MODIFIED MATCHED ULNAR RESECTION FOR ARTHROSIS OF DISTAL RADIOULNAR JOINT IN RHEUMATOID ARTHRITIS

Hand Surgery ◽  
2006 ◽  
Vol 11 (01n02) ◽  
pp. 15-19 ◽  
Author(s):  
K. N. Srikanth ◽  
S. A. Shahane ◽  
J. H. Stilwell
Keyword(s):  
Rheumatoid Arthritis ◽  
Retrospective Study ◽  
Pain Relief ◽  
Distal Radius ◽  
Distal Radioulnar Joint ◽  
Rheumatoid Patient ◽  
Radioulnar Joint ◽  
Ulnar Head

The pain of distal radioulnar arthrosis in rheumatoid patients is often due to disease largely confined to the radioulnar rather than the ulnocarpal articulation. This is a retrospective study of 14 patients (14 wrists) who underwent selective shaving of the radial articulation of the ulnar head leaving the ulnocarpal articulation intact. The ulnar head is reduced to the circumference of its shaft and a dorsal retinacular flap is interposed between it and the distal radius. Average age of the patients and follow-up were 63.5 years and 31 months, respectively. All patients had rheumatoid arthritis. Pain improved in 14 out of 15 wrists. Overall results were 67% good to excellent and 33% fair based on the modified Mayo's wrist score. This novel procedure for DRUJ arthrosis produces predictable pain relief in low demand rheumatoid patient.

scholarly journals Radius distraction could contribute to long-term stability for treating distal radioulnar joint instability during volar plating of distal radius fracture: a retrospective case series study

2021 ◽  
Author(s):  
Cheng-Yu Yin ◽  
Hui-Kuang Huang ◽  
Duretti Fufa ◽  
Jung-Pan Wang
Keyword(s):  
Surgical Technique ◽  
Distal Radius Fracture ◽  
Distal Radius ◽  
Case Series ◽  
Distal Radioulnar Joint ◽  
Radius Fracture ◽  
Radioulnar Joint ◽  
Druj Instability

Abstract BackgroundThe surgical technique of radius distraction for stabilization of distal radioulnar joint (DRUJ) if intraoperative DRUJ instability was found after the fixation of distal radius fracture has been previously described, but this surgical technique lacks clinical and radiographic effect in minimal 3 years follow-up. We therefore evaluated the clinical outcome and radiographic results of radius distraction in minimal 3 years follow-up.MethodsWe reviewed the case series of distal radius fracture with concomitant DRUJ instability receiving radius distraction from the senior author over a 5-year period (January 1st, 2013 to June 30th, 2017) retrospectively, and the evaluation of clinical and radiographic outcomes was performed at clinic as long-term follow-up; a total 34 patients had been evaluated.ResultsAt minimal post-operative 36 months follow-up, all cases demonstrated acceptable wrist range of motion with stable DRUJs and low NRS of wrist pain (0.6, SD 0.7) and DASH score (mean 9.1, SD 6.2), and there were no cases suffering from nonunion of distal radius. The mean ulnar variance of injured wrist and uninjured wrist were − 1.2 mm and 0.2mm, respectively (SD 1.0 and 0.6) with significant statistical difference.ConclusionsRadius distraction during volar fixation of distal radius fracture should be consider if DRUJ instability was found by the radioulnar stress test intraoperatively, and the long-term DRUJ stability could be achieved by maintenance of normal-to-negative ulnar variance, with decreased wrist pain and satisfactory function outcome.Level of EvidenceTherapeutic Level IV

Clinical, radiological and patient-rated outcome comparison between total and partial ulnar head implants

2021 ◽  
pp. 175319342110484
Author(s):  
Lea Estermann ◽  
Lisa Reissner ◽  
Andrea B. Rosskopf ◽  
Andreas Schweizer ◽  
Ladislav Nagy
Keyword(s):  
Grip Strength ◽  
Distal Radioulnar Joint ◽  
Joint Arthroplasty ◽  
Dash Score ◽  
Level Of Evidence ◽  
Radioulnar Joint ◽  
Ulnar Head ◽  
Outcome Comparison ◽  
Pain At Rest

