Comparative Study of 2 Bone Anchors Using a Limited Open Procedure for the Management of Distal Radioulnar Joint Instability

Background: Arthroscopic and open surgical procedures are commonly used to repair distal radioulnar joint (DRUJ) instability. Both may result in patient dissatisfaction and recurrence of DRUJ instability. An alternative treatment that yields improved outcomes is a limited open approach using a bone anchor to support the DRUJ. Methods: A retrospective chart review of 58 patients (59 extremities) aged 18 to 60 years with type 1B Palmer rupture (3 months or more after injury) of the triangular fibrocartilage complex (TFCC) without distal radius fracture was conducted. Inclusion criteria are: 3 to 12 months after injury, clinical DRUJ instability, and minimum of 6 months of postoperative follow-up. Operative fixation with Stryker Sonic or Depuy Mitek anchor was done by the same surgeon using a limited open procedure. Preoperative and postoperative assessments included Disability of the Arm, Shoulder, and Hand; Brief Pain Inventory; Wong-Baker FACES Pain Rating Scale; Numeric Pain Scale; range of motion; and recurrence of instability. A multivariate analysis of variance model was fit to imputed data to assess the effect of both anchors. Results: Clinical and statistical differences were found in preoperative and postoperative assessments for either the Stryker Sonic or the Depuy Mitek anchor but not between anchor types. There was no recurrence after 3 years with either anchor. Conclusion: Patients requiring TFCC repair using the Stryker Sonic or Depuy Mitek anchor experienced: (1) significant clinical and statistical improvement in postoperative assessments; (2) patient satisfaction; and (3) corrected DRUJ instability. Consequently, major determinants in deciding which bone anchor to use may be based on cost or surgeon’s preference.

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Preliminary Report of Arthroscopically Assisted Sauvé–Kapandji Procedure for Distal Radioulnar Joint Arthritis

Journal of Wrist Surgery ◽

10.1055/s-0040-1721854 ◽

2021 ◽

Author(s):

Yukio Abe ◽

Youhei Takahashi ◽

Kenzo Fujii

Keyword(s):

Rating Scale ◽

Numerical Rating Scale ◽

Kirschner Wire ◽

Distal Radioulnar Joint ◽

Contralateral Side ◽

Level Of Evidence ◽

Radioulnar Joint ◽

Advantages And Disadvantages ◽

Arthroscopically Assisted ◽

Therapeutic Study

Abstract Background The arthroscopically assisted Sauvé–Kapandji (S-K) procedure has been described as a safe and promising technique for distal radioulnar joint (DRUJ) arthrodesis. Our purpose was to investigate the advantages and disadvantages of the arthroscopically assisted S-K procedure. Methods Eight patients underwent an arthroscopically assisted S-K procedure. All patients were diagnosed as DRUJ osteoarthritis (OA), including six primary DRUJ OA, one OA following a distal radius fracture, and one rheumatoid arthritis (RA). Arthroscopy was performed in neutral forearm rotation with vertical traction. The surface of the DRUJ was debrided through arthroscopy to expose the subchondral surface, and the DRUJ was fixed with a cannulated screw and Kirschner wire (K-wire) with zero or minus ulnar variance in the same posture. Bone graft was not performed. Results Bone union was achieved at 2 to 3.5 months postoperatively. At an average of 17-month follow-up, the pain intensity on 10-point numerical rating scale (NRS) decreased from 10 preoperatively to 0.4 postoperatively, average range of pronation significantly improved from 77 degrees to 89 degrees, and average grip strength as a percentage of contralateral side improved from 76 to 104%. Conclusion Satisfactory outcomes were achieved with the arthroscopically assisted S-K procedure. Advantages of this procedure included the ability to achieve union without bone grafting, preservation of the extensor mechanism integrity, and easy reduction of the ulnar head due to its wrist positioning. No major complications were encountered. Disadvantages included its required use of arthroscopic technique and potential contraindication for cases with severe deformity at the sigmoid notch. Level of Evidence This is a Level IV, therapeutic study.

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Clinical and Non-Clinical Aspects of Distal Radioulnar Joint Instability

The Open Orthopaedics Journal ◽

10.2174/1874325001206010204 ◽

2012 ◽

Vol 6 (1) ◽

pp. 204-210 ◽

Cited By ~ 31

Author(s):

MME Wijffels ◽

PRG Brink ◽

IB Schipper

Keyword(s):

