Replacement of the Distal Radioulnar Joint (original) (raw)
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Distal Radioulnar Joint Reconstruction After Fracture of the Distal Radius
The Journal of Hand Surgery, 2010
A 50-year-old man had a distal radius fracture of his dominant right hand 3 years ago. He reports wrist pain for the past 6 months. He has pain with forearm rotation, and supination is limited to 30°. He is tender at the distal radioulnar joint (DRUJ) and has pain with forceful ulnar deviation of the wrist. Radiographs show dorsal angulation of the distal radius and positive ulnar variance.
Distal radioulnar joint: arthroplasty and strength assessments
2018
The growing interest in distal radioulnar (DRUJ) disorders underlines the need for further improved evaluations of treatment outcome. Load-bearing and optimising torque are important features of the DRUJ, but they are rarely measured when assessing DRUJ interventions. To make these measurements easily accessible in clinical situations, we developed two methods for quantifying lifting strength and forearm torque. In this thesis, we report the outcomes after surgery with two types of DRUJ implant arthroplasty and the result of our evaluation of the new strength measurement methods. In Study I, we reviewed 21 patients treated with the Herbert ulnar head prosthesis and, in Study II, we included nine patients treated with the Scheker total DRUJ prosthesis after previously failed DRUJ surgery. For both types of arthroplasty, the patient-reported outcome was satisfactory, scores for pain were low and there were no signs of radiographic loosening. There was one re-operation (Herbert prosthe...
Distal Radioulnar Joint Replacement in the Scarred Wrist
Journal of Wrist Surgery, 2018
Background Radiocarpal or midcarpal arthritis can occur simultaneously with arthritis of the distal radioulnar joint (DRUJ), leading to functional impairment of the wrist. Treatment often involves wrist arthroplasty or arthrodesis, either with simultaneous or secondary procedures, addressing the DRUJ. Successful treatment of solitary DRUJ arthritis with DRUJ replacement has been reported. However, outcomes in patients with multiple prior wrist surgeries are lacking. Surgery in these wrists is challenging because surgical scarring and advanced bone deformities make implant positioning more difficult. Therefore, the aim of this study was to evaluate the outcomes in patients that underwent total wrist arthrodesis and DRUJ replacement after multiple prior wrist surgeries. Methods We prospectively enrolled patients that underwent total wrist arthrodesis and replacement of the DRUJ, either simultaneously or during separate procedures from 1999 to 2012. We included 14 patients with a media...
Distal Oblique Bundle Reconstruction and Distal Radioulnar Joint Instability
Journal of Wrist Surgery, 2013
Background This study created an anatomic reconstruction of the distal oblique bundle (DOB) of the interosseous membrane to determine its effect on distal radioulnar joint (DRUJ) instability and compare this technique with distal radioulnar ligament (DRUL) reconstruction. Questions/Purposes We hypothesized that this reconstruction would provide equivalent stability to DRUL reconstruction and that combining the two techniques would enhance stability. Methods Six cadaveric upper limbs were affixed to a custom frame. The volar/dorsal translation of the radius relative to the ulna was measured in 60°pronation, neutral, and 60°supination. Translation was sequentially measured with the DRUJ intact, with sectioned DRULs and triangular fibrocartilaginous complex (TFCC), and with sectioned DOBs. Reconstructions were performed on the DRULs, on the DOB tensioned in both neutral and supination, and employing both techniques. Results The DOB reconstruction, tensioned both in the neutral position and in 60°s upination, was more stable than the partial and complete instability in 6/6 specimens in pronation and the neutral position and in 5/6 specimens in supination. The DOB reconstruction and the DOB reconstruction tensioned in supination were more stable than the DRUL reconstruction in 4/6 patients. Combining the two techniques did not further reduce translation. Conclusions The DOB reconstruction is capable of improving stability in the unstable DRUJ.
Archives of Orthopaedic and Trauma Surgery, 2003
Introduction An intact distal radioulnar joint (DRUJ) is essential for normal functioning of the upper limb. Osteoarthritis of the DRUJ often leads to ulnar wrist pain, limitation of forearm rotation and reduced grip strength, all of which limit activities of daily living. Once the joint is damaged, salvage procedures are recommended. Materials and methods Between 1986 and 1996 a modified Sauvé-Kapandji procedure was performed in 117 patients with painfully limited forearm rotation and osteoarthritis of the distal radioulnar joint (DRUJ). Of the 117 patients, 73 women and 32 men, whose ages at operation ranged from 22 to 74 years (average 58 years), were retrospectively reviewed clinically and radiologically 8 years (range 5–12 years) after the operation. The DASH questionnaire was used with 53 patients, 43 patients were accepted for the study, and 10 were excluded. Results Forearm rotation improved in all patients, ulnar wrist pain was reduced in 97% of the patients, and 9% had mild pain at the proximal ulnar stump. Grip strength improved from a preoperative mean of 38% to a postoperative mean of 55% compared with the contralateral side. The mean DASH score was 28 points (range 0–53 points). In all cases the arthrodesis fused within 8 weeks. The radiographs showed approximation between the proximal ulna stump and the radius compared with the preoperative situation in 74% of the patients. Conclusion Our clinical and radiological findings suggest that the Sauvé-Kapandji procedure is indicated in symptomatic, non-reconstructable disorders of the DRUJ. The DASH questionnaire provides a general view of the functional outcome after the Sauvé-Kapandji procedure. The DASH questionnaire is very helpful in evaluating the effect of the Sauvé-Kapandji procedure on the entire upper limb.