This study aimed to analyse the clinical and radiological outcomes after ulnar head replacement and to compare partial and total ulnar head implants. Twenty-two patients with 23 implants were available with a mean follow-up time of 7 years (range 1.3 to 17) after distal radioulnar joint arthroplasty. At the final follow-up, patients had a low level of pain at rest and during effort, a median Disabilities of the Arm, Shoulder, and Hand (DASH) score of 12 and Patient-Rated Wrist Evaluation score of 12 with partial ulnar head implants, and scores of 20 and 22 in total ulnar head implants, respectively. While the range of motion in patients with partial ulnar head implants was slightly reduced in comparison with the preoperative condition and to the patients with total ulnar head implants, there was a tendency to a higher grip strength and rotational torque. Both types of prosthesis showed sigmoid notch resorptions and resorptions around the neck. We conclude that the results after partial ulnar head replacement do not significantly differ from the total ulnar head implants in many aspects. Level of evidence: III

scholarly journals Radius' Giant Cell Tumor: Allograft with Conservation of Distal Radioulnar Joint

2019 ◽  
Vol 08 (03) ◽  
pp. 215-220 ◽  
Author(s):  
S. Ruatti ◽  
M. Boudissa ◽  
P. Grobost ◽  
G. Kerschbaumer ◽  
J. Tonetti
Keyword(s):  
Range Of Motion ◽  
Giant Cell Tumor ◽  
Giant Cell ◽  
Distal Radius ◽  
Functional Results ◽  
Distal Radioulnar Joint ◽  
Cell Tumor ◽  
The Other ◽  
Radioulnar Joint

Purpose Giant cell tumor of the distal radius are frequent lesions, and different types of surgeries have been described. Functional results, after conservative treatment or arthrodesis, often find a decreased strength and range of motion. The sacrifice of the distal radioulnar joint could be one of the causes. We report the case of a 26-year-old patient who presented with a Campanacci Grade III giant cell tumor of the distal radius. We managed his case by the association of en bloc resection and allograft reconstruction with the preservation of distal radioulnar joint. Hypothesis This procedure could improve functional results, without increasing the risk of recurrence at 2 years follow-up. Case Report The originality of our technique was the possibility of distal radioulnar joint conservation. We preserved a long portion of cortex bone all through the ulnar side of the distal radius. We then used an allograft of distal radius, fixed by a reconstruction anatomical plate. Results At 2 years follow-up, the range of motion was 100° with 60° of palmar flexion, 40° of extension, 75° of pronation, and 70° of supination. Radial and ulnar inclination were 10 and 15°, respectively. MTS (Musculoskeletal Tumor Society Score) 1993 was 88% and DASH score was 6. Concerning grip strength, it was measured at 85% in comparison with the other side. Pronation and supination strengths were 80 and 73%, respectively, in comparison with the other side. At follow-up, standard X-rays showed no recurrence. The allograft was well integrated. Conclusion Conservative treatment of the distal radioulnar joint allowed an almost ad integrum recovery, concerning strengths and range of motion. It allows a better functional recovery, without increasing the risk of recurrence.

A comparison of diaphyseal and metaphyseal techniques of ulna shortening

2012 ◽  
Vol 38 (5) ◽  
pp. 542-549 ◽  
Author(s):  
G. Sennwald ◽  
D. Della Santa ◽  
J.-Y. Beaulieu
Keyword(s):  
Retrospective Study ◽  
Pain Relief ◽  
Scoring System ◽  
Delayed Union ◽  
Study Group ◽  
Self Assessment ◽  
Plate Removal ◽  
Non Union ◽  
Ulnar Head

The aim of this retrospective study was to compare two techniques of ulna shortening for ulnocarpal abutment. The technique performed initially was diaphyseal osteotomy. Subsequently, a metaphyseal osteotomy was performed to avoid the drawbacks related to the plate. The study group consisted of 29 patients: 13 with diaphyseal and 16 with metaphyseal osteotomies. The pre-operative diagnosis was ulnocarpal abutment in all cases. The results were graded according to the scoring system of Chun and Palmer and patients’ self-assessment. Both rankings were related to indications, age, gender, occupation, and surgery. Final follow-up occurred at a median of 54 (range 15–144) months after surgery. There was no delayed union or non-union, necrosis of the ulnar head, or infection. Pain relief was the main benefit. Both techniques gave similar outcomes for pain relief, satisfaction, and objective results. The shortening was significantly greater in the metaphyseal group without any apparent consequence on function or pain. No screw removal was needed after metaphyseal osteotomy; in contrast, plate removal was required in all patients. We conclude that both techniques are valuable alternatives for treating ulnocarpal abutment.

