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Kolovich GP, Heifner JJ, Falgiano PA, Mahoney B. Distal Radioulnar Joint Instability. J Orthop Trauma 2024; 38:S4-S10. [PMID: 39150287 DOI: 10.1097/bot.0000000000002859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/03/2024] [Indexed: 08/17/2024]
Abstract
SUMMARY The distal radioulnar joint (DRUJ) is vital to the stability and function of the wrist and forearm. The osseous morphology is variable and provides little stability. A complex of confluent soft tissues is the primary stabilizer; however, the contribution of each component has yet to be elucidated. It has become increasingly clear that the anatomic fixation of distal radius fractures restores DRUJ stability, obviating the need for additional DRUJ stabilization. This review will describe the anatomy and biomechanics of the DRUJ and discuss injury patterns, treatments, and clinical results.
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Affiliation(s)
| | - John J Heifner
- Department of Orthopedic Surgery, Larkin Hospital, Miami, FL
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Shaer SA, van der Palen J, Teunissen J, Fink A, van der Heijden B, Zöphel O, The Hand Wrist Study Group. An alternative treatment for degenerative triangular fibrocartilage complex injuries with distal radioulnar joint instability: first experience with 48 patients. J Hand Surg Eur Vol 2024; 49:240-249. [PMID: 37694851 PMCID: PMC10845826 DOI: 10.1177/17531934231197942] [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] [Received: 09/20/2023] [Revised: 07/20/2023] [Accepted: 08/13/2023] [Indexed: 09/12/2023]
Abstract
Treatment of ulnar impaction syndrome combined with distal radioulnar joint instability due to irreparable degenerative triangular fibrocartilage complex injuries can be complex. We describe the outcomes of a novel technique for restoring distal radioulnar stability due to ulnar impaction syndrome using a distally based extensor carpi ulnaris tendon strip combined with ulnar shortening osteotomy in 48 patients. Patients were assessed using standardized outcome measurements. The patient-rated wrist/hand evaluation total score improved from 66 (SD 15) at intake to 40 (SD 25) at 3 months, and 28 (SD 23) at 12 months postoperatively (p < 0.001). Wrist extension and flexion improved significantly at 12 months from 53° (SD 11) to 65° (SD 8) (p < 0.001) and from 45° (SD 10) to 56° (SD 12) (p = 0.01), respectively. Adding a distally based longitudinal extensor carpi ulnaris strip to ulnar shortening osteotomy for restoring distal radioulnar joint stability seems to be an effective treatment in patients with irreparable degenerative triangular fibrocartilage complex injuries due to ulnar impaction syndrome. Level of evidence: IV.
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Affiliation(s)
- Sanharib Al Shaer
- Department of Surgery, UMC Utrecht, Utrecht, The Netherlands
- Hand and Wrist Center, Xpert Clinics, Handtherapy, Enschede, The Netherlands
| | - Job van der Palen
- Department of Epidemiology, Medisch Spectrum Twente, Enschede & Section Cognition, Data and Education, Faculty BMS, University of Twente, Enschede, The Netherlands
| | - Joris Teunissen
- Hand and Wrist Center, Xpert Clinics, Handtherapy, Enschede, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Alexandra Fink
- Hand and Wrist Center, Xpert Clinics, Handtherapy, Enschede, The Netherlands
| | - Brigitte van der Heijden
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Jeroen Bosch Ziekenhuis ‘s-Hertogenbosch, The Netherlands
| | - Oliver Zöphel
- Hand and Wrist Center, Xpert Clinics, Handtherapy, Enschede, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Ziekenhuisgroep Twente, Hengelo, The Netherlands
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Carratalá V, Lucas FJ, Miranda I, Martínez C, Guisasola E. All-Arthroscopic Triangular Fibrocartilage Complex Ligamentoplasty: Technique and Results. J Wrist Surg 2023; 12:104-112. [PMID: 36926213 PMCID: PMC10010905 DOI: 10.1055/s-0042-1757765] [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] [Received: 10/16/2021] [Accepted: 06/28/2022] [Indexed: 11/25/2022]
Abstract
