Chronic Instability of Distal Radioulnar Joint

Hyun-Dae Shin; Soo-Min Cha

doi:10.12790/jkssh.2014.19.2.79

Journal List > J Korean Soc Surg Hand > v.19(2) > 1106483

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Shin and Cha: Chronic Instability of Distal Radioulnar Joint

REVIEW ARTICLE

J Korean Soc Surg Hand 2014;19(2):79-86.

Published online: 11 June 2014

DOI: https://doi.org/10.12790/jkssh.2014.19.2.79

Chronic Instability of Distal Radioulnar Joint

Hyun-Dae Shin, Soo-Min Cha

Department of Orthopaedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea

Correspondence to: Hyun-Dae Shin, Department of Orthopaedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, 266 Munhwa-ro, Jung-gu, Daejeon 301-721, Korea, TEL: +82-42-280-7340, FAX: +82-42-252-7098, E-mail: hyunsd@cnu.ac.kr

Received 10 May 2014 Accepted 2 June 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Distal radioulnar joint, Instability, Ligament reconstruction, Salvage procedure

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Fig. 1.

The four anatomic variations of the sigmoid notch.

Fig. 2.

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

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).

Fig. 4.

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

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.

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