INTRA-ARTICULAR RADIOULNAR LIGAMENT RECONSTRUCTION FOR CHRONIC INSTABILITY OF DISTAL RADIOULNAR JOINT_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 IAPingguang , CAIXianhua , WANGQing , HUANGWeibing , HUHao

Department of Orthopaedics, Wuhan General Hospital of Guangzhou Command, Wuhan Hubei, 430070, P. R. China;

Corresponding author：

IAPingguang, Email: xiapg@sina.com

Keywords：

Distal radioulnar joint; Chronic joint dislocation; Intra-articular radioulnar ligament reconstruction

DOI：

10.7507/1002-1892.20140044

Video：

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Objective To evaluate the effectiveness of intra-articular radioulnar ligament reconstruction in the treatment of chronic instability of the distal radioulnar joint. Methods Between January 2006 and June 2012, the intra-articular radioulnar ligament reconstruction was used to treat chronic instability of the distal radioulnar joint in 12 patients. Of 12 cases, 8 were males and 4 were females with an average age of 37.3 years (range, 22-54 years). The causes of injury were tumble in 9 patients, traffic accident in 2 patients, and sprain in 1 patient. The average time from initial injury to operation was 6.2 months (range, 2-13 months). The pain and function of the wrists were assessed with Patient-Rated Wrist Evaluation (PRWE) (27.5±4.7). Broadening of the distal radioulnar joint space was seen on the anteroposterior radiograph in all the patients. Lateral view showed dorsal instability in 10 patients and palmar instability in 2 patients. There was no radial fracture, ulnar fractures or degeneration of the distal radioulnar joint. Results All patients achieved primary healing of incision. No complication of deep infection or nerve injury occurred. They were followed up from 12 to 30 months (mean, 20.6 months). Pain and the clicking sound of the wrists disappeared; grip strength increased; the range of motion values of the wrist and forearm were restored. PRWE score was 5.8±2.1 at last follow-up, showing significant difference when compared with preoperative score (t=14.215, P=0.000). Imaging examination showed good appositions of the distal radioulnar joint, with no dislocation or subluxation. Conclusion Intra-articular radioulnar ligament reconstruction can rebuild the anatomic stability of the distal radioulnar joint, which does not damage the adjacent structures of the joints and can obtain satisfactory function of the reconstructed joint. It is a good choice for chronic instability of the distal radioulnar joint without articular degeneration.

Citation： IAPingguang, CAIXianhua, WANGQing, HUANGWeibing, HUHao. INTRA-ARTICULAR RADIOULNAR LIGAMENT RECONSTRUCTION FOR CHRONIC INSTABILITY OF DISTAL RADIOULNAR JOINT. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(2): 205-208. doi: 10.7507/1002-1892.20140044 Copy

1.	Zimmermann R,Gschwentner M,Arora R,et al.Treatment of distal radioulnar joint disorders with a modified Sauvé-Kapandji procedure:long-term outcome with special attention to the DASH Questionnaire.Arch Orthop Trauma Surg,2003,123(6):293-298.
2.	Martineau PA,Bergeron S,Beckman L,et al.Reconstructive procedure for unstable radial-sided triangular fibrocartilage complex avulsions.J Hand Surg (Am),2005,30(4):727-732.
3.	Johnston K,Durand D,Hildebrand KA.Chronic volar distal radioulnar joint instability:joint capsular plication to restore function.Can J Surg,2009,52(2):112-118.
4.	MacDermid JC,Turgeon T,Richards RS,et al.Patient rating of wrist pain and disability:a reliable and valid mersurement tool.J Orthop Trauma,1998,12(8):577-586.
5.	Lo IK,MacDermid JC,Bennett JD,et al.The radioulnar ratio:a new method of quantifying distal radioulnar joint subluxation.J Hand Surg (Am),2001,26(2):236-243.
6.	Szabo RM.Distal radioulnar joint instability.Instr Course Lect,2007,56:79-89.
7.	Xu J,Tang JB.In vivo changes in lengths of the ligaments stabilizing the distal radioulnar joint.J Hand Surg (Am),2009,34(1):40-45.
8.	Mulford JS,Axelrod TS.Traumatic injuries of the distal radioulnar joint.Orthop Clin North Am,2007,38(2):289-297.
9.	Carlsen BT,Dennison DG,Moran SL.Acute dislocations of the distal radioulnar joint and distal ulna fractures.Hand Clin,2010,26(4):503-516.
10.	Watanabe A,Souza F,Vezeridis PS,et al.Ulnar-sided wrist pain.Ⅱ.Clinial and treatment.Skeletal Radiol,2010,39(9):837-857.
11.	Moriya T,Aoki M,Iba K,et al.Effect of triangular ligament tears on distal radioulnar joint instability and evaluation of three clinical tests:a biomechanical study.J Hand Surg (Eur),2009,34(2):219-223.
12.	Tay SC,Tomita K,Berger RA.The "ulnar fovea sign" for defining ulnar wrist pain:an analysis of sensitivity and specificity.J Hand Surg (Am),2007,32(4):438-444.
13.	Mino DE,Palmer AK,Levinsohn EM.Radiography and computerized tomography in the diagnosis of incongruity of the distal radio-ulnar joint.A prospective study.J Bone Joint Surg (Am),1985,67(2):247-252.
14.	Kim JP,Park MJ.Assessment of distal radioulnar joint instability after distal radius fracture:comparison of computed tomography and clinical examination results.J Hand Surg (Am),2008,33(9):1486-1492.
15.	Amrami KK,Moran SL,Berger RA,et al.Imaging the distal radioulnar joint.Hand Clin,2010,26(4):467-475.
16.	Arimitsu S,Moritomo H,Kitamura T,et al.The stabilizing effect of the distal radioulnar joint in an ulnar shortening procedure:a biomechanical study.J Bone Joint Surg (Am),2011,93(21):2022-2030.
17.	Sebastin SJ,Larson BP,Chung KC.History and evolution of the Sauvé-Kapandji procedure.J Hand Surg (Am),2012,37(9):1895-1902.
18.	Adams BD,Lawler E.Chronic instability of the distal radioulnar joint.J Am Acad Orthop Surg,2007,15(9):571-575.
19.	Szabo RM.Distal radioulnar joint instability.J Bone Joint Surg (Am),2006,88(4):884-894.
20.	Hagert E,Hagert CG.Understanding stability of the distal radioulnar joint through an understanding of its anatomy.Hand Clin,2010,26(4):459-466.