Objective The aim of the study is to describe the modified all-arthroscopic technique for triangular fibrocartilage complex (TFCC) ligamentoplasty in chronic injuries of the TFCC with distal radioulnar joint (DRUJ) instability, and to present the results obtained. Methods A prospective study was conducted including 11 consecutive patients with chronic TFCC injury with DRUJ instability who underwent an all-arthroscopic TFCC ligamentoplasty. During follow-up, the range of joint motion, grip strength, pain according to the visual analog scale (VAS), functional outcomes according to the Mayo Wrist Score (MWS), and the QuickDASH Score were measured, and any complications and necessary reinterventions were recorded Results We analyzed 11 patients with distal radioulnar ligament injury treated using the all-arthroscopic ligamentoplasty technique. Mean follow-up was 31.5 ± 4.4 (range 12-58) months. The technique presented achieved DRUJ stability in 100% of cases at 12 months. Grip strength and pain, showed a statistically significant improvement between the preoperative score and the two postoperative assessments. Functional assessment using the QuickDASH score and the MWS also improved significantly. Conclusion The all-arthroscopic technique for the reconstruction of irreparable peripheral TFCC tears is a reliable technique, intended not only to minimize the surgical trauma to reduce postoperative pain and to facilitate rehabilitation, but also to improve both the quality of the reconstruction and the functional outcome.
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Affiliation(s)
- Vicente Carratalá
- Hand and Upper Limb Surgery Unit, Hospital Quirónsalud Valencia, Valencia, Spain
| | | | | | - Cristóbal Martínez
- Hand and Upper Limb Surgery Unit, Hospital Quirónsalud Valencia, Valencia, Spain
- Traumaunit, Teknon Clinic, Barcelona, Spain
| | - Eva Guisasola
- Hand and Upper Limb Surgery Unit, Hospital Quirónsalud Valencia, Valencia, Spain
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Atzei A, Tandioy-Delgado FA, Marcovici LL, Aust TW, Luchetti R. Allinside Anatomic Arthroscopic (3A) Reconstruction of Irreparable TFCC Tear. J Wrist Surg 2023; 12:2-8. [PMID: 36644726 PMCID: PMC9836779 DOI: 10.1055/s-0041-1735981] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 08/10/2021] [Indexed: 01/18/2023]
Abstract
Background In recent years, new arthroscopic techniques have been introduced to address the irreparable tears of the triangular fibrocartilage complex (TFCC) (Palmer type 1B, Atzei class 4) by replicating the standard Adams-Berger procedure. These techniques, however, show the same limitations of the open procedure in relation to the anatomically defective location of the radial origins of the radioulnar ligaments (RUL) and the risk of neurovascular and/or tendon injury. Aiming to improve the quality of reconstruction and reduce surgical morbidity, a novel arthroscopic technique was developed, with the advantages of reproducing the anatomical origins of the RUL ligaments and providing all-inside tendon graft (TG) deployment and fixation. Description of Technique The Allinside anatomic arthroscopic (3A) technique is indicated for TG reconstruction of irreparable TFCC tears in the absence of distal radioulnar joint (DRUJ) arthritis. Standard wrist arthroscopy portals are used. A small incision in the radial metaphyseal area and arthroscopic control are required to set a Wrist Drill Guide and create two converging tunnels, whose openings are at the radial anatomical origins of the RUL. An ulnar tunnel is drilled at the fovea from inside-out via the 6U portal. A 3-mm tendon strip, from the palmaris longus or extensor carpi radialis brevis, is woven through the tunnels and then secured into the ulnar tunnel with an interference screw. Postoperative immobilization with restricted forearm rotation is discontinued at 5 weeks, and then postoperative rehabilitation is started. Patients and Methods The 3A technique was applied on 5 patients (2 females and 3 males), with an average age 42 years. DRUJ stability, range of motion (ROM), pain (0-10 visual analogue scale [VAS]), grip strength, modified Mayo wrist score (MMWS), and patient satisfaction were used for evaluation before surgery and at follow-up. Results No intraoperative or early complications were registered. At a mean follow-up of 26 months, DRUJ was stable in all patients, which recovered 99% ROM. Pain VAS decreased from 7 to 0.6. Grip strength increased from 38 to 48.8 Kgs. There were 4 excellent results and 1 good result on MMWS. All patient showed high satisfaction. Conclusions Although the 3A technique requires dedicated instrumentation and arthroscopic expertise, it takes advantage of improved intra-articular vision and minimized surgical trauma to reduce the risk of complications and obtain promising functional results.
