Distal Radioulnar Joint Arthroplasty Research Articles

Semiconstrained Distal Radioulnar Joint Arthroplasty: Functional Outcomes and Complications

Abstract Background: The semiconstrained distal radioulnar joint (DRUJ) prosthesis (Aptis Medical, Louisville, KY) is an option in the treatment of refractory DRUJ pathology that has shown promising results. Purpose: This study aims to evaluate the short- to midterm functional outcomes, complications, and factors affecting outcomes of semiconstrained DRUJ arthroplasty. Methods: We retrospectively reviewed 47 DRUJ arthroplasty procedures (on 46 consecutive patients) from a single surgeon between 2010 and 2022. Demographic data, range of motion, grip strength, and patient-reported outcome measures (PROMs: Quick Disability of the Arm, Shoulder, and Hand; Patient-Rated Wrist Evaluation; modified Mayo Wrist Score [mMWS]; and visual analog scale [VAS] for pain) were collected. Complications were classified as major (requiring surgery) or minor (treated conservatively). Results: The average follow-up was 3.37 years (standard deviation, 3.51; range, 0.04–15.62 years). A total of 30% of patients (n = 14) were followed for more than 5 years. Postoperatively, supination significantly increased and VAS pain scores improved significantly. Patients also experienced improved function in the operative wrist as assessed by the mMWS. Patients with prior DRUJ and/or triangular fibrocartilage complex surgery were more likely to have additional diagnoses at the time of definitive surgery and our postoperative outcomes varied based on prior surgery and additional diagnoses, with a trend toward higher pain levels and worse PROMs. The overall complication rate was 17%, with one major complication consisting of a posttraumatic periprosthetic ulna fracture. All other complications were minor. Implant survival was 100%. Conclusion: Semiconstrained DRUJ arthroplasty significantly improves pain levels and functional outcomes at short- to midterm follow-up. Patients who had undergone previous related surgeries were showed a trend toward higher postoperative pain levels and worse PROMs. Although complications were common, overall patient satisfaction and implant survivorship were high. Level of Evidence: IV

Performance of the Aptis distal radioulnar joint implant: kinematic and geometric analysis.

This study reviews the performance of the Aptis distal radioulnar joint arthroplasty by comparing multiple kinematic and geometric measurements in the operated and contralateral healthy forearm to elucidate whether these are altered after arthroplasty. Forearm geometry and motion were captured using 3-D and 4-D computed tomography in 12 patients with unilateral Aptis arthroplasties. After segmentation and registration, the axis of forearm rotation, translation of the radius along the ulna and range of wrist flexion-extension were measured, and the Dice coefficient and Hausdorff distance were calculated. The forearm rotation axis in the corrected arm deviated 2.3° from the healthy contralateral rotation axis, radial translation along the ulna decreased by 45% and wrist flexion-extension also decreased significantly. Multiple intra-individual geometric differences were observed. The Aptis distal radioulnar joint arthroplasty considerably alters forearm kinematics, which can have clinical implications.Level of evidence: IV.

Advancements in Diagnosis and Management of Distal Radioulnar Joint Instability: A Comprehensive Review Including a New Classification for DRUJ Injuries.

Distal radioulnar joint (DRUJ) instability is a complex condition that can severely affect forearm function, causing pain, limited range of motion, and reduced strength. This review aims to consolidate current knowledge on the diagnosis and management of DRUJ instability, emphasizing a new classification system that we propose. The review synthesizes anatomical and biomechanical factors essential for DRUJ stability, focusing on the interrelationship between the bones and surrounding soft tissues. Our methodology involved a thorough examination of recent studies, incorporating clinical assessments and advanced imaging techniques such as MRI, ultrasound, and dynamic CT. This approach allowed us to develop a classification system that categorizes DRUJ injuries into three distinct grades. This system is intended to be practical for both clinical and radiological evaluations, offering clear guidance for treatment based on injury severity. The review discusses a range of treatment options, from conservative measures like splinting and physiotherapy to surgical procedures, including arthroscopy and DRUJ arthroplasty. The proposed classification system enhances the accuracy of diagnosis and supports more effective decision making in clinical practice. In summary, our findings suggest that the integration of advanced imaging techniques with minimally invasive surgical interventions can lead to better outcomes for patients. This review serves as a valuable resource for clinicians, providing a structured approach to managing DRUJ instability and improving patient care through the implementation of our new classification system.

