Preventing recurrence of radioulnar synostosis with pedicled adipofascial flaps

2011 ◽  
Vol 37 (3) ◽  
pp. 244-250 ◽  
Author(s):  
J. Sonderegger ◽  
S. Gidwani ◽  
M. Ross
Keyword(s):  
Distal Radioulnar Joint ◽  
Forearm Rotation ◽  
Radioulnar Synostosis ◽  
Radioulnar Joint ◽  
Interosseous Artery ◽  
Posterior Interosseous Nerve Palsy ◽  
Post Traumatic ◽  
Term Maintenance

The surgical treatment of post-traumatic radioulnar synostosis is difficult. Recurrence after resection alone is a concern with poor long-term maintenance of forearm rotation. We report on the use of pedicled adipofascial flaps to prevent recurrence and facilitate maintenance of movement in six adult patients with radioulnar synostosis. Five involved the proximal radioulnar joint and one the distal radioulnar joint. In four the flap was based on the radial artery and in two on the posterior interosseous artery. Mean intraoperative supination was 78° and pronation was 76°. Mean follow up was 32 months. At follow-up, mean supination was 71° and pronation was 70°. No patient had radiological recurrence of synostosis. The only complication was a transient posterior interosseous nerve palsy. Pedicled adipofascial flaps are a safe addition to resection alone which may prevent recurrence and maintain the range of forearm rotation achieved at operation.

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

SAUVÉ-KAPANDJI PROCEDURE IN A PATIENT WITH WRIST DISARTICULATION: CASE REPORT

Hand Surgery ◽  
2014 ◽  
Vol 19 (02) ◽  
pp. 227-229
Author(s):  
Hyun Sik Gong ◽  
Myung Ki Chung ◽  
Goo Hyun Baek
Keyword(s):  
Case Report ◽  
Distal Radioulnar Joint ◽  
Forearm Rotation ◽  
Ulnar Styloid ◽  
Chronic Instability ◽  
Radioulnar Joint ◽  
Post Traumatic

The advantage of preserving the distal radioulnar joint in wrist disarticulation is that full forearm rotation is possible if the joint is intact, which improves the capability of the amputee. The Sauvé-Kapandji procedure has been performed to treat rheumatoid or post-traumatic chronic instability and/or arthritis of the distal radioulnar joint. We report a patient with wrist disarticulation that presented to us with limited supination of the wrist due to an injured distal radioulnar joint. We performed the Sauvé-Kapandji procedure, and the patient could regain functional supination of the forearm without losing the ulnar styloid flare that improved prosthetic suspension. This case suggests that the Sauvé-Kapandji procedure can be performed to maintain the advantage of wrist disarticulation even when the initial trauma involves an irreparable injury of the distal radioulnar joint.

A Comparative Study Between Darrach and Sauvé-Kapandji Procedures for Post-Traumatic Distal Radioulnar Joint Dysfunction

Hand ◽  
2019 ◽  
pp. 155894471985544 ◽  
Author(s):  
Svenna H. W. L. Verhiel ◽  
Sezai Özkan ◽  
Marco J. P. F. Ritt ◽  
Neal C. Chen ◽  
Kyle R. Eberlin
Keyword(s):  
Patient Reported Outcomes ◽  
Distal Radioulnar Joint ◽  
Reoperation Rate ◽  
Measurement Information ◽  
Radioulnar Joint ◽  
Radiographic Outcomes ◽  
Radiographic Measurements ◽  
Patient Reported ◽  
Post Traumatic

Background: There are various treatments for post-traumatic distal radioulnar joint (DRUJ) dysfunction. The present study aimed to assess differences in long-term patient-reported outcomes on physical function, pain, and satisfaction between the Darrach and Sauvé-Kapandji procedures. Secondary aims were to describe the radiographic outcomes and to assess the difference in rate and type of complications and reoperations between these 2 procedures. Methods: We retrospectively analyzed 85 patients who had a post-traumatic DRUJ derangement and had been treated by either a Darrach (n = 57) or Sauvé-Kapandji procedure (n = 28). Fifty-two patients (61%) completed patient-rated outcomes surveys at a median of 8.4 years after their procedure. Radiographic measurements consisted of ulnar distance, radioulnar distance, and ulnar gap (only in Sauvé-Kapandji group). Results: There were no significant differences in Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity (UE) Function score, pain score, satisfaction score, complications, and reoperations between patients who had a Darrach procedure or a Sauvé-Kapandji procedure. Seventeen patients (30%) in the Darrach group experienced a complication, and 14 patients (50%) in the Sauvé-Kapandji group experienced a complication ( P = .09). The most common complication was instability of the ulnar stump (n = 10), followed by symptoms of the dorsal sensory branch of the ulnar nerve (n = 8). Patients who underwent a Sauvé-Kapandji procedure had more reoperations for excision of heterotopic ossification. Conclusions: Darrach and Sauvé-Kapandji procedures show comparable long-term patient-reported outcomes in treatment of post-traumatic DRUJ dysfunction. Complication and reoperation rate are relatively high, with non-significant differences between the 2 procedures.

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.