Distal Radioulnar Joint ◽

Lateral View ◽

Joint Capsule ◽

Clinical Aspects ◽

Clinical Tests ◽

Radioulnar Joint ◽

Radiologic Evaluation ◽

Druj Instability ◽

Common Diagnosis ◽

Extensive Range

Untreated distal radioulnar joint (DRUJ) injuries can give rise to long lasting complaints. Although common, diagnosis and treatment of DRUJ injuries remains a challenge. The articulating anatomy of the distal radius and ulna, among others, enables an extensive range of forearm pronosupination movements. Stabilization of this joint is provided by both intrinsic and extrinsic stabilizers and the joint capsule. These structures transmit the load and prevent the DRUJ from luxation during movement. Several clinical tests have been suggested to determine static or dynamic DRUJ stability, but their predictive value is unclear. Radiologic evaluation of DRUJ instability begins with conventional radiographs in anterioposterior and true lateral view. If not conclusive, CT-scan seems to be the best additional modality to evaluate the osseous structures. MRI has proven to be more sensitive and specific for TFCC tears, potentially causing DRUJ instability. DRUJ instability may remain asymptomatic. Symptomatic DRUJ injuries treatment can be conservative or operative. Operative treatment should consist of restoration of osseous and ligamenteous anatomy. If not successful, salvage procedures can be performed to regain stability.

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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

10.21203/rs.3.rs-617556/v1 ◽

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

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Radius-ulna shaft fracture with distal radioulnar joint instability in a case of ipsilateral malunited colles fracture: a case report

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20211635 ◽

2021 ◽

Vol 7 (3) ◽

pp. 695

Author(s):

Neetin P. Mahajan ◽

Prasanna Kumar G. S. ◽

Kishor Jadhav ◽

Kartik Pande ◽

Tushar Patil

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

Shaft Fracture ◽

Distal Radioulnar Joint ◽

Fracture Site ◽

Ulnar Variance ◽

Radioulnar Joint ◽

Druj Instability ◽

Colles Fracture ◽

K Wires

<p class="abstract">Malunion of the distal end of radius is a known consequence of the conservative management. The functional impairment depends on the severity of the deformity and it can be associated with distal radioulnar joint (DRUJ) instability. Subsequent radius ulna fracture in an elderly osteoporotic patient is a challenging task to manage. A 60 year old female patient came with radius ulna shaft fracture with DRUJ instability with ipsilateral malunited distal radius fracture. We managed with open reduction and internal fixation using 3.5 mm locking compression plate (LCP) with ulnar shortening and K wires for DRUJ. At one year, follow-up, patient is having good clinical and radiological outcome without any complications. Radius ulna shaft fracture in cases of malunited colles fracture with positive ulnar variance with DRUJ instability can be managed well with open reduction and internal fixation of radius-ulna shaft which provides stable fixation, ulnar shortening at the fracture site to maintain the neutral/negative ulnar variance and DRUJ fixation using K wires. Use of multiple vicryl sutures to tie the plate to the bone gives additional stability in osteoporotic bones till the fracture unites and prevents implant failure. Combination of the above mentioned procedures helps in getting good functional outcome in elderly osteoporotic patients.</p>

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Anatomic Reconstruction of the Triangular Fibrocartilage Complex for the Treatment of Chronic Instability of the Distal Radioulnar Joint. A Systematic Review

Revista Iberoamericana de Cirugía de la Mano ◽

10.1055/s-0041-1736570 ◽

2021 ◽

Vol 49 (02) ◽

pp. e97-e104

Author(s):

Ignacio Miranda ◽

Francisco J. Lucas ◽

Vicente Carratalá ◽

Joan Ferràs-Tarragó ◽

Francisco J. Miranda

Keyword(s):

Systematic Review ◽

Surgical Techniques ◽

Case Series ◽

Distal Radioulnar Joint ◽

Triangular Fibrocartilage Complex ◽

Anatomic Reconstruction ◽

Wrist Arthroscopy ◽

Radioulnar Joint ◽

Druj Instability ◽

Triangular Fibrocartilage

Abstract Introduction Peripheral injuries of the triangular fibrocartilage complex (TFCC) can produce pain and instability of the distal radioulnar joint (DRUJ). There are several techniques for the reconstruction of the TFCC. The aim of the present paper was to summarize the tendon plasties of the DRUJ ligaments for the anatomic reconstruction of TFCC, to analyze the surgical techniques, and to evaluate their outcomes. Methods In order to perform a systematic review, we searched in the literature the terms DRUJ instability OR chronic distal radioulnar joint instability OR distal radioulnar tendon plasty. Results In total, 11 articles with level of evidence IV (case series) were retrieved. Most studies achieved good results, with recovery of wrist stability, improvement of the pain, and increase in grip strength in the functionality tests. In the historical evolution of the published series, wrist surgeons tried to perform a more anatomical plasty, with a more stable fixation and less invasive techniques. Conclusion The Adams procedure continues to be a valid and reproducible technique for the treatment of chronic DRUJ instability. If wrist arthroscopy and implants are available and surgeons have been technically trained, the authors recommend an arthroscopy-assisted technique, or, if possible, an all-arthroscopic TFCC reconstruction with implant fixation of the plasty in its anatomical points of insertion. Comparative studies between open and arthroscopic TFCC reconstruction techniques are needed.