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Affiliation(s)
- Andrea Atzei
- Pro-Mano, Hand Surgery and Rehabilitation, Treviso, Italy
| | | | | | | | - Riccardo Luchetti
- Rimini Hand and Upper Limb Surgery & Rehabilitation Center, Rimini, Italy
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Verbeek DO, Wilssens NOJ, Ten Bosch JA, Hannemann PFW. Long-term results of distal oblique bundle reinforcement for treatment of chronic bidirectional instability of the distal radioulnar joint. J Hand Surg Eur Vol 2022; 47:1128-1133. [PMID: 36071642 DOI: 10.1177/17531934221121925] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Distal oblique bundle (DOB) reinforcement for treatment of post-traumatic bidirectional instability of the distal radioulnar joint (DRUJ) has previously been reported. The objective of the current study was to assess the incidence of symptomatic graft failure and the need for secondary wrist procedures at a longer follow-up in an updated patient cohort of 27 patients with 28 DOB reinforcement procedures. Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and patient-rated wrist/hand evaluation (PRWHE) outcome measures were also evaluated. At median 82 months follow-up, pre- to postoperative QuickDASH score improved from a mean of 62 (SD 14) to 31 (SD 22) (p < 0.01) and PRWHE score from a mean of 67 (SD 17) to 34 (SD 23) (p < 0.01). Symptomatic graft failure with resultant painful DRUJ instability occurred in four out of 28 procedures, which was better than the published results of alternative surgical options for DRUJ instability. DOB reinforcement presents a relatively safe, effective and durable method for treatment of post-traumatic DRUJ instability.Level of evidence: III.
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Affiliation(s)
- Diederik O Verbeek
- Department of Surgery, Division of Trauma Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Nicholas O J Wilssens
- Department of Plastic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jan A Ten Bosch
- Department of Surgery, Division of Trauma Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Pascal F W Hannemann
- Department of Surgery, Division of Trauma Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
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Hidajat NN, Arsa W, Fadli S, Nong I, Aprilya D. The Unpredictable Palmaris Longus Tendon Variation in Distal Radio-Ulnar Joint Reconstruction: A Technical Consideration for Undersized Graft. Orthop Res Rev 2022; 14:319-326. [PMID: 36118013 PMCID: PMC9481415 DOI: 10.2147/orr.s381694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 09/03/2022] [Indexed: 12/02/2022] Open
Abstract
Background Distal radioulnar joint (DRUJ) instability results from the disruption of the triangular fibrocartilaginous complex consisting of DRUJ’s primary and secondary stabilizers. The gold standard of stabilization procedure remains ligament reconstruction that utilizes tendon grafts to reanimate the volar and dorsal radioulnar ligament (RUL) as the primary stabilizers of the joint. The palmaris longus (PL) tendon, the graft of choice in reconstructive surgery, is commonly used in DRUJ reconstruction. However, it can exhibit anatomic variations from agenesis to the variation in morphology, location, and attachment that is rarely encountered other than in cadaveric studies. Case Presentation We present a case of a 14-year-old boy with ulnar-sided wrist pain and instability following an injury in a boxing match four months before admission. The clinical and radiological results suggested a DRUJ injury with extensor carpi ulnaris (ECU) tendinitis. A ligament reconstruction using the PL tendon graft was planned. Intraoperatively, the PL was found anomalous with dual distal attachments and a short graft length. Results We performed Adams ligament reconstruction technique with some modifications to the original design. To overcome the under-sized graft, instead of passing it around the ulnar neck, we added one more bone tunnel on the ulna to enhance the construct stability by a tendon to bone healing. Conclusion In reconstructive surgeries, surgeons should consider the other sources of grafts as graft variations exist. Otherwise, as in our case, modifications to the standard technique can be made.