1. Zimmermann R,Gschwentner M,Arora R,et al.Treatment of distal radioulnar joint disorders with a modified Sauvé-Kapandji procedure:long-term outcome with special attention to the DASH Questionnaire.Arch Orthop Trauma Surg,2003,123(6):293-298.
2. Martineau PA,Bergeron S,Beckman L,et al.Reconstructive procedure for unstable radial-sided triangular fibrocartilage complex avulsions.J Hand Surg (Am),2005,30(4):727-732.
3. Johnston K,Durand D,Hildebrand KA.Chronic volar distal radioulnar joint instability:joint capsular plication to restore function.Can J Surg,2009,52(2):112-118.
4. MacDermid JC,Turgeon T,Richards RS,et al.Patient rating of wrist pain and disability:a reliable and valid mersurement tool.J Orthop Trauma,1998,12(8):577-586.
5. Lo IK,MacDermid JC,Bennett JD,et al.The radioulnar ratio:a new method of quantifying distal radioulnar joint subluxation.J Hand Surg (Am),2001,26(2):236-243.
6. Szabo RM.Distal radioulnar joint instability.Instr Course Lect,2007,56:79-89.
7. Xu J,Tang JB.In vivo changes in lengths of the ligaments stabilizing the distal radioulnar joint.J Hand Surg (Am),2009,34(1):40-45.
8. Mulford JS,Axelrod TS.Traumatic injuries of the distal radioulnar joint.Orthop Clin North Am,2007,38(2):289-297.
9. Carlsen BT,Dennison DG,Moran SL.Acute dislocations of the distal radioulnar joint and distal ulna fractures.Hand Clin,2010,26(4):503-516.
10. Watanabe A,Souza F,Vezeridis PS,et al.Ulnar-sided wrist pain.Ⅱ.Clinial and treatment.Skeletal Radiol,2010,39(9):837-857.
11. Moriya T,Aoki M,Iba K,et al.Effect of triangular ligament tears on distal radioulnar joint instability and evaluation of three clinical tests:a biomechanical study.J Hand Surg (Eur),2009,34(2):219-223.
12. Tay SC,Tomita K,Berger RA.The "ulnar fovea sign" for defining ulnar wrist pain:an analysis of sensitivity and specificity.J Hand Surg (Am),2007,32(4):438-444.
13. Mino DE,Palmer AK,Levinsohn EM.Radiography and computerized tomography in the diagnosis of incongruity of the distal radio-ulnar joint.A prospective study.J Bone Joint Surg (Am),1985,67(2):247-252.
14. Kim JP,Park MJ.Assessment of distal radioulnar joint instability after distal radius fracture:comparison of computed tomography and clinical examination results.J Hand Surg (Am),2008,33(9):1486-1492.
15. Amrami KK,Moran SL,Berger RA,et al.Imaging the distal radioulnar joint.Hand Clin,2010,26(4):467-475.
16. Arimitsu S,Moritomo H,Kitamura T,et al.The stabilizing effect of the distal radioulnar joint in an ulnar shortening procedure:a biomechanical study.J Bone Joint Surg (Am),2011,93(21):2022-2030.
17. Sebastin SJ,Larson BP,Chung KC.History and evolution of the Sauvé-Kapandji procedure.J Hand Surg (Am),2012,37(9):1895-1902.
18. Adams BD,Lawler E.Chronic instability of the distal radioulnar joint.J Am Acad Orthop Surg,2007,15(9):571-575.
19. Szabo RM.Distal radioulnar joint instability.J Bone Joint Surg (Am),2006,88(4):884-894.
20. Hagert E,Hagert CG.Understanding stability of the distal radioulnar joint through an understanding of its anatomy.Hand Clin,2010,26(4):459-466.

Chinese Journal of Reparative and Reconstructive Surgery

INTRA-ARTICULAR RADIOULNAR LIGAMENT RECONSTRUCTION FOR CHRONIC INSTABILITY OF DISTAL RADIOULNAR JOINT

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