Periprosthetic Ulna Fractures Following Aptis Distal Radioulnar Joint Arthroplasty: A Series of Four Cases

Periprosthetic Ulna Fractures Following Aptis Distal Radioulnar Joint Arthroplasty: A Series of Four Cases

Early Results in Total Replacement of the Distal Radioulnar Joint.

Pathology of the distal radioulnar joint (DRUJ) including instability and arthritis presents a challenge for hand and upper extremity surgeons. Surgical options include a Darrach procedure and similar resections, soft tissue interposition arthroplasty, and a one-bone forearm. In 2005, a prosthesis for DRUJ arthroplasty was approved for use in the United States. The authors hypothesize that DRUJ arthroplasty will lead to improved pain and range of motion (ROM) with a moderate, but manageable, complication rate. A retrospective review of 46 patients who underwent DRUJ arthroplasty by a single private group of hand surgeons was performed. Demographics, complications, postoperative visual analog scale (VAS), and postoperative ROM were obtained and analyzed. The patients were followed up for a mean of 60 weeks. The implant was used both as primary surgical treatment for DRUJ pathology and as salvage for previous failed procedures. Twenty-two percent of patients experienced complications: 15% required revision surgery. No patients were converted to another type of implant, including those who underwent revision surgery. Prominent hardware was the most common indication requiring revision. Patients achieved an improvement in supination of 17° and extension of 5°. They additionally achieved a decrease in average VAS score from 7.1 to 2.3. Distal radioulnar joint arthroplasty reduces pain and improves ROM in patients with DRUJ pathology with a 22% complication rate. This cohort demonstrates improved pain, modest improvement in ROM, but a 22% complication rate for this implant. Further long-term studies are encouraged.

Aptis Distal Radioulnar Joint Arthroplasty: A Multicenter Evaluation of Functional Outcomes, Complications, and Patient Satisfaction.

Background The Aptis distal radioulnar joint (DRUJ) implant has been commonly used to replace the DRUJ and restore wrist function in patients with a severely destroyed DRUJ. Objective Promising results have been described in the literature. However, the clinical results in a multicenter setting are sparse and variable. This study evaluates the short- to midterm clinical results of 53 patients with a (mean) follow-up of 51 months. Patients and Methods Fifty-three patients (59 implants) treated between 2011 and 2020 in three different institutions were retrospectively identified in a prospectively collected database. The main indication for Aptis DRUJ arthroplasty was a destroyed DRUJ and gross distal radioulnar instability and isolated DRUJ osteoarthritis. Functional outcome, complications, and patient satisfaction were evaluated. Patients completed the Patient-Rated Wrist Evaluation (PRWE) questionnaire and an additional questionnaire about patient satisfaction and return to hobby/work. Results Implant survival was 92%, the surgical follow-up showed many complications (64,4%), and revision surgery was needed frequently (40.7%). In 13 cases, the follow-up was longer than 5 years. Three reimplantations had to be performed and two implants were permanently explanted. In spite of this all, wrist and forearm motion as well as pain reduction was adequate and patient satisfaction was reasonable (72.2%). Conclusion The Aptis DRUJ arthroplasty is a viable option that can provide adequate wrist and forearm function after secure patient selection and surgical placement of the implant in the wrist with a good bone stock of the radius. The complication rate was found to be high, yet patient satisfaction was reasonable. In the case of secondary surgery, additional surgery seems to be needed. For primary surgery, the implant seems to be successful without complications. Different complications have been described, but further analysis is warranted to find the causes of complications and to objectify the performance of the Aptis DRUJ implant. Level of Evidence IV.

Wrist and Distal Radioulnar Joint Arthroplasty: Maximizing Results in Difficult Conditions.

Traditional management of wrist arthritis consists of proximal row carpectomy, partial carpal fusions, or, in the event of pancarpal arthritis, total wrist fusion. Although proximal row carpectomy and partial wrist fusions preserve some motion at the wrist while relieving pain symptoms, the quality of results obtained from these procedures is not predictable or optimal in many instances. Management of hip, knee, ankle, and shoulder joints has evolved from arthrodesis to arthroplasty. The wrist joint is following the same pattern of evolution with the advent of reliable designs.