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Affiliation(s)
- Nucki Nursjamsi Hidajat
- Hand, Upper Limb and Microsurgery Division, Department of Orthopaedic and Traumatology, Hasan Sadikin General Hospital, Universitas Padjadjaran, Bandung, Indonesia
| | - Widya Arsa
- Hand, Upper Limb and Microsurgery Division, Department of Orthopaedic and Traumatology, Hasan Sadikin General Hospital, Universitas Padjadjaran, Bandung, Indonesia
- Correspondence: Widya Arsa, Hand, Upper limb and Microsurgery Division, Department of Orthopaedic and Traumatology, Hasan Sadikin General Hospital, Jl. Pasteur No. 38, Bandung, 40161, West Java, Indonesia, Tel +6222-2034953, Fax +6222-2032216, Email
| | - Sanditya Fadli
- Department of Orthopaedic and Traumatology, Hasan Sadikin General Hospital, Universitas Padjadjaran, Bandung, Indonesia
| | - Ira Nong
- Department of Orthopaedic and Traumatology, Wahidin Sudirohusodo General Hospital, Hasanuddin University, Makassar, Indonesia
| | - Dina Aprilya
- Department of Orthopaedic and Traumatology, Siloam Agora Hospital, Jakarta, Indonesia
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Aly AM, El-Sadek RE. Physeal sparing distal radio-ulnar joint ligament reconstruction in children. J Pediatr Orthop B 2022; 31:55-59. [PMID: 33528228 DOI: 10.1097/bpb.0000000000000852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Distal radio-ulnar joint (DRUJ) injuries are under-reported in the paediatric population. No single study has discussed methods of DRUJ reconstruction in immature patients with chronic instability. We present a physeal sparing ligamentoplasty for chronic DRUJ instability and describe the outcomes in two patients. Two consecutive children with chronic DRUJ instability were treated using physeal sparing ligamentoplasy. After the failure of triangular fibrocartilage complex repair, reconstruction was done using palmaris longus tendon graft that was tunnelled through the distal radius epiphysis and wrapped subperiosteally around the ulnar neck. Graft was tied in a neutral forearm position. DRUJ stability was achieved in both patients. Grip strength averaged 90% of the healthy side. Prono-supination range of motion (ROM) averaged 88 and 86%, respectively, of the healthy side, without intraoperative nor postoperative complications. Our novel technique was effective in the regain of DRUJ stability with minor effect on the prono-supination ROM. Further studies are planned to experiment the biomechanical effectiveness of our technique. Level of evidence: Therapeutic IV.