DISTAL RADIOULNAR JOINT DORSAL INSTABILITY TREATED WITH DORSAL CAPSULAR RECONSTRUCTION

Hand Surgery ◽  
2004 ◽  
Vol 09 (01) ◽  
pp. 55-61 ◽  
Author(s):  
Kwok-Ho Wong ◽  
Tak-Hing Yip ◽  
Wing-Cheung Wu
Keyword(s):  
Pain Relief ◽  
Range Of Motion ◽  
Distal Radius Fracture ◽  
Distal Radius ◽  
Distal Radioulnar Joint ◽  
Tendon Graft ◽  
Radioulnar Joint ◽  
Complex Injury ◽  
Triangular Fibrocartilage ◽  
Post Traumatic

Six patients with post-traumatic distal radioulnar joint dorsal instability were treated with dorsal capsular reconstruction. This new technique of reconstruction requires less extensive dissection than the previously described methods in the literature and requires no tendon graft. A total of six patients treated from 1999 to 2001 were included in this study. Two were males and four were females. The average age of patients was 30 years and all the instabilities were secondary to trauma. One of them had associated minimally displaced distal radius fracture. All patients had arthrogram and arthroscopy done before the reconstruction and had no significant triangular fibrocartilage complex injury. The surgery consisted of duplication capsulorrhaphy of the dorsal capsular structures of the distal radioulnar joint. All patients had satisfactory results after the operations in terms of pain relief, range of motion and stability.

scholarly journals Functional and Radiographic Outcomes of the Sauvé-Kapandji and Darrach Procedures in Rheumatoid Arthritis

2018 ◽  
Vol 11 (02) ◽  
pp. 071-079 ◽  
Author(s):  
Hannah M. Carl ◽  
Scott D. Lifchez
Keyword(s):  
Rheumatoid Arthritis ◽  
Range Of Motion ◽  
Average Length ◽  
Distal Radioulnar Joint ◽  
Functional Improvement ◽  
Single Institution ◽  
Radioulnar Joint ◽  
Radiographic Outcomes ◽  
Radiocarpal Joint

Abstract Background Deterioration of the distal radioulnar joint (DRUJ) in rheumatoid arthritis (RA) manifests as pain, weakness, and reduced range of motion. The Darrach and Sauvé-Kapandji (S-K) procedures are used when medical management fails to control these symptoms. However, there is a paucity of literature comparing the outcomes of these procedures. The purpose of this study is to compare the clinical and radiographic outcomes of the Darrach and S-K procedures in RA patients. Materials and Methods This is a retrospective, single institution cohort study of RA patients who underwent the Darrach or S-K procedure between 2008 and 2016. Ulnar translation, range of motion, and functional improvement were compared. Results Nine patients (13 wrists) underwent the Darrach procedure, and nine patients (11 wrists) underwent the S-K procedure. The average length of follow-up was 1.3 years. Pain, function, and range of motion improved in both groups. The degree of ulnar translation did not significantly change after either procedure. Conclusion Given their similar outcomes, we found no evidence that the S-K procedure is superior to the Darrach procedure or vice versa. However, when surgery is indicated for younger RA patients with DRUJ disease and ulnar translation, the S-K may be better suited to prevent radiocarpal joint dislocation.