Retrospective and Prospective Outcomes of Distal Radioulnar Joint Prosthesis Arthroplasty at a Single Center

Distal radioulnar joint (DRUJ) arthritis can cause painful and limited motion of the forearm leading to decreased function. When conservative treatment options are exhausted, surgical treatments are the next step. The purpose of this study was to retrospectively and prospectively evaluate outcomes of Scheker DRUJ total arthroplasty at a single center and add to the limited data on this procedure. In a retrospective and prospective cohort of 12 patients, 13 DRUJ prosthetics implanted from 2014 to 2021 were evaluated from a single center. The primary outcome was patient satisfaction with the procedure, including comparisons of preoperative and postoperative visual analog scale, Disabilities of the Arm, Shoulder, and Hand, and willingness to repeat the procedure. Secondary outcomes included range of motion, subjective grip strength, need for hardware revision, subsequent procedures, and postoperative complaints. Out of 12 patients that were at least 1-year after surgery from DRUJ arthroplasty, 1 was deceased at the time of final survey and 1 underwent bilateral DRUJ arthroplasty. Seven of 12 available patients were surveyed over the phone. On average, patient range of motion after surgery was 76° in each direction for pronation and supination. There was a clinically significant improvement in the Disabilities of the Arm, Shoulder, and Hand score and a statistically significant improvement in visual analog scale pain rating. Seventy-five percent of patients surveyed were satisfied with their outcomes and would undergo the surgery again. Only one patient required additional surgery, and there were no instances of hardware failure at an average follow-up of 40 months. Our study has shown positive outcomes with decrease in pain, improvement in function via Disabilities of the Arm, Shoulder, and Hand evaluation, and subjective patient satisfaction, with a 100% prosthesis survival rate. The DRUJ arthroplasty prosthesis is a viable alternative to other DRUJ salvage procedures. Therapeutic Level III.

Clinical Results of Patients with Combined Aptis Distal Radioulnar Joint Arthroplasty and Total Wrist Arthroplasty.

Background Severely destroyed wrists can be managed by combined radiocarpal and distal radioulnar joint (DRUJ) replacement that reduces pain while mobility is ought to be reserved. The combination of these arthroplasties is rarely reported in the literature. Purpose This article describes the clinical outcomes of six consecutive patients with both total wrist and Aptis DRUJ arthroplasty with a median follow-up of 50 months (range: 18-108 months). Patients and Methods Patients with a TWA combined with an Aptis DRUJ arthroplasty were retrospectively identified. The patients were treated between 2011 and 2020. Results The flexion-extension arc was slightly decreased in three cases while forearm rotation was improved in three patients. Pain was adequately reduced in four patients and significant pain was seen in two patients. Although three of four patients could not return to previous work, all patients claimed to be satisfied with the result of the procedure. Conclusion This article demonstrates the possible feasibility of this combined arthroplasty in patients with a destroyed and unstable wrist. Level of Evidence Level III.

Twenty-Year Experience With Primary Distal Radioulnar Joint Arthroplasty From a Single Institution

The use of implant arthroplasty in the distal radioulnar joint is increasing. Two main types of implants are commonly used, ulnar head prosthesis (UHP) and hemi or semi-constrained total distal radioulnar joint arthroplasty. The literature consists mainly of small patient series. The purpose of this study was to examine our long-term outcomes of distal radioulnar joint arthroplasty. Patient data were collected in a patient registry from 2000 to 2019. The follow-up included radiographic examination, physical examination, Mayo Wrist Scores, pain level, range of motion, and grip strength. Reoperations were recorded. The implants were a semi-constrained prosthesis and a metallic UHP. The mean age at surgery was 50 years. Patient demographics were similar, but the semi-constrained group had a higher preoperative percentage of instability (85 vs 52 percent). The median follow-up time was 30 months for the semi-constrained implants group and 102 months for the UHP group. A total of 53 primary semi-constrained total joint arthroplasties and 102 UHPs were included. The grip strength and Mayo Wrist Score improved for both the implant groups. Pain reduced in 76% of the patients. Supination improved for the semi-constrained total joint arthroplasty group. Lifting capacity was better in the semi-constrained total joint arthroplasty patients. The unadjusted reoperation rate was 23% for the semi-constrained implants group and 34% for the UHP group. Twenty-two implants were bilateral; these had comparable results to unilateral implants. Kaplan-Meier survival curves demonstrated 94% survival rate for the semi-constrained implants group and 87% survival for the UHP group after 5 years. The risk factors associated with reoperation for the combined implant group included younger age at surgery, previous wrist surgery, ulnar shortening, and wrist fusion. Distal radioulnar joint arthroplasty improved functional outcomes in both the implant groups, but reoperations were frequent. The semi-constrained implants group had better lifting capacity. The bilateral implants had comparable outcomes to the unilateral implants. Therapeutic IV.

