Reconstruction of the deep fibers of the distal radioulnar ligaments facilitating atendon graft-Adams' procedure

Abstract

Anatomical reconstruction of the deep fibers of the distal radioulnar ligaments to stabilise the distal radioulnar joint. Multidirectional instability of the distal radioulnar joint without the possibility for anatomic refixation of the distal radioulnar ligaments. General operative contraindications, infection, insufficient soft tissue coverage, osteoarthritis of the distal radioulnar joint, excessive ulna impaction syndrome, osseous deformation. Dorsal approach to the distal radioulnar joint, preparation of the ulna head, transosseous transfer of tendon graft through the distal ulnar corner of the radius at the sigmoid notch, transfer through the ulnar fovea and transosseous fixation within the ulna head using aninterference screw. Long arm cast for 4-6weeks, then Bowers splint for further 4weeks; optional long arm orthosis without limiting elbow flexion and extension for 4-6weeks, then Bowers splint for further 4weeks; starting exercises after 12weeks. Reconstruction of the distal radioulnar ligaments using tendon grafts stabilises the distal radioulnar joint with restoration of joint kinematics.