Artelon spacer for post-traumatic distal radioulnar joint post-traumatic osteoarthritis: 10 years follow-up in five patients

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.

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

Journal of Hand Surgery (European Volume) ◽

10.1054/jhsb.2000.0476 ◽

2001 ◽

Vol 26 (1) ◽

pp. 41-44 ◽

Cited By ~ 26

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.

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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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Desmoid tumour of the distal forearm involving the distal radioulnar joint

BMJ Case Reports ◽

10.1136/bcr-2020-237097 ◽

2020 ◽

Vol 13 (11) ◽

pp. e237097

Author(s):

Apoorv Sehgal ◽

Pratyush Shahi ◽

Avijeet Prasad ◽

Manoj Bhagirathi Mallikarjunaswamy

Keyword(s):

Distal Radioulnar Joint ◽

Treatment Modalities ◽

Desmoid Tumour ◽

X Rays ◽

Distal Forearm ◽

Left Wrist ◽

Radioulnar Joint ◽

Magnetic Resonance Imaging Mri ◽

Epidemiology Investigation

A 32-year-old woman presented with progressive pain and swelling of the left wrist for 6 months. Physical examination revealed a firm, tender, oval swelling over the left wrist. X-rays showed a pressure effect on the distal radius and ulna. Magnetic Resonance Imaging (MRI) revealed a well-defined, asymmetrical, dumbbell-shaped soft-tissue lesion involving the interosseous region of the distal forearm and extending until the distal radioulnar joint (DRUJ). Core needle biopsy confirmed the diagnosis of desmoid tumour. Marginal excision of the tumour was done. At the 2-year follow-up, the patient was doing well and had painless and improved left wrist motion. Desmoid tumour involving the DRUJ has not been previously reported. We, through this case, report new observation and discuss the epidemiology, investigation of choice, treatment modalities, and the need for a regular follow-up for appendicular desmoid tumours.

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The rein-type arthroscopic capsular suture for triangular fibrocartilage complex foveal tears: midterm results for 90 patients

Journal of Hand Surgery (European Volume) ◽

10.1177/17531934211024177 ◽

2021 ◽

pp. 175319342110241

Author(s):

I-Ning Lo ◽

Kuan-Jung Chen ◽

Tung-Fu Huang ◽

Yi-Chao Huang

Keyword(s):

Simple Procedure ◽

Distal Radioulnar Joint ◽

Triangular Fibrocartilage Complex ◽

Joint Stability ◽

Level Of Evidence ◽

Radioulnar Joint ◽

High Satisfaction ◽

Ultrasound Assessment ◽

Triangular Fibrocartilage

We describe an arthroscopic rein-type capsular suture that approximates the triangular fibrocartilage complex to the anatomical footprint, and report the results at a minimum 12 month follow-up. The procedure involves two 3-0 polydioxanone horizontal mattress sutures inserted 1.5 cm proximal to the 6-R and 6-U portals to obtain purchase on the dorsal and anterior radioulnar ligaments, respectively. The two sutures work as a rein to approximate the triangular fibrocartilage complex to the fovea. Ninety patients with Type IB triangular fibrocartilage complex injuries were included retrospectively. The 12-month postoperative Modified Mayo Wrist scores, Disabilities of Arm, Shoulder and Hand scores and visual analogue scale for pain showed significant improvements on preoperative values. Postoperative range of wrist motion, grip strength and ultrasound assessment of the distal radioulnar joint stability were comparable with the normal wrist. The patients had high satisfaction scores for surgery. There were minor complications of knot irritation. No revision surgery for distal radioulnar joint instability was required. It is an effective and technically simple procedure that provides a foveal footprint contact for the triangular fibrocartilage complex. Level of evidence: IV

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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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PROXIMAL ULNAR STUMP STABILITY AFTER USING THE PRONATOR QUADRATUS MUSCLE TRANSFER COMBINED WITH THE SUAVÉ-KAPANDJI PROCEDURE IN RHEUMATOID WRIST

Hand Surgery ◽

10.1142/s0218810414500051 ◽

2014 ◽

Vol 19 (01) ◽

pp. 25-32 ◽

Cited By ~ 2

Author(s):

Chairoj Uerpairojkit ◽

Somsak Leechavengvongs ◽

Kanchai Malungpaishorpe ◽

Kiat Witoonchart ◽

Panai Buddhavibul

Keyword(s):

Sagittal Plane ◽

Distal Radioulnar Joint ◽

Muscle Transfer ◽

Pronator Quadratus ◽

Radioulnar Joint ◽

Rheumatoid Wrist ◽

Joint Disorder ◽

The Mean ◽

Pronator Quadratus Muscle

The pronator quadratus muscle transfer combined with the Sauvé-Kapandji procedure was used to treat the distal radioulnar joint disorder in ten rheumatoid wrists for prevention against instability of the proximal ulnar stump. All patients were female with a mean age of 46.6 years. The mean follow-up time was 24.2 months. Postoperatively, supination increased in all patients with a mean of 50 degrees. Pain decreased significantly and none complained of prominence of the proximal ulnar stump in normal pronated position and during a tight grip. The wrist radiographs of both coronal and sagittal planes in normal and stress fisting views were used to evaluate the postoperative static and physiologic loaded stability of the proximal ulnar stump. It had shown this procedure provided good static proximal ulnar stump stability in both coronal and sagittal planes. However, in physiologic loaded condition, it was able to provide stability only in the sagittal plane.

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

Hand Surgery ◽

10.1142/s0218810414720150 ◽

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.

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

Journal of Hand Surgery (European Volume) ◽

10.1177/17531934211048406 ◽

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

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

Journal of Wrist Surgery ◽

10.1055/s-0039-1683364 ◽

2019 ◽

Vol 08 (03) ◽

pp. 215-220 ◽

Cited By ~ 1

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.

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