Complications of Scheker semiconstrained distal radioulnar joint arthroplasty in a low-volume unit

Semiconstrained arthroplasty of the distal radioulnar joint (DRUJ) (Scheker prosthesis, Aptis Medical, Glenview, KY, USA) is a treatment option in case of irreparable destruction of the DRUJ. In our unit, a Scheker endoprosthesis was implanted in 5 wrists in 4 patients. 3/5 wrists (60%) in 3/4 patients (75%) underwent revision surgery. Reasons for revision surgery were implant loosening, periprosthetic fracture of the radius and suspicion of periprosthetic infection. Asymptomatic loosening of the screw of the radial head cover was detected in one wrist. Scheker arthroplasty is technically demanding. The prosthesis is prone to failure over the long term. Before implantation, all patients should be informed of the high risk of revision surgery.

Outcomes following Distal Radioulnar Joint Arthroplasty in the Setting of Total or Partial Wrist Fusion.

Purpose To evaluate the functional outcome and complications following primary ulnar head or total distal radial ulnar joint (DRUJ) arthroplasty in patients who have a partial or total wrist fusion. Methods We conducted a retrospective review of 33 primary DRUJ implants in 31 patients who had a partial or total wrist fusion. Follow-up time averaged 67 months. There were 11 partial and 22 total wrist fusions with 22 ulnar head prosthesis and 11 total DRUJ implants. The mean age of the patients was 49 years. Eighty-one percent had previous surgeries with an average number of 4.6 previous wrist procedures. Pre- and postoperative pain levels were recorded. Mayo Wrist Scores were calculated. Grip strength, range of motion (ROM), and post-operative complications were noted. Results The pain scores improved in 67% of the patients. The Mayo Wrist Score improved significantly from a mean of 39 preoperatively to 51 postoperatively. The grip strength and pro-supination remained stable. The wrist ROM also remained stable in the patients with partial wrist fusions. During the follow-up period, 10 (30%) of the DRUJ implants were explanted, with a trend toward higher explantation rates in total wrist fusions with one in the partial fusion group and nine in the total wrist fusion group. Four of the explantations happened in the first postoperative year. Nineteen (61%) of the patients required a second surgery for a DRUJ implant-related complication; this rate was similar between the partial and total fusion groups. Conclusions DRUJ replacement resulted in improved pain scores and Mayo wrist scores in the majority of patients; however, the combination of primary DRUJ arthroplasty and total wrist fusion was associated with high complication rates. Surgeons should be aware of the high complication rate seen with DRUJ arthroplasty when combined with total wrist fusion.

Bone Remodeling after Ulna Head Replacement in Distal Radioulnar Joint Arthroplasty: A Radiographic Comparison between a Partial and a Total Ulna Head Concept.

Background Ulna head arthroplasty has become an eligible solution for injury or disease in the distal radioulnar joint. Bone resorption beneath the prosthetic head is often reported, but mechanism poorly understood. Purpose The aims were to evaluate bone remodeling and radiological instability in two conceptually different distal radioulnar joint arthroplasties: the total and the partial ulna head replacement. Patients and Methods We conducted a retrospective radiographic assessment of 51 ulna head arthroplasties; 26 Herbert ulna (total ulna head replacement) and 25 First Choice (partial ulna head replacement), to analyze periprosthetic bone resorption and radiologic instability. Intraoperative/immediate postoperative and 1-year radiographs were reviewed by two independent assessors. The radiographic follow-up averaged 13 (10-17) months. The size of the stem in relation to the diameter of the ulna (filling ratio) was measured on the intraoperative/immediate postoperative radiographs. Bone resorption beneath the collar of the prothesis was measured on the 1-year radiographs and expressed as a bone resorption index (BRI) between the length of the resorption and the length of the implant stem. Radiological stability was measured on both the preoperative and the 1-year lateral radiographs. Results The total ulna head prothesis presented with more extensive bone resorption beneath the prosthetic head than the partial ulna head prothesis at 1-year post surgery ( p <0.001). The filling ratio did not influence the 1-year bone resorption and there was no difference regarding radiological instability between the two prosthetic designs. Conclusion The pattern of bone adaptions after an ulna head prothesis may differ due to design and concept of the prosthesis.

Clinical and radiological results of distal radioulnar joint arthroplasty with the Aptis prosthesis.