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Affiliation(s)
- Amr M Aly
- Department of Orthopaedic Surgery, Université libre de Bruxelles, Brussels, Belgium
- Hand and Microsurgery Unit, Division of Orthopaedic Surgery, Ain Shams University Hospital
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Rodríguez-Merchán EC, Shojaie B, Kachooei AR. Distal Radioulnar Joint Instability: Diagnosis and Treatment. THE ARCHIVES OF BONE AND JOINT SURGERY 2022; 10:3-16. [PMID: 35291239 PMCID: PMC8889419 DOI: 10.22038/abjs.2021.57194.2833] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/30/2021] [Indexed: 01/24/2023]
Abstract
Distal radioulnar joint (DRUJ) instability and triangular fibrocartilage complex (TFCC) tears are more usual than estimated and are frequently overlooked. Diagnosis is often clinical, which can be confirmed using computed tomography (CT) scan and magnetic resonance imaging (MRI). In doubtful cases, bilateral computed tomography in neutral forearm rotation, supination, and pronation should also be performed. Wrist arthroscopy can be diagnostic and therapeutic for ulnar-sided wrist pain. Two systematic reviews showed equivalent outcomes between open and arthroscopic repair of the TFCC. There is scant proof to advise one technique over the other in clinical practice. TFCC repair and reconstruction are contraindicated when there is a bony deformation of the radius or ulna or osteoarthritis of the DRUJ. With the advancement of implant arthroplasty, salvage procedures are less desirable. Constrained distal radioulnar arthroplasty is stable, and the longevity is encouraging.
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Affiliation(s)
- E Carlos Rodríguez-Merchán
- Department of Orthopaedic Surgery, La Paz University Hospital, Madrid, Spain
- Osteoarticular Surgery Research, Hospital La Paz Institute for Health Research - IdiPAZ (La Paz University Hospital - Autonomous University of Madrid), Madrid, Spain
| | - Babak Shojaie
- Department of Hand, Plastic and reconstructive Surgery,Göttingen University of medical Sciences,Klinikum Bremen Mitte,Bremen,Germany
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir R Kachooei
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, USA
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Miranda I, Lucas FJ, Carratalá V, Ferràs-Tarragó J, Miranda FJ. Anatomic Reconstruction of the Triangular Fibrocartilage Complex for the Treatment of Chronic Instability of the Distal Radioulnar Joint. A Systematic Review. REVISTA IBEROAMERICANA DE CIRUGÍA DE LA MANO 2021. [DOI: 10.1055/s-0041-1736570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
Introduction Peripheral injuries of the triangular fibrocartilage complex (TFCC) can produce pain and instability of the distal radioulnar joint (DRUJ). There are several techniques for the reconstruction of the TFCC. The aim of the present paper was to summarize the tendon plasties of the DRUJ ligaments for the anatomic reconstruction of TFCC, to analyze the surgical techniques, and to evaluate their outcomes.
Methods In order to perform a systematic review, we searched in the literature the terms DRUJ instability OR chronic distal radioulnar joint instability OR distal radioulnar tendon plasty.
Results In total, 11 articles with level of evidence IV (case series) were retrieved. Most studies achieved good results, with recovery of wrist stability, improvement of the pain, and increase in grip strength in the functionality tests. In the historical evolution of the published series, wrist surgeons tried to perform a more anatomical plasty, with a more stable fixation and less invasive techniques.
Conclusion The Adams procedure continues to be a valid and reproducible technique for the treatment of chronic DRUJ instability. If wrist arthroscopy and implants are available and surgeons have been technically trained, the authors recommend an arthroscopy-assisted technique, or, if possible, an all-arthroscopic TFCC reconstruction with implant fixation of the plasty in its anatomical points of insertion. Comparative studies between open and arthroscopic TFCC reconstruction techniques are needed.