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THE BEAUTY OF STABILITY: DISTAL RADIOULNAR JOINT STABILITY IN ARTHROSCOPIC TRIANGULAR FIBROCARTILAGE COMPLEX REPAIR

Hand Surgery ◽

10.1142/s0218810413500044 ◽

2013 ◽

Vol 18 (01) ◽

pp. 21-26 ◽

Cited By ~ 7

Author(s):

Chris Tang ◽

Boris Fung ◽

Rebecca Chan ◽

Margaret Fok

Keyword(s):

Stress Test ◽

Distal Radioulnar Joint ◽

Small Sample ◽

Triangular Fibrocartilage Complex ◽

Radioulnar Joint ◽

Transosseous Suture ◽

Sigmoid Notch ◽

Druj Instability ◽

Triangular Fibrocartilage

The triangular fibrocartilage complex (TFCC) has an important role in the stability of the distal radioulnar joint (DRUJ) stability. We designed a new method of TFCC tear repair that has satisfactory post-operative DRUJ stability. From May 2004 to August 2010, 14 patients who underwent this operation were reviewed. The average post-operative follow-up period was 8.2 months; 66.7% of the patients with TFCC tear in sigmoid notch had clinical DRUJ instability, while only 50% of tear in fovea and 16.7% of tear in base of ulnar styloid had clinical DRUJ instability. Transosseous suture via inside-outside technique was used for repair. At the final follow-up, all 14 patients have soft end point with < 5 mm translations of the DRUJ shown by the stress test. Based on this small sample with satisfactory outcome assessed by the Mayo modified wrist score and DRUJ stability, we recommend TFCC tear in sigmoid notch, which has a higher chance of DRUJ instability, to be repaired by transosseous suture.

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Extensor Retinaculum Reconstruction of the Distal Radioulnar Joint in Adolescents

Hand ◽

10.1177/1558944720966707 ◽

2020 ◽

pp. 155894472096670

Author(s):

Andrea S. Bauer ◽

Stella J. Lee ◽

Michael D. Smith ◽

Donald S. Bae ◽

Peter M. Waters

Keyword(s):

Distal Radius ◽

Distal Radioulnar Joint ◽

Surgical Reconstruction ◽

Extensor Retinaculum ◽

Radioulnar Joint ◽

Druj Instability ◽

Outcome Scores ◽

High Level ◽

Age Range ◽

Prior Injury

Background This study characterizes the outcomes and complications of surgical reconstruction of distal radioulnar joint (DRUJ) instability using the extensor retinaculum (Herbert sling). Our hypothesis was that extensor retinaculum reconstruction is a reliable method of DRUJ stabilization in adolescents. Methods This was a retrospective study of pediatric patients treated surgically using the Herbert sling for DRUJ instability at a single institution. We identified 22 subjects who underwent surgery at an average of 16.2 years of age (range, 12-18 years). Medical records and available imaging were reviewed for all subjects, and patients were contacted to participate in the prospective completion of the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire. Results Preoperative symptoms were more commonly pain (95%) than feelings of DRUJ instability (45%), although 100% had instability on physical examination. Eight (36%) patients demonstrated limited supination preoperatively. Twenty-one subjects (95%) noted prior injury to that wrist, 15 of which were distal radius fractures. Surgery consisted of stabilization of the DRUJ using extensor retinaculum, in concert with other procedures to address all potential causes of wrist pain. Postoperatively, DRUJ stability was maintained in 21 of 22 subjects. Of the 12 patients who provided functional outcome scores, median QuickDASH score was 7.6 (range, 0-45). Conclusions Distal radioulnar joint instability in adolescents is often preceded by fracture of the distal radius. Surgeons must maintain a high level of suspicion to appropriately diagnose DRUJ instability, which is often not an isolated pathoanatomical problem. The Herbert sling technique using extensor retinaculum can successfully confer DRUJ stability in this population.

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FUNCTIONAL RESULTS POST-TRIANGULAR FIBROCARTILAGE COMPLEX RECONSTRUCTION WITH EXTENSOR CARPI ULNARIS WITH OR WITHOUT ULNAR SHORTENING IN CHRONIC DISTAL RADIOULNAR JOINT INSTABILITY

Hand Surgery ◽

10.1142/s0218810405002759 ◽

2005 ◽

Vol 10 (02n03) ◽

pp. 169-176 ◽

Cited By ~ 15

Author(s):

Jui-Tien Shih ◽

Hung-Maan Lee

Keyword(s):