We report the results of the treatment of disorders of the distal radioulnar joint with the semi-constrained Aptis prosthesis. Nineteen patients were assessed at a mean follow-up of 7 years. All patients had been operated on previously at the wrist, forearm or elbow. The Disabilities of Arm, Shoulder and Hand score had a mean value of 40, the Patient-Rated Wrist Evaluation score had a mean of 49 and the visual analogue scale for pain had a mean of 3.9. The mean ranges of pronation, supination, wrist flexion and wrist extension were 78°, 76°, 60° and 51°, respectively. The mean grip strength was 23 kg. Complications were noted in ten patients. Eighteen patients would undergo the operation again. The 10-year cumulative survival rate was 84%. The Aptis prosthesis may be a solution to treat patients in whom previous surgery at the distal radioulnar joint has failed.Level of evidence: IV.

Clinical, radiological and patient-rated outcome comparison between total and partial ulnar head implants.

This study aimed to analyse the clinical and radiological outcomes after ulnar head replacement and to compare partial and total ulnar head implants. Twenty-two patients with 23 implants were available with a mean follow-up time of 7years (range 1.3 to 17) after distal radioulnar joint arthroplasty. At the final follow-up, patients had a low level of pain at rest and during effort, a median Disabilities of the Arm, Shoulder, and Hand (DASH) score of 12 and Patient-Rated Wrist Evaluation score of 12 with partial ulnar head implants, and scores of 20 and 22 in total ulnar head implants, respectively. While the range of motion in patients with partial ulnar head implants was slightly reduced in comparison with the preoperative condition and to the patients with total ulnar head implants, there was a tendency to a higher grip strength and rotational torque. Both types of prosthesis showed sigmoid notch resorptions and resorptions around the neck. We conclude that the results after partial ulnar head replacement do not significantly differ from the total ulnar head implants in many aspects.Level of evidence: III.

Salvage of Painful Porous Coated Stem Ulnar Head Prosthesis With Semiconstrained Distal Radioulnar Joint Arthroplasty

To determine the functional outcome and complications after conversion from a painful and unstable ulnar head prosthesis to a semiconstrained distal radioulnar joint arthroplasty. We conducted a retrospective review of 11 ulnar head prostheses in 10 patients with porous coated stems that were revised to semiconstrained prostheses. The median age of the patients was 47 years. The median number of wrist surgeries prior to conversion was 4 (range, 1-9). The median time from the ulnar head implant to the revision surgery was 47 months. Pre- and postoperative pain levels were recorded. Mayo Wrist Scores were calculated. Grip strength, range of motion, and complications and reoperations were recorded. All patients reported moderate or severe pain before surgery, whereas 3 patients reported moderate pain after surgery. The Mayo Wrist Score improved considerably from a median of 50 before surgery to 65 after surgery. The grip strength and forearm pronation-supination showed no change following surgery. The median wrist flexion-extension range improved considerably. Follow-up was a median of 64 (range, 15-132) months after revision surgery. Removal of the ulnar head implant was described as difficult by the surgeons, except in 1 case where the implant was loose. Resection of bone from the distal ulna was often necessary. One patient needed a reoperation requiring prosthesis removal for aseptic loosening of the stem 5 years after revision. There were 2 nondisplaced periprosthetic fractures successfully treated with cast immobilization and 2 additional minor complications, 1 postoperative stitch abscess, and 1 extensor carpi ulnaris tendinitis. Conversion from an ulnar head implant to a semiconstrained prosthesis provided improved pain scores and function with a low reoperation rate in this patient series. Removal of an ulnar head prosthesis can be technically challenging, but it can be performed leaving enough bone stock for immediate implantation of a semiconstrained implant. Therapeutic V.

Radioscapholunate Arthrodesis and Distal Radioulnar Joint Arthroplasty for Rheumatoid Wrist Arthritis: A Surgical Technique

