Functional Results of the Darrach Procedure: A Long-Term Outcome Study

Abstract

To assess long-term functional outcome after ulnar head excision for distal radioulnar joint dysfunction with prior or concomitant wrist trauma. We hypothesized that long-term outcomes would reflect good functional results with satisfactory pain relief. A retrospective chart review identified patients who had undergone the Darrach procedure for traumatic or posttraumatic distal radioulnar joint (DRUJ) pathology. We assessed subjective outcomes using a visual analog scale questionnaire to assess pain, wrist stability, and overall satisfaction. We evaluated objective functional outcomes using the Quick Disabilities of the Shoulder, Arm, and Hand and Patient-Rated Wrist Evaluation measures. Final radiographs were compared with preoperative x-rays to investigate the effect of possible ulnar impingement syndrome (convergent instability). A total of 98 patients with 99 wrists met our predetermined inclusion criteria. Of these, 27 patients with a total of 27 wrists were available for final follow-up, 15 of whom were available for final in-office follow-up with radiographs (6-20 y). Patients displayed an average Quick Disabilities of the Shoulder, Arm, and Hand score of 17 and a Patient-Rated Wrist Evaluation score of 14. Final average visual analog scale scores for pain (0-4), pain with activity (0-4), overall satisfaction (0-4), and wrist stability (0-10) were 0.1, 0.6, 3.7, and 1.5, respectively. Final average wrist range of motion was 85°/78° and 41°/45° for pronation-supination and flexion-extension, respectively. A total of 7 patients displayed radioulnar impingement based on dynamic radiography. This ulnar impingement was not associated with clinical reports of pain and did not affect outcome measures in a statistically significant manner. The Darrach procedure provides reliably good long-term subjective and objective results for the treatment of a symptomatic DRUJ after a distal radius fracture. Patients can expect to have excellent forearm range of motion at long-term follow-up. Nearly one-half of patients had dynamic convergence of the DRUJ when stressed radiographically; however, the presence of radiographic dynamic convergence did not influence clinical outcomes.