Functional Results ◽

Distal Radioulnar Joint ◽

Triangular Fibrocartilage Complex ◽

Radioulnar Joint ◽

Extensor Carpi Ulnaris ◽

Druj Instability ◽

Sport Activities ◽

Triangular Fibrocartilage ◽

Post Traumatic

From September 1996 to September 2001, 37 adult patients were diagnosed with chronic triangular fibrocartilage complex (TFCC) tears with distal radioulnar joint (DRUJ) instability in our clinic. They had all received the procedure of TFCC reconstruction with partial extensor carpi ulnaris (ECU) combined with or without ulnar shortening. There were 36 males and one female in the study with a mean age of 22.4 years. The follow-up period ranged from 25 to 48 months with a mean of 36.2 months. All patients received the rehabilitation programme and were re-examined at our outpatient department. The results were graded according to the Mayo Modified Wrist Score. Eleven of the 37 patients rated their wrists "excellent", 22 rated "good", and four rated "fair". Overall, a total of 33 patients (89%) rated satisfactorily and returned to work or sport activities. Therefore, TFCC reconstruction with partial ECU tendon combined with or without ulnar shortening procedure is an effective method for post-traumatic chronic TFCC tears with DRUJ instability suggested by this study.

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Botulinum toxin for the treatment of lower limb cramp pain in patients with Amyotrophic Lateral Sclerosis

RRNMF Neuromuscular Journal ◽

10.17161/rrnmf.v1i1.13553 ◽

2020 ◽

Vol 1 (1) ◽

Author(s):

Tejas Mehta ◽

Richard Sommers ◽

Raghav Govindarajan

Keyword(s):

Amyotrophic Lateral Sclerosis ◽

Pain Score ◽

Lower Limb ◽

Rating Scale ◽

Retrospective Chart Review ◽

Pain Scale ◽

Wilcoxon Test ◽

Safe Procedure ◽

Lateral Sclerosis

Background: Muscle cramps and pain associated with them can be seen in patients with amyotrophic lateral sclerosis (ALS) and are known to reduce the quality of life. Pharmacological treatment may not benefit all patients in treating these cramps. We assess the efficacy of Onabotulinum toxin A (BTX-A) in the treatment of lower limb cramps in patients with ALS. Methods: This retrospective chart review included a total of ten patients with ALS who suffered from pain due to lower limb cramps and were managed with BTX-A. Data including patient demographics, visual analog pain scale at different intervals during follow up, ALS functional rating scale and site of onset of ALS symptoms were documented. The pain score at baseline (before administration), at 3 months follow up and at 6 months follow up were compared using Wilcoxon test to assess BTX-A’s efficacy. Results: A significant improvement in average pain score due to cramps from baseline to the 6-month interval with a change of 3.1±0.7 (p<0.05,95%CI) was seen on the pain scale. No adverse events were noted during administration or post injections. Conclusion: Local BTX-A administration is an efficacious and safe procedure for improving pain associated with cramps in patients with ALS.

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Posttraumatic distal radius growth arrest as a cause of the development of distal radioulnar joint instability in children

Pediatric Traumatology Orthopaedics and Reconstructive Surgery ◽

10.17816/ptors42558 ◽

2021 ◽

Vol 9 (1) ◽

pp. 87-94

Author(s):

Yaroslav N. Proschenko ◽

Sergey Yu. Semenov

Keyword(s):

Distal Radius ◽

Wrist Joint ◽

Growth Arrest ◽

Clinical Manifestations ◽

Growth Zone ◽

Distal Radioulnar Joint ◽

Time Interval ◽

Radius Fractures ◽

Radioulnar Joint ◽

Druj Instability

BACKGROUND: The distal radial physis is involved in the injury process in approximately 15% of distal radius fractures. Distal radius physeal arrest and the normal functioning of the distal ulna growth lead to lengthening and dislocation of the head of the ulna in the distal radioulnar joint (DRUJ). These changes, in turn, lead to pain syndrome and forearm dysfunction, which is a manifestation of DRUJ instability. AIM: This study aims to evaluate the results of a study of pediatric patients with traumatic DRUJ instability. MATERIALS AND METHODS: An analysis of the results of the examination of 11 children aged from 13 to 17 years with traumatic type DRUJ instability due to the distal radius growth arrest. RESULTS: According to the X-ray examination data, all children showed closure of the distal growth zone of the radius and ulnar positive variant (ulna +). The shortening of the radius was calculated. Also, the time interval between the injury and the discovery of the wrist joint pathology was estimated. All types of radius fractures with growth plate involvement can cause physeal arrest, leading to a DRUJ instability. The interval from the acute wrist injury with damage to the distal radius growth zone to develop clinical manifestations of a DRUJ instability is 2.4 years on average. CONCLUSION: The development of this type of traumatic DRUJ instability is typical only in children since changes occur in the presence of an active growth zone and are associated with previous fractures of the distal radius. Therefore, a long-term dispensary observation by a traumatologist-orthopedist is necessary for patients with this pathology.

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