J Korean Soc Surg Hand.  2014 Jun;19(2):79-86. 10.12790/jkssh.2014.19.2.79.

Chronic Instability of Distal Radioulnar Joint

• Shin HD
• Cha SM

• KMID: 2097613
• DOI: http://doi.org/10.12790/jkssh.2014.19.2.79

Abstract

Chronic instability of distal radioulnar joint (DRUJ) can develop after injury such as fractures or dislocations, to the bony structures or to the soft tissue as like ligament, capsule. If proper treatment is not performed, normal biomechanics of DRUJ would be altered, thus arthritic joint with chronic functional impairment, pain resulted in. The proper treatments included several procedures for repair of the bony structures and recovery of realignment, various methods for soft tissue repair and reconstruction in unstable condition without bony structures destruction. Several salvage methods such as Darrach procedure, hemiresectional interposition arthroplasty, Sauve-Kapandji procedure, were recommended for the advanced arthritic DRUJ. Wide ulnar resection, one-bone forearm procedure, prosthetic replacement for DRUJ were rarely indicated, but the a few long-term results were reported. Operative stabilization (repair or reconstruction) for each structure assumed as DRUJ instability, is essential and proper selection among the several salvage procedures for the advanced arthritis joint, is needed.

Keyword

Distal radioulnar joint; Instability; Ligament reconstruction; Salvage procedure

MeSH Terms

Arthritis
Arthroplasty
Dislocations
Forearm
Joints*
Ligaments

Figure

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  Fig. 1. The four anatomic variations of the sigmoid notch.

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  Fig. 2. Illustration of plication of the Flexor carpi ulnaris tendon graft onto its proximal limb.

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  Fig. 3. (A, B) Preoperative radiographs of painful, unstable wrist. (C, D) 6 years follow-up radiographs after distal radioulnar joint reconstruction (Adam's technique).

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  Fig. 4. Illustrations of passing the free tendon graft (palmaris longus) through the radial and ulnar bone tunnels and around the ulnar neck.

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  Fig. 5. (A) A 45-year-old man with painful, unstable wrist during 2 years. Incongruency in distal radioulnar joint (DRUJ) and mild degenerative lesion in sigmoid notch were seen. (B) Volar subluxed ulnar head was definitive in axial view of DRUJ. (C) Chronic triangular fibrocartilage complex wear and irregularity of articular surface of DRUJ was seen in magnetic resonance imaging. (D) Two years follow-up radiograph after Sauve-Kapandji pracecure.

Reference

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