Hemiresection Interposition Arthroplasty of the Distal Radioulnar Joint: A Long-term Outcome Study

Hand ◽  
2019 ◽  
pp. 155894471987343 ◽  
Author(s):  
Femke Nawijn ◽  
Svenna H. W. L. Verhiel ◽  
Jesse B. Jupiter ◽  
Neal C. Chen
Keyword(s):  
Inflammatory Arthritis ◽  
Distal Radioulnar Joint ◽  
Long Term Outcome ◽  
Radioulnar Joint ◽  
Pain Scores ◽  
Custom Made ◽  
Patient Reported ◽  
The Mean

Background: The aim of this study was to assess factors associated with long-term patient-reported functional, pain, and satisfaction scores in patients who underwent (Bowers) hemiresection interposition technique (HIT) arthroplasty of the distal radioulnar joint (DRUJ). The secondary aims were to determine the complication and reoperation rates. Methods: A retrospective study with long-term follow-up of patients undergoing HIT arthroplasty was performed. Demographic, disease, and treatment characteristics were collected for the 66 included patients. Thirty-one patients completed all surveys, which were the Quick Disabilities of Arm, Shoulder and Hand (QuickDASH), our custom-made HIT arthroplasty questionnaire, Numeric Rating Scale (NRS) for pain, and NRS for satisfaction. The mean interval between surgery and follow-up by means of questionnaires was 8.6 ± 3.4 years. Results: The mean QuickDASH score was 31.0 ± 20.2. The mean score of the HIT arthroplasty questionnaire was 2 ± 2. The median NRS for pain was 1 (interquartile range [IQR], 0-3), and the median NRS for satisfaction was 9 (IQR, 8-10). The complication rate and reoperation rate were 14% and 8%, respectively. Conclusion: Overall, patients expressed satisfaction with HIT arthroplasty, despite a mean QuickDASH score of 31.0. In our cohort, patients with inflammatory arthritis had higher satisfaction and lower pain scores. Patients who had prior trauma, prior surgery, or DRUJ subluxation are generally less satisfied. Men, older patients, and posttraumatic patients had higher long-term pain scores; however, posterior interosseous nerve neurectomy is associated with improved pain scores. Our findings support the use of HIT arthroplasty in patients with inflammatory arthritis.

Chronic Posttraumatic Instability of the Distal Radioulnar Joint: Foveal Reattachment of the Triangular Fibrocartilage Complex With Dorsal Capsuloplasty and Extensor Retinaculum Imbrications

Hand ◽  
2020 ◽  
pp. 155894472091256
Author(s):  
Bernardo C. Neto ◽  
Junot H. S. Neto
Keyword(s):  
Medical Records ◽  
Distal Radioulnar Joint ◽  
Triangular Fibrocartilage Complex ◽  
Extensor Retinaculum ◽  
Forearm Rotation ◽  
Radioulnar Joint ◽  
Posttraumatic Instability ◽  
Triangular Fibrocartilage ◽  
Dash Questionnaire

Background: The purpose of this article is to describe the surgical technique used by the authors and the outcome in the treatment of chronic posttraumatic instability of the distal radioulnar joint (DRUJ). Methods: A retrospective study was conducted analyzing the medical records of 11 patients with chronic posttraumatic instability of the DRUJ, treated by a foveal reattachment of the triangular fibrocartilage complex with dorsal capsular and extensor retinaculum imbrications between 2016 and 2017, with a follow-up evaluation of 1 year. Results: All patients reported pain relief and the absence of instability, returning to normal activities in 3 to 6 months. Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire ranged from 2 to 25, resulting in a mean score of 9.5. Forearm rotation averaged 89° of pronation and 85° of supination. Conclusion: Foveal reattachment of the triangular fibrocartilage complex with dorsal capsular and extensor retinaculum imbrications is an effective surgical procedure for the treatment of DRUJ chronic posttraumatic instability.

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

Hand Surgery ◽  
2005 ◽  
Vol 10 (02n03) ◽  
pp. 169-176 ◽  
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.

scholarly journals Evaluation of an Image-Based Tool to Examine the Effect of Fracture Alignment and Joint Congruency on Outcomes after Wrist Fracture

2015 ◽  
Vol 9 (1) ◽  
pp. 168-178 ◽  
Author(s):  
Emily A Lalone ◽  
Ruby Grewal ◽  
Graham W King ◽  
Joy C MacDermid
Keyword(s):  
Distal Radius Fracture ◽  
Clinical Outcomes ◽  
Distal Radius ◽  
Distal Radioulnar Joint ◽  
Radius Fracture ◽  
Joint Congruency ◽  
Radioulnar Joint ◽  
Pain Disability ◽  
Post Traumatic

Some mal-alignment of the wrist occurs in up to 71% of patients following a distal radius fracture. A multiple case study was used to provide proof of principle of an image-based technique to investigate the evolution and impact of post-traumatic joint changes at the distal radioulnar joint. Participants who had a unilateral distal radius fracture who previously participated in a prospective study were recruited from a single tertiary hand center. Long term follow-up measures of pain, disability, range of motion and radiographic alignment were obtained and compared to joint congruency measures. The inter-bone distance, a measure of joint congruency was quantified from reconstructed CT bone models of the distal radius and ulna and the clinical outcome was quantified using the patient rated wrist evaluation. In all four cases, acceptable post-reduction alignment and minimal pain/disability at 1-year suggested good clinical outcomes. However, 10 years following injury, 3 out of 4 patients had radiographic signs of degenerative changes occurring in their injured wrist (distal radioulnar joint/radio-carpal joint). Proximity maps displaying inter-bone distances showed asymmetrical congruency between wrists in these three patients. The 10-year PRWE (patient rated wrist evaluation) varied from 4 to 60, with 3 reporting minimal pain/disability and one experiencing high pain/disability. These illustrative cases demonstrate long-term joint damage post-fracture is common and occurs despite positive short-term clinical outcomes. Imaging and functional outcomes are not necessarily correlated. A novel congruency measure provides an indicator of the overall impact of joint mal-alignment that can be used to determine predictors of post-traumatic arthritis and is viable for clinical or large cohort studies.

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