Introduction: We describe the treatment of rheumatoid radiocarpal joint and distal radioulnar joint (DRUJ) arthritis with radioscapholunate (RSL) arthrodesis and DRUJ arthroplasty in 2 patients with 2 years follow-up. The RSL arthrodesis utilizes nitinol staples and local distal radius autograft to fuse the scaphoid and lunate to the distal radius. Materials and Methods: One patient was treated in their nondominant extremity, and the other patient had bilateral procedures. A constrained endoprosthesis was used for the DRUJ arthroplasty portion, using the same dorsal approach to the wrist as the RSL arthrodesis. Results: Before his procedures, this first patient-reported a Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score of 66, which improved to 16 at 2 years postoperatively. He also reported a Visual Analog Scale score of 6/10 at rest in both wrists preoperatively. Following his procedures, Visual Analog Scale scores improved to 3/10 in the right wrist and 0/10 in the left wrist. Active wrist range of motion was measured to be a 60-degree arc on the right and a 47-degree arc on the left. Our second patient reported an improved QuickDASH score from 97 preoperatively to 68 at 2 years postoperatively and had a 70-degree arc of left wrist range of motion. No postoperative complications or reoperations were encountered in the cases. Discussion: The benefit of this technique is to allow simultaneous treatment of radiocarpal joint arthritis with RSL arthrodesis, permitting wrist flexion and extension through the midcarpal joints, and DRUJ arthritis with DRUJ arthroplasty, preserving pronation and supination.

Two-Year Clinical and Radiographic Evaluation of Scheker Prosthesis (Aptis) Distal Radioulnar Joint Arthroplasty

To evaluate the clinical and radiographic outcomes of patients who underwent semiconstrained distal radioulnar joint arthroplasty. A retrospective analysis was performed on a series of patients who underwent distal radioulnar joint arthroplasty with more than a 23-month follow up. The quantitative outcome variables included the visual analog scale for pain; Disability of the Arm, Shoulder, and Hand (DASH) score; Patient-Rated Wrist Evaluation (PRWE); and Mayo wrist score. The range of motion, grip strength, torque, and lifting capacity were measured at final follow up and compared with that of the nonsurgical extremity. Complications related to the prosthesis were assessed. Twenty-one patients (mean age 57 years) were assessed at an average 41-month follow up (23-73 months). Fifteen underwent prior hand, wrist, or elbow procedures. Four patients required 5 reoperations. The postoperative median visual analog scale pain score was 0.6 at rest and 2.1 with activity. The median postoperative DASH score was 26.7, PRWE 41, and Mayo wrist score was 65. Upon comparing the supination torque of the operative and intact sides, the operative side was found to average 87% of the intact side on a work simulator and 77% on the simulator's D-ring. Eight of 20 patients had lysis around the collar of the ulnar component (40%), as detected using radiography. Three of 21 (14%) radial plates were malpositioned, with 2 resulting in a fracture. The overall complication rate was 29%. Distal radioulnar joint arthroplasty using the Scheker prosthesis demonstrated good patient pain scores and the restoration of supination strength. The collar lysis resulted in weaker supination and grip strength. Still, the patients experienced mild levels of pain and moderate disability. A moderate complication rate persisted, as reported by other authors. Accurate radial component placement is important. Therapeutic IV.

Distal-Ulna Stump Stability: The Role of Distal Interosseous Membrane: Myth or Reality? Anatomical Research.

Distal-ulna stump (DUS) instability often occurs when performing a distal radioulnar joint (DRUJ) arthroplasty. Recent studies suggest that the distal interosseous membrane (DIOM) reinforces the triangular fibrocartilage complex, providing additional stability to the DRUJ. The aim of this study was to determine whether the DIOM stabilizes the ulnar stump. Twenty fresh-frozen random forearms were dissected. The presence of a distal oblique bundle (DOB) was recorded and measured. The radius was fixed to a vise and the ulna kept free. The DRUJ was fixed with a lag screw. A bone slice was removed by transverse ulna osteotomies 10 and 15 mm proximal to the DRUJ. A 10-N force was applied to the ulna in dorsal and volar directions. Displacements were measured. The DIOM was then transected, and maneuvers and measurements were repeated and compared. A distinct distal membrane was present in 70% and a cord-like DOB in 30%. The mean length was 29 mm. Its origin was proximal to the sigmoid notch; its insertion was on the distal third of the ulna, at its lateral border. This attachment is comprised between 39 and 48 mm proximal to the ulnocarpal joint. Initial displacements averaged 22 mm dorsally and 13 mm volarly. After DIOM transection, ulnar translocation increased to 31 mm dorsally and 19 mm volarly. In DRUJ arthroplasties, the DIOM does not appear to be a stabilizer of the DUS beneath a useful threshold. Its retaining effect occurs only after an initial 22-mm dorsal displacement, which we consider not clinically admissible. Therefore, in DRUJ arthroplasties, some augmentation might be advisable.

Distal radioulnar joint arthroplasty after primary excision of a giant cell tumor of distal ulna: A case report

Distal radioulnar joint arthroplasty after primary excision of a giant cell tumor of distal ulna: A case report