The pronator quadratus interposition transfer: An adjunct to resection arthroplasty of the distal radioulnar joint

Abstract

Ulnar head resection for treatment of painful traumatic and arthritic conditions of the distal radioulnar joint has been performed for over 100 years. Although this is a time-honored procedure, several negative sequelae of the operation have been described. Most of these problems have been due to the instability of the ulna remnant with respect to surrounding structures, including the radius and extensor tendons. This report describes an operative technique to prevent and treat this problem. The pronator quadratus origin is transferred to the dorsum of the ulna, placing the muscle belly between the radius and the ulna remnant. Theoretically, this may provide a soft tissue cushion to prevent ulnoradial impingement. We have been performing this operation since 1985 and report here the results on 16 wrists in 15 patients who underwent surgery between 1985 and 1989. Patients included in this study had pain in the distal radioulnar joint due to osteoarthritis, post-traumatic arthritis, or incongruity. No patients with rheumatoid or other autoimmune arthritis were included. The average follow-up period was 8 years, with a range of 5-9 years. Two groups of patients were studied, including seven who had failure of prior ulna head resection and eight who underwent this procedure (one on both wrists) concomitantly with ulnar head resection.