Surgical Approaches to the Distal Radioulnar Joint
Hand Clinics, 2010
According to Gupta and colleagues 8 and Shigemitsu and colleagues, 9 the palmar capsule, anterior radioulnar, and ulnolunate ligaments are mostly innervated by branches of the ulnar nerve. Branches from the anterior interosseous nerve (AIN) are additionally found to innervate the volar DRUJ capsule, 10,11 but detailed microscopic studies have not disclosed AIN contributions to
Shafa Orthopedic Journal
Background: Several procedures have been described for the management of post-traumatic disorders of the distal radioulnar joint (DRUJ). Amongst them, Sauve-Kapandji (SK) procedure has shown promising results; yet, it is not infallible. Here, we evaluated the radiologic and clinical outcomes of the SK procedure in eight patients with post-traumatic disorders of DRJU. Methods: In a retrospective study, patients with post-traumatic derangement of the DRUJ that underwent the SK procedure were included. The radiologic outcomes were evaluated using the assessment of union, ulnar variation, and radial deviation. The forearm range of motion and Mayo Modified Wrist Score (MMWS) were used for the clinical evaluation of the outcomes. The grip strength of the injured hand was compared with the grip strength of contralateral hand. Results: The mean extension, flexion, supination, and pronation of the patients were 67.5°, 65°, 77.5°, and 78.1°, respectively. The mean ulnar and radial deviations were 20.6°and 17.5°, respectively. The mean grip strength was 45.6 ± 14.1 Ib for the injured hand and 75.4 ± 30 Ib for the non-injured hand (P = 0.012). The mean MMWS was 83.8 ± 5.2. Based on the MMWS, the functional outcome was categorized as excellent in two patients, good in five patients, and fair in one patient. At the last follow-up, radiologic union was observed in all the patients but one. No other complications were recorded. Conclusions: The SK procedure could result in acceptable radiologic and functional outcomes for the management of posttraumatic DRUJ problems. However, it might compromise some indices of the forearm such as grip strength.
The Distal Radioulnar Joint as a Load-Bearing Mechanism—A Biomechanical Study
The Journal of Hand Surgery, 2004
Purpose: A biomechanical study was performed to define the normal profiles of force transmission across the distal radioulnar joint (DRUJ) and their alteration as the result of surgical modification of the joint and its ligaments. Methods: Twelve cadaver arms were used in this investigation. A custom-made jig was designed to hold the arm and allow axial loading of the hand. Force transmitted across the DRUJ was measured with sensor film. The axial force transmitted through the ulna and radius was measured with strain gauges mounted to the surface of each bone and the strain in the dorsal and volar distal radioulnar ligaments (DRUL) was measured with differential variable reluctance transducers. Measurements of force and strain with the DRUJ in the surgically unmodified condition were performed in various positions of forearm rotation and with sequential loads. Subsequently, the same series of measurements was performed after DRUL division and after reconstruction of the ligament. The effect of excision of the ulna head (Darrach's procedure) was also studied. Results: Force varied significantly (p Ͻ .05) with the applied load and with forearm position, being greater in supination than pronation (sensor film data). Force transmitted through the ulna varied in an approximately reciprocal pattern with that of the radius. The greatest forces through the ulna occurred in supination and therefore mirrored the change in force transmission across the DRUJ. Between 32% and 34%, respectively, of the applied load (5-10 kg) was transmitted through the ulna and the remainder was transmitted through the radius (strain gauge data). Division of either the volar or the dorsal DRUL tended to increase the force transmitted across the DRUJ (p ϭ .09), and reconstruction of the disrupted DRUL restored the force pattern toward the previous values (not significant) (differential variable reluctance transducer data). Excision of the ulna head disrupted the force transmission profiles, producing the biomechanical equivalent of a 1-bone forearm. Only 1.8% and 2.7% of the applied force (10 kg and 5 kg), respectively, was transmitted through the ulna (strain gauge data only). Conclusions: The data show consistent and characteristic force transmission profiles across the DRUJ and through both ulna and radius. The joint is important in the transmission of load and its anatomic integrity should be respected in surgical procedures if normal biomechanics are to be preserved.
Distal Radioulnar Joint Injuries Associated With Fractures of the Distal Radius
Clinical Orthopaedics and Related Research, 1996
The most common cause of residual wrist disability after fractures of the distal radius is the distal radioulnar joint. The 3 basic conditions that produce radioulnar pain and limitation of forearm rotation are instability, joint incongruency, and ulnocarpal abutment. The last 2 entities initiate irreversible cartilage damage that eventually leads to degenerative joint disease. Early recognition and management in the acute stage aim at the anatomic reconstruction of the distal radioulnar joint including bone, joint surfaces, and ligaments in an effort to reduce the incidence of painful sequelae and functional deficit. This article provides a description and the treatment options of the distal radioulnar joint lesions that occur in association with fractures of the distal radius, and the results obtained with open and arthroscopic techniques. Both acute and chronic disorders are analyzed, and a prognostic and treatment oriented classification is presented. Furthermore, the pathoanatomy and management of chronic distal radioulnar joint de-From the