A study of functional outcomes following implantation of a total distal radioulnar joint prosthesis

Allograft tendon interposition and brachioradialis tendon stability augmentation in revision surgery for failed Darrach distal ulna resections

Achilles allograft interposition is one treatment alternative for failed Darrach distal ulna resections, good results have been reported with its use but concern remains with the stability of the distal ulnar stump. The use of brachioradialis tendon passed through the radius and then divided in to 2 branches to pass over the volar and dorsal aspect of the ulnar stump with the Achilles tendon interposition, seems to represent a more reliable, secure, and biological way of restoring palmar and dorsal stability to the distal ulnar stump; while it allows a better control of the tension given to the Achilles allograft interposed than that achieved when using only suture anchors as described in the original technique.

Periprosthetic bone resorption and sigmoid notch erosion around ulnar head implants: a concern?

Metallic ulnar head implants have been proposed not only to solve symptomatic radioulnar impingement after Darrach or Sauvé-Kapandji procedures, but also to prevent such an impingement when treating arthritic distal radioulnar joint. This article prospectively analyzes a series of ulnar head implants with special reference to bone resorption at the prosthesis collar and erosion of the sigmoid notch of the distal radius at an average follow-up of 32 months (minimum 24 months).

A new total distal radioulnar joint prosthesis: functional outcome

PURPOSE

To present the evolution of design and the short-term functional outcome of our distal radioulnar joint (DRUJ) prosthesis. This total DRUJ prosthesis differs from others in that it consists of 2 parts and attains bony fixation by its hydroxyapatite coating.

METHODS

Nineteen patients received a DRUJ prosthesis after a failed Darrach procedure (n = 10), Sauvé-Kapandji procedure (n = 7), trauma (n = 1), or DRUJ synovitis (n = 1). Indications for the placement were decreased grip, decreased forearm motion, and pain due to ulnar impingement syndrome and instability of the distal ulna. Seven prostheses were removed, 5 due to loosening, 1 due to continuing pain, and 1 at the request of the patient. The 5 prostheses that loosened were an intermediate prototype no longer in use. In 12 remaining cases, range of motion, grip strength, and pinch strength were measured, and patients completed the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Pain was assessed with the visual analog scale (range, 0-10). A paired t-test was performed to assess the significance of the difference between preoperative and postoperative measurements.

RESULTS

Statistically significant improvements were seen in forearm pronation, from an average of 79° to 88°; grip strength, from an average of 10 kg to an average of 16 kg; and visual analog scale score, decreased from a mean of 5.3 to a mean of 3.5. The distal ulna was clinically stable in all 12 patients who retained the prosthesis.

CONCLUSIONS

The intermediate prototype had a high failure rate, 5 out of 5. The early results for the current prosthesis prototype show clinical improvement. Based on these results, we conclude that this prosthesis offers a new treatment option for ulnar instability after distal ulnar resection.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

The functional anatomy of forearm rotation

The elbow, forearm and wrist act as a unified structure to provide a stable, strong and highly mobile strut for positioning the hand in space and for conducting load-bearing tasks. An understanding of the relevant anatomy and biomechanics is important for the surgeon assessing and treating disorders of forearm function. This paper is concerned with illuminating the principles and concepts governing forearm rotation and load-bearing functions.

Total distal radioulnar joint arthroplasty in adults with symptomatic Madelung's deformity

Madelung's deformity is a well-known congenital anomaly of the wrist. A number of procedures have been described to correct the deformity and thus improve function at the wrist. Most of these procedures have to a large extent addressed the alignment and consequent function of the radiocarpal joint but not the persistent problem of painful stiffness at the distal radioulnar joint (DRUJ). The availability of a total DRUJ prosthesis appears to provide a solution to this problem. This article discusses our early experience with total DRUJ arthroplasty using the Scheker prosthesis for managing pain and decreased range of motion in three adult patients with symptomatic Madelung's deformity.

New trends in arthroscopic management of type 1-B TFCC injuries with DRUJ instability

Advances in radiocarpal and distal radioulnar joint (DRUJ) diagnostic arthroscopy permits a treatment-oriented classification of triangular fibrocartilage complex (TFCC) peripheral tears: 1) repairable distal tears; 2) repairable complete tears; 3) repairable proximal tears; 4) non-repairable tears; and 5) tears associated with DRUJ arthritis. Class 1 tears should be sutured; Class 2 and 3 are associated with DRUJ instability and require TFCC reattachment to the fovea; Class 4 tears need reconstruction using a tendon graft and Class 5 tears require an arthroplasty. Arthroscopic assisted TFCC foveal reattachment is possible through the direct foveal portal, a dedicated DRUJ working portal. Arthroscopic TFCC reconstruction using a tendon graft showed promising results.

Reconstruction of the distal ulna: instability, impaction, impingement, and arthrosis

A number of afflictions may affect the distal radioulnar joint that can lead to severe pain, disuse, dysfunction, and disability. The disorders that affect this small anatomic region are complex, have multifactorial etiologies, and can sometimes present difficult diagnostic and treatment options. This article presents an overview of recent developments in the diagnosis and treatment of a variety of conditions that affect the joint and surrounding bone and soft tissues.