects. This technique stabilizes the distal radioulnar joint, tightens the ulnar collateral ligament, reduces inferior subluxation of the distal radius on the ulna, and reduces the pressure of the ulnocarpal joint. The procedure is best indicated for young adult cases of ulnocarpal impingement syndrome without severe degenerative ulnocarpal joint disease of deformity of the distal radioulnar articular surface.
西日本整形・災害外科学会の論文