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Affiliation(s)
- Ignacio Miranda
- Orthopedic Surgery and Traumatology Service, Hospital Arnau de Vilanova, Valencia, España
| | - Francisco J. Lucas
- Hand and Upper Limb Surgery Unit, Hospital Quirónsalud Valencia, Valencia, España
| | - Vicente Carratalá
- Hand and Upper Limb Surgery Unit, Hospital Quirónsalud Valencia, Valencia, España
| | - Joan Ferràs-Tarragó
- Orthopedic Surgery and Traumatology Service, Hospital Arnau de Vilanova, Valencia, España
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Geller JS, Taormina DP, Greene JD, Dodds SD. Delayed Presentation of Unstable Triangular Fibrocartilage Complex Tears Treated with Volar Foveal Ligament Repair. J Wrist Surg 2021; 10:144-149. [PMID: 33815950 PMCID: PMC8012092 DOI: 10.1055/s-0040-1721410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/19/2020] [Indexed: 10/22/2022]
Abstract
Hypothesis An open volar surgical approach with suture anchor repair of the foveal ligament and temporary pinning of the distal radioulnar joint (DRUJ) is an effective way to treat DRUJ instability associated with chronic foveal tears of the triangular fibrocartilage complex (TFCC). Methods We retrospectively reviewed nine patients with foveal ligament tears of the TFCC and DRUJ instability who underwent open repair of the TFCC using a volar surgical approach, combined with temporary pinning of the DRUJ for 8 weeks. Pain, instability, arc of motion, and functional outcomes scores were evaluated. Results Mean patient age was 40.5 years (range 16.3-56.2). Average time from injury to surgery was 8.4 months (range 2.9-23.3 months). Average final follow-up was 18.9 months from injury (range 12.0-29.3 months), 10.5 months from surgery (range 3.9-18.6 months), and 8.7 months from pin removal (range 1.7-17.2 months). At final follow-up, all patients demonstrated clinically stable DRUJ. Pain scores diminished significantly from pre to final postoperative visits, with averages of 6.8 (range 4.0-9.0) improving to a mean of 0.70 (range 0.0-2.0), respectively. Average postoperative forearm rotation was 71.1 degrees in supination and 76.1 degrees in pronation (average total arc of motion 147.2 degrees, range 90-160 degrees). Average postoperative wrist motion was 68.8 degrees in flexion and 70.6 degrees in extension (average total arc of motion 139.4 degrees, range 110-160 degrees). No patients developed crepitus, recurrent DRUJ instability, or required revision surgery (subsequent to pin removal). Conclusion Volar suture anchor repair of the foveal ligament of the TFCC with DRUJ pinning led to reliable outcomes within this patient group including a stable DRUJ with improved functional outcomes regarding pain, stability, and range of motion in patients with foveal TFCC tears and associated DRUJ instability. These results compare favorably with dorsal repair of the foveal ligament. Level of Incidence This is a Level IV, therapeutic study.
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Affiliation(s)
- Joseph S. Geller
- University of Miami Miller School of Medicine, Department of Orthopedic Surgery and Rehabilitation, Bascom Palmer Institute, Department of Ortho, Miami, Florida
| | - David P. Taormina
- University of Miami Miller School of Medicine, Department of Orthopedic Surgery and Rehabilitation, Bascom Palmer Institute, Department of Ortho, Miami, Florida
| | - Janelle D. Greene
- Yale University School of Medicine, Department of Orthopedic Surgery and Rehabilitation, New Haven, Connecticut
| | - Seth D. Dodds
- University of Miami Miller School of Medicine, Department of Orthopedic Surgery and Rehabilitation, Bascom Palmer Institute, Department of Ortho, Miami, Florida
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Delbast L, Pic JB, Marty-Diloy T, Dimet J, Lepetit C. Stabilization of the distal radioulnar joint by reconstructing the interosseous membrane's distal oblique bundle: Cadaver study. Orthop Traumatol Surg Res 2020; 106:1581-1587. [PMID: 33082121 DOI: 10.1016/j.otsr.2020.03.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 02/27/2020] [Accepted: 03/27/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The distal radioulnar (DRU) ligaments play a key role in stabilizing the DRU joint. Ligament reconstruction in this area is an accepted treatment. However, another structure may also be a significant DRUJ stabilizer-the distal oblique bundle (DOB) of the interosseous membrane (IOM). Recent studies have described DOB reconstruction methods, which should be compared to DRU ligament reconstruction. METHODS Twelve upper limbs were used. First, a descriptive anatomy study was done to determine the prevalence and features of the DOB (insertions, thickness, and relationship with DRU ligaments). Second, biomechanical testing was done with the wrist in neutral position, supination, and pronation. Distal radius translation was evaluated first on an intact wrist then evaluated again after creating bidirectional instability. Lastly, the same tests were repeated after DRU reconstruction using the Adams-Berger technique and DOB reconstruction using the Riggenbach technique. RESULTS The DOB was present in 50% of specimens and was bilateral. Reconstructing the DOB stabilized the wrist to the same degree as the Adams-Berger technique in neutral and pronation (8% residual major instability). Stability was harder to achieve in supination (25% major instability). It was better at controlling posterior radial translation than anterior translation (3% versus 14% major instability). CONCLUSION DOB reconstruction appears to be a reliable and less invasive treatment option for DRUJ instability since it is extra-articular. However, the wrist's position and the direction of radial translation seem to alter the stabilization's effectiveness. LEVEL OF EVIDENCE IV; Cadaver study.
