ARTICULAR EXTERNAL FIXATION FOR CHRONIC DORSAL INSTABILITY OF DISTAL RADIOULNAR JOINT_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

JIANGZongyuan ,  XIAJiang , MATao , XULei , HUCaizhi , WANGYinze , HUBin

Department of Hand and Foot Surgery, Yijishan Hospital of Wannan Medical College, Wuhu Anhui, 241001, P. R. China;

Corresponding author：

XIAJiang, Email: vatxia@126.com

Keywords：

Distal radioulnar joint; Ligament reconstruction; Tenodesis; Articular external fixation

DOI：

10.7507/1002-1892.20140045

Video：

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Objective To discuss the clinical result of extrinsic radioulnar tether combined with anchoring nail fixation for treating chronic dorsal instability of the distal radioulnar joint (DRUJ). Methods Between July 2011 and December 2012, 6 patients with chronic dorsal instability of the DRUJ were treated with extrinsic radioulnar tether combined with anchoring nail fixation. There were 1 male and 5 females with the average age of 27.3 years (range, 22-35 years). All of 6 patients had a wrist trauma history. The average disease duration was 4.8 years (range, 6 months to 15 years). Radiographs were taken postoperatively to observe the anchoring nail loosening. The stress test and forearm rotation test were used to evaluate the function of DRUJ. The complications, the grip power, range of motion, and visual analogue scale (VAS) scores were recorded at last follow-up. And the joint function was evaluated by disability of arm, shoulder, and hand (DASH) score. Results Primary healing of incision was obtained in all cases, without any complications such as infection and ulnar neck fracture. All 6 patients were followed up 6-24 months (mean, 13.7 months). Stability was achieved in all patients. Radiographs showed that the joint space was widened and dislocation of the ulnar head was improved at 3 and 6 months after operation. The results of the stress test and forearm rotation test were negative. At last follow-up, the grip power, DASH score, VAS score, and range of motion of the wrist were significantly improved when compared with preoperative ones (P<0.05). Conclusion Extrinsic radioulnar tether combined with anchoring nail fixation is an easy method of surgical revision to treat chronic dorsal instability of DRUJ, which can maintain the stability and protect the blood supply of triangular fibrocartilage complex.

Citation： JIANGZongyuan, XIAJiang, MATao, XULei, HUCaizhi, WANGYinze, HUBin. ARTICULAR EXTERNAL FIXATION FOR CHRONIC DORSAL INSTABILITY OF DISTAL RADIOULNAR JOINT. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(2): 209-212. doi: 10.7507/1002-1892.20140045 Copy

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8.	Dy CJ,Ouellette EA,Makowski AL.Extensor retinaculum capsulorrhaphy for ulnocarpal and distal radioulnar instability:the Herbert sling.Tech Hand Up Extrem Surg,2009,13(1):19-22.
9.	Unglaub F,Manz S,Bruckner T,et al.Dorsal capsular imbrication for dorsal instability of the distal radioulnar joint.Oper Orthop Traumatol,2013,25(6):609-614.
10.	Glowacki KA,Shin LA.Stabilization of the unstable distal ulna:the Linscheid-Hui procedure.Tech Hand Up Extrem Surg,1999,3(4):229-236.
11.	Hui FC,Linscheid RL.Ulnotriquetral augmentation tenodesis:a reconstructive procedure for dorsal subluxation of the distal radioulnar joint.J Hand Surg (Am),1982,7(3):230-236.
12.	Fulkerson JP,Watson HK.Congenital anterior subluxation of the distal ulna.A case report.Clin Orthop Relat Res,1978,(131):179-182.
13.	Purisa H,Sezer I,Kabakas F,et al.Ligament reconstruction using the Fulkerson-Watson method to treat chronic isolated distal radioulnar joint instability:short-term results.Acta Orthop Traumatol Turc,2011,45(3):168-174.
14.	董英海,董吟林,马卫东.旋前方肌紧缩术治疗陈旧性下尺桡关节背侧脱位.中国修复重建外科杂志,1992,6(2):80-81.
15.	Gofton WT,Gordon KD,Dunning CE,et al.Comparison of distal radioulnar joint reconstructions using an active joint motion simulator.J Hand Surg (Am),2005,30(4):733-742.
16.	Petersen MS,Adams BD.Biomechanical evaluation of distal radioulnar reconstructions.J Hand Surg (Am),1993,18(2):328-334.
17.	Adams BD,Lawler E.Chronic instability of the distal radioulnar joint.J Am Acad Orthop Surg,2007,15(9):571-575.
18.	Kataoka T,Moritomo H,Omokawa S,et al.Palmar reconstruction of the triangular fibrocartilage complex for instability of the distal radioulnar joint:a biomechanical study.J Hand Surg (Eur Vol),2013,38(5):515-522.

