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Hernández-Cortés P, Catena A, Hernández-Peregrina P, Elizondo-Espósito D, Pajares-López M, Rosales RS. Association between radioulnar impingement and salvage surgical procedures of the distal radioulnar joint: influence of confounding variables. J Hand Surg Eur Vol 2024; 49:73-81. [PMID: 37676234 DOI: 10.1177/17531934231192848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
We conducted an ambispective cohort study to assess the association between symptomatic radioulnar impingement syndrome (SRUIS) and distal radioulnar joint (DRUJ) salvage surgery to examine the influence of confounders on the final effect. The outcome variable was the incidence of SRUIS and the exposure variable was the surgical procedure. Seventy-two patients with median age of 48 years (IQR 25-78) were examined using bivariate and logistic regression multivariate analyses, and confounders were analysed in 15 multivariate models. Overall, SRUIS occurred in 21 patients (29%). Bivariate analysis showed a significant association between SRUIS and type of surgical procedure, observed in 71% after Sauvé-Kapandji, 50% after Bowers and 15% after Darrach procedure. When adjusted for age, aetiology and previous surgery, the significant association disappeared. Confounding is an important factor when accounting for SRUIS after DRUJ salvage surgery. The risk of SRUIS did not depend on the procedure, but rather on patient's age, aetiology and previous surgery.Level of evidence: II.
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Affiliation(s)
- Pedro Hernández-Cortés
- Upper Limb Surgery Unit, Orthopedic Surgery Department, University Hospital of Granada, Spain
- Surgery Department, School of Medicine, Granada University, Spain
- Biosanitary Research Institute of Granada, Spain
| | - Andrés Catena
- Mind, Brain, and Behavior Research Center, University of Granada, Spain
| | | | - Diana Elizondo-Espósito
- Upper Limb Surgery Unit, Orthopedic Surgery Department, University Hospital of Granada, Spain
| | - Miguel Pajares-López
- Upper Limb Surgery Unit, Orthopedic Surgery Department, University Hospital of Granada, Spain
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Darrach vs. Sauve-Kapandji: A Comprehensive Meta-Analysis of Surgical Outcomes in Distal Radioulnar Joint (DRUJ) Dysfunction. Indian J Orthop 2023; 57:565-570. [PMID: 37006734 PMCID: PMC10050530 DOI: 10.1007/s43465-023-00826-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 01/12/2023] [Indexed: 02/15/2023]
Abstract
Introduction Optimal treatment of chronic distal radioulnar joint (DRUJ) arthritis and instability remains unresolved in the literature. Specifically, no systematic comparison of two common options, Sauve-Kapandji (SK) and Darrach's, is available. Methods A meta-analysis was performed utilizing the PUBMED and EMBASE databases and yielded a total of 47 available studies. Objective outcomes, such as wrist range of motion (ROM), forearm ROM, grip strength, and subjective outcomes, including pain and rate of return to work, were recorded. Statistical analysis was done using t test and chi-square test. Results For both the SK and Darrach's procedures, forearm ROM was significantly better postoperatively in both pronation (p = 0.0001 for both groups) and supination (p = 0.0001 for both groups). Wrist flexion decreased in the SK group (p = 0.0007), but no difference was found for wrist extension (p = 0.09). The Darrach's group showed a significance improvement in wrist extension (p = 0.0001). Grip strength was improved in the SK group (p < 0.0001), but not in the Darrach's group (p = 0.7831). No difference existed between the SK and Darrach's groups in proportion of patients who were pain-free. The SK group had higher numbers of patients return to work (p = 0.0057). There was not enough data from the studies to make any meaningful analysis in term of treatment failure and complications. Conclusions Overall, both the SK and Darrach's procedures helped improve pain, wrist ROM, and forearm ROM in patient with chronic DRUJ disorders. The SK procedure can have advantages over the Darrach's procedures in terms of grip strength and rate of return to work. Supplementary Information The online version contains supplementary material available at 10.1007/s43465-023-00826-5.
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Katt BM, Tawfik A, Zingas N, Sirch F, Beredjiklian PK, Fletcher D. Distal Radioulnar Joint Osteoarthritis: An Update on Treatment Options. J Hand Microsurg 2023; 15:5-12. [PMID: 36761052 PMCID: PMC9904983 DOI: 10.1055/s-0041-1725222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
The distal radioulnar joint (DRUJ), the articulation between the sigmoid notch of the radius and the distal ulna, plays a pivotal role in stability and load bearing and allows for pronation and supination of the forearm. Osteoarthritis (OA) of the DRUJ commonly occurs due to distal radius trauma but may also be the result of conditions such as joint instability, septic arthritis, or primary OA. It is initially managed with conservative therapy, but surgery is often considered when nonoperative methods fail. The surgical approaches available to treat this pathology have grown over the years. The procedures have generally favorable outcomes, each with their own unique complications and considerations. This paper comprises a review of the outcomes and complications for the different procedures commonly used to surgically treat DRUJ OA.