Ulnar Shortening for the Treatment of Early Post-Traumatic Osteoarthritis at the Distal Radioulnar Joint

2001 ◽  
Vol 26 (1) ◽  
pp. 41-44 ◽  
Author(s):  
L. R. SCHEKER ◽  
A. SEVERO
Keyword(s):  
Contact Area ◽  
Distal Radioulnar Joint ◽  
Early Osteoarthritis ◽  
Self Assessment ◽  
Radioulnar Joint ◽  
Ulnar Head ◽  
Relieve Pain ◽  
Post Traumatic ◽  
The Mean

This prospective study describes the outcome of ulnar shortening performed on 32 wrists with early osteoarthritis of the distal radiounlar joint (DRUJ) in an attempt to change the contact area between the ulnar head and the radial sigmoid notch. By changing the contact area, we attempted to relieve pain, while maintaining the function of the DRUJ. The mean age of the patients was 34 years, and the mean follow-up was three years and two months. The wrists were graded by the patients’ self-assessment of satisfaction and by a clinical wrist rating that assessed pain, functional status, range of motion, and grip strength. In terms of self-assessment, 16/32 patients were very satisfied, with complete pain relief. Of the 32 patients, 26 said that they would have surgery again if circumstances were similar. The postoperative wrist ratings were 7/32 excellent, 11/32 good, 9/32 fair, 5/32 poor. The most frequent postoperative complaint was plate irritation.

THE SAUVÉ-KAPANDJI PROCEDURE IN COMBINATION WITH OPENING RADIAL WEDGE OSTEOTOMY FOR MALUNION OF DISTAL RADIUS FRACTURES

Hand Surgery ◽  
1998 ◽  
Vol 03 (02) ◽  
pp. 257-262
Author(s):  
Yasunori Hattori ◽  
Kazuteru Doi ◽  
Noriyuki Kuwata ◽  
Fujio Kawakami ◽  
Ken Ohtuka
Keyword(s):  
Distal Radius ◽  
Severe Pain ◽  
Distal Radioulnar Joint ◽  
Distal Radius Fractures ◽  
Wedge Osteotomy ◽  
Radius Fractures ◽  
Forearm Rotation ◽  
Radiographic Evidence ◽  
Radioulnar Joint

The Sauvé-Kapandji procedure in combination with an opening radial wedge osteotomy for malunion of distal radius fractures was performed in six patients. Follow-up at an average of 40.3 months showed two excellent, three good, and one poor result. Satisfactory results were obtained in restoration of forearm rotation and improvement of pain in all patients. The Sauvé-Kapandji procedure in addition to an opening radial wedge osteotomy was indicated when a preoperative limitation of forearm rotation with severe pain and radiographic evidence of degenerative changes in the distal radioulnar joint were present. We have found combining these two procedures to be a reliable treatment option for malunion of distal radius fractures.

scholarly journals Modified Sauve-Kapandji procedure for patients with old fractures of the distal radius

Open Medicine ◽  
2017 ◽  
Vol 12 (1) ◽  
pp. 417-423 ◽  
Author(s):  
Zhitao Guo ◽  
Yuli Wang ◽  
Yacong Zhang
Keyword(s):  
Distal Radius ◽  
Functional Limitations ◽  
Distal Radioulnar Joint ◽  
Posttraumatic Arthritis ◽  
Salvage Procedure ◽  
Score System ◽  
Radioulnar Joint ◽  
Radiographic Outcomes ◽  
Time Of Admission

AbstractObjectiveTo evaluate the clinical and radiographic outcomes of a modified Sauve-Kapandji procedure for patients with old fractures in the distal radius.MethodsFifteen patients (10 male and 5 female patients with an average age of 40 years old) were treated by the modified Sauve-Kapandji procedure from January 2014 to April 2016. All patients had undergone at least one previous operation on the involved wrist, and they were still suffering from pain and functional limitations at the time of admission. The postoperative follow-up period was 12-26 months and the average was 20 months. Functional assessment was made at the last follow-up. All patients were evaluated according a Modified Mayo Wrist Score system.ResultsOf the fifteen patients with posttraumatic arthritis, thirteen had excellent results, two had good results, and one had fair results. There were no major complications.ConclusionsThe modified Sauve-Kapandji procedure is a safe and effective surgical alternative for intractable disorders of the distal radioulnar joint and can be recommended as a salvage procedure when previous treatments fail.

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