1. Huang JI,Hanel DP.Anatomy and biomechanics of the distal radioulnar joint.Hand Clin,2012,28(2):157-163.
2. Szabo RM.Distal radioulnar joint instability.J Bone Joint Surg (Am),2006,88(4):884-894.
3. Hagert CG.Distal radius fracture and the distal radioulnar joint-anatomical considerations.Handchir Mikrochir Plast Chir,1994,26(1):22-26.
4. Stuart PR,Berger RA,Linscheid RL,et al.The dorsopalmar stability of the distal radioulnar joint.J Hand Surg (Am),2000,25(4):689-699.
5. Kakar S,Carlsen BT,Moran SL,et al.The management of chronic distal radioulnar instability.Hand Clin,2010,26(4):517-528.
6. Adams BD,Berger RA.An anatomic reconstruction of the distal radioulnar ligaments for posttraumatic distal radioulnar joint instability.J Hand Surg (Am),2002,27(2):243-251.
7. Seo KN,Park MJ,Kang HJ.Anatomic reconstruction of the distal radioulnar ligament for posttraumatic distal radioulnar joint instability.Clin Orthop Surg,2009,1(3):138-145.
8. Dy CJ,Ouellette EA,Makowski AL.Extensor retinaculum capsulorrhaphy for ulnocarpal and distal radioulnar instability:the Herbert sling.Tech Hand Up Extrem Surg,2009,13(1):19-22.
9. Unglaub F,Manz S,Bruckner T,et al.Dorsal capsular imbrication for dorsal instability of the distal radioulnar joint.Oper Orthop Traumatol,2013,25(6):609-614.
10. Glowacki KA,Shin LA.Stabilization of the unstable distal ulna:the Linscheid-Hui procedure.Tech Hand Up Extrem Surg,1999,3(4):229-236.
11. Hui FC,Linscheid RL.Ulnotriquetral augmentation tenodesis:a reconstructive procedure for dorsal subluxation of the distal radioulnar joint.J Hand Surg (Am),1982,7(3):230-236.
12. Fulkerson JP,Watson HK.Congenital anterior subluxation of the distal ulna.A case report.Clin Orthop Relat Res,1978,(131):179-182.
13. Purisa H,Sezer I,Kabakas F,et al.Ligament reconstruction using the Fulkerson-Watson method to treat chronic isolated distal radioulnar joint instability:short-term results.Acta Orthop Traumatol Turc,2011,45(3):168-174.
14. 董英海,董吟林,马卫东.旋前方肌紧缩术治疗陈旧性下尺桡关节背侧脱位.中国修复重建外科杂志,1992,6(2):80-81.
15. Gofton WT,Gordon KD,Dunning CE,et al.Comparison of distal radioulnar joint reconstructions using an active joint motion simulator.J Hand Surg (Am),2005,30(4):733-742.
16. Petersen MS,Adams BD.Biomechanical evaluation of distal radioulnar reconstructions.J Hand Surg (Am),1993,18(2):328-334.
17. Adams BD,Lawler E.Chronic instability of the distal radioulnar joint.J Am Acad Orthop Surg,2007,15(9):571-575.
18. Kataoka T,Moritomo H,Omokawa S,et al.Palmar reconstruction of the triangular fibrocartilage complex for instability of the distal radioulnar joint:a biomechanical study.J Hand Surg (Eur Vol),2013,38(5):515-522.

Chinese Journal of Reparative and Reconstructive Surgery

ARTICULAR EXTERNAL FIXATION FOR CHRONIC DORSAL INSTABILITY OF DISTAL RADIOULNAR JOINT

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