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Affiliation(s)
- Brian M. Katt
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania,, United States
| | - Amr Tawfik
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania,, United States
| | - Nicholas Zingas
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Francis Sirch
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania,, United States
| | - Pedro K. Beredjiklian
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania,, United States
| | - Daniel Fletcher
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania,, United States
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Chen KJ, Wang JP, Huang HK, Huang YC. An investigation of dynamic ulnar impingement after the Darrach procedure with ultrasonography. J Plast Surg Hand Surg 2021; 56:277-284. [PMID: 34431746 DOI: 10.1080/2000656x.2021.1968416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Dynamic ulnar impingement is a common and painful symptom after the Darrach procedure. However, the current detection method with static radiographs often falls short of examining the dynamically symptomatic wrists. We, therefore, investigate the utility of ultrasonography to assess dynamic ulnar impingement. In this cross-sectional study, 20 patients, with 22 wrists, who had undergone the Darrach procedure were evaluated at a mean of 55 months (range, 25-171) from the index procedure. Real-time ultrasonographic imaging in the axial plane of the bone and soft tissue was performed during three different dynamic testing methods, including weight-stressed (WS), pronation-supination (PS), and forceful fist clenching (FC), to investigate ulnar impingement. Dynamic radiographs were obtained for comparison. Clinical outcomes were evaluated with grip strength and patient-reported outcomes including pain in daily activities on a numeric rating scale (NRS), the Patient-Rated Wrist Evaluation (PRWE), and the Quick Disability of the Arm, Shoulder and Hand (QDASH). Ultrasonographic ulnar impingement found during PS method was associated with worse pain and function, yet impingement diagnosed with dynamic radiographs or ultrasonography with WS and FC method was not associated with worse outcomes. While radiographic impingement was found in a total of 12 wrists (55%), ultrasonography with the WS and PS method revealed true bone contact in only 2 (9%) and 4 (18%) of the wrists, respectively. The addition of ultrasonography may be valuable in follow-up evaluations after the Darrach procedure.
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Affiliation(s)
- Kuan-Jung Chen
- Department of Orthopaedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jung-Pan Wang
- Department of Orthopaedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hui-Kuang Huang
- Department of Orthopaedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Orthopaedics, Chiayi Christian Hospital, Chiayi, Taiwan.,Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - Yi-Chao Huang
- Department of Orthopaedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Verhiel SHWL, Özkan S, Ritt MJPF, Chen NC, Eberlin KR. A Comparative Study Between Darrach and Sauvé-Kapandji Procedures for Post-Traumatic Distal Radioulnar Joint Dysfunction. Hand (N Y) 2021; 16:375-384. [PMID: 31248288 PMCID: PMC8120580 DOI: 10.1177/1558944719855447] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
| | - Sezai Özkan
- Massachusetts General Hospital, Harvard
Medical School, Boston, USA
| | | | - Neal C. Chen
- Massachusetts General Hospital, Harvard
Medical School, Boston, USA
| | - Kyle R. Eberlin
- Massachusetts General Hospital, Harvard
Medical School, Boston, USA,Kyle R. Eberlin, Division of Plastic and
Reconstructive Surgery, Harvard Medical School, Massachusetts General Hospital,
Wang 435, 15 Parkman Street, Boston, MA 02114, USA.
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Abstract
This article reviews the anatomy and mechanics of pronation and supination (axial rotation) of the forearm through the distal radioulnar joint (DRUJ), and the proximal radioulnar joint (PRUJ). Injuries to the bones and/or ligaments of the forearm, wrist, or elbow can result in instability, pain, and limited rotation. Acute dislocations of the DRUJ commonly occur along with a fracture to the distal radius, radial metadiaphysis, or radial head. These injuries are all caused by high-energy trauma. Outcomes are predicated on anatomic reduction and restoration of stability to the DRUJ and PRUJ with or without ligamentous repair or reconstruction.
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Affiliation(s)
- Louis H Poppler
- Department of Plastic & Reconstructive Surgery, St. Luke's Health System, Boise, ID, USA
| | - Steven L Moran
- Department of Plastic & Reconstructive Surgery, Mayo Clinic, Rochester, MN, USA; Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
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