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Affiliation(s)
- Laurent Delbast
- Service de chirurgie orthopédique du centre hospitalier de Mont-de-Marsan, 417, avenue Pierre-de-Coubertin, BP 417, 40024 Mont-de-Marsan cedex, France.
| | - Jean-Baptiste Pic
- Service de chirurgie orthopédique du centre hospitalier de Niort, 40, avenue Charles-de-Gaulle, BP 70600, 79021 Niort cedex, France
| | - Thibault Marty-Diloy
- Service de chirurgie orthopédique du centre hospitalier universitaire de Poitiers, 2, rue de la-Milétrie, 86021 Poitiers, France
| | - Jérôme Dimet
- Centre de recherche clinique GHT des Landes, centre hospitalier de Mont-de-Marsan, 417, avenue Pierre-de-Coubertin, BP 417, 40024 Mont-de-Marsan cedex, France
| | - Cédric Lepetit
- Capio clinique Aguiléra, 21, rue de l'Estagnas, CS 60179, 64201 Biarritz, France
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Frantz LM, Helsper EA, Morris HA, Hearon BF. Outcomes after anatomic reconstruction of the radioulnar ligaments for distal radioulnar joint instability. J Hand Surg Eur Vol 2020; 45:909-915. [PMID: 32706604 DOI: 10.1177/1753193420942668] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This retrospective study investigated the clinical outcomes of patients treated for chronic distal radioulnar joint instability with open anatomic reconstruction of the palmar and dorsal radioulnar ligaments. After the midpoint of a tendon graft is anchored at the ulnar fovea, the two graft limbs traverse the distal radioulnar joint. One limb is woven into the palmar wrist capsule and the other is secured to the dorsal wrist capsule and retinaculum to stabilize the joint. Of 30 patients (31 wrists) treated with this technique, 19 were followed longitudinally for a mean of 10 years (range 3-21). In this long-term cohort, there were statistically significant improvements in ulnar-sided wrist pain on the visual analogue scale and in distal radioulnar joint stability on the dorsopalmar stress test. The modified Mayo Wrist Scores were classified as three excellent, 12 good, three fair and one poor. Of the 30 patients studied, failure occurred in four patients, two from graft rupture and two from distal radioulnar joint arthrosis. We conclude that anatomic reconstruction of the palmar and dorsal radioulnar ligaments is an effective treatment for distal radioulnar joint instability and is associated with high satisfaction and durable outcomes.Level of evidence: IV.
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Affiliation(s)
- Lisa M Frantz
- Department of Orthopaedic Surgery, University of Kansas School of Medicine, Wichita, KS, USA
| | - Elizabeth A Helsper
- Department of Orthopaedic Surgery, University of Kansas School of Medicine, Wichita, KS, USA
| | - Harry A Morris
- Department of Orthopaedic Surgery, University of Kansas School of Medicine, Wichita, KS, USA.,Advanced Orthopaedic Associates, Wichita, KS, USA
| | - Bernard F Hearon
- Department of Orthopaedic Surgery, University of Kansas School of Medicine, Wichita, KS, USA.,Advanced Orthopaedic Associates, Wichita, KS, USA
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