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Hultén Variant – Ulnar Variance at the Wrist

The Hultén variant describes the length relationship between the ulna and radius at the wrist and is clinically relevant in wrist pain and injuries.

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Things worth knowing about "Hultén Variant"

The Hultén variant describes the length relationship between the ulna and radius at the wrist and is clinically relevant in wrist pain and injuries.

What is the Hultén Variant?

The Hultén variant (also known as ulnar variance) is a radiological measurement that describes the relative lengths of the ulna and radius at the wrist joint. It was first described by Swedish surgeon Olof Hultén in 1928. The variance indicates whether the ulna is equal in length to the radius, longer, or shorter.

This measurement is determined on a standardized X-ray of the wrist in a neutral position and has important diagnostic and therapeutic implications for various wrist conditions.

Classification of the Hultén Variant

Three types are distinguished:

Neutral ulnar variance (0 mm): The ulna and radius end at the same level. This is considered a normal finding.
Positive ulnar variance: The ulna is longer than the radius, projecting beyond the level of the radius.
Negative ulnar variance: The ulna is shorter than the radius.

Clinical Significance

Positive Ulnar Variance

A positive Hultén variant is associated with increased loading of the ulnocarpal complex. This raises the risk of:

Injuries to the triangular fibrocartilage complex (TFCC) – an important ligament structure at the wrist
Lunate malacia (Kienböck's disease) – an avascular necrosis of the lunate bone
Arthritis in the ulnocarpal region

Negative Ulnar Variance

A negative Hultén variant is frequently associated with Kienböck's disease. Due to the shortened ulna, the lunate bone (os lunatum) is subjected to increased stress, which can lead to impaired blood supply and ultimately to avascular necrosis of the bone.

Diagnosis

The Hultén variant is determined using a standardized posteroanterior (PA) radiograph of the wrist taken with the elbow flexed at 90 degrees and the forearm in neutral rotation. The difference in length is measured in millimeters.

If needed, additional imaging such as MRI or CT scanning may be performed to better evaluate associated injuries or structural damage.

Treatment

Treatment depends on the clinical findings and the underlying condition:

Conservative treatment: Immobilization, physiotherapy, and pain management for mild symptoms
Surgical treatment: In cases of symptomatic positive ulnar variance, an ulnar shortening osteotomy (surgical shortening of the ulna) can be performed to reduce loading of the TFCC.
In negative ulnar variance associated with Kienböck's disease, radial shortening or ulnar lengthening procedures may be considered.

References

Hultén O. - Über anatomische Variationen der Handgelenkknochen. Acta Radiologica, 1928.
Lichtman DM, Lesley NE, Simmons SP. - The classification and treatment of Kienboeck's disease: the state of the art and a look at the future. Journal of Hand Surgery (European Volume), 2010; 35(7): 549-554.
Schmitt R, Lanz U. - Bildgebende Diagnostik der Hand. 3rd edition. Thieme Verlag, Stuttgart, 2014.

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