Distal Radioulnar Joint Injuries Research Articles

Arthroscopic Examination of the Triangular Fibrocartilage Complex in Galeazzi Injuries: Revisiting a Complex Injury

AbstractGaleazzi fracture-dislocations result from severe trauma and can lead to loss of function of the wrist and forearm if not treated appropriately. To avoid such disasters, meticulous surgical management of the injury is necessary. The current literature talks about symptomatic distal radioulnar joint injuries in Galeazzi fracture-dislocations and the various approaches to managing instability. However, unfortunately, there is a dearth of data on the true incidence of injury to the triangular fibrocartilage in the backdrop of the severity of the mechanism of Galeazzi fractures and the damage it may cause as direct inspection of the triangular fibrocartilage complex is not done routinely as a part of management of such cases. We conducted a retrospective review of six consecutive patients with Galeazzi fracture-dislocations. Wrist arthroscopy was performed in these cases, which revealed complex tears of the triangular fibrocartilage complex involving large segments of the ligament and always involving the dorsal periphery. All tears followed the same pattern of disruption of the attachments of two sides of the triangular fibrocartilage complex. We believe our findings will pave the path to further prospective studies in understanding the degree of damage in the triangular fibrocartilage in such devastating injuries and the need for meticulous arthroscopic repair.

Interosseus Membrane Reconstruction Following a Forearm Injury: A Case Report

Abstract Background Essex-Lopresti injuries are complex, frequently missed forearm/elbow injuries consisting of a fracture of the radial head with disruption of both the distal radioulnar joint (DRUJ) and the interosseous membrane (IOM). Ideal management of these injuries remains controversial, especially in relation to the IOM, due in part to underdiagnosis of IOM injury and incomplete understanding of the IOM role. Methods A 43-year-old man sustained an open radial shaft fracture with associated radial head subluxation, coronoid base fracture, and DRUJ injury with ulnar head subluxation. He was taken for surgery, where elbow instability with near complete disruption of the IOM was observed. Persistent gross rotational instability was noted following radius fixation, so braided suture and button reconstruction of the central band of the IOM was performed. This restored rotational and longitudinal stability to the radiocapitellar joint and DRUJ. Over 1 year out from the index surgery, the patient's elbow and DRUJ have remained stable, and he is back working as a laborer. Results While little literature exists on outcomes of acute IOM reconstruction in these injuries, recent biomechanical studies have shown the importance of the central band on rotational elbow stability. Conclusion This case supports the importance of the central band of the IOM by demonstrating the impact of its repair on the longitudinal and rotational stability of the elbow and DRUJ. IOM repair has the potential to improve our treatment of this complicated injury by better restoring forearm stability and function of the elbow, which future studies could help further elucidate.

Length Changes in the Interosseous Membrane During Forearm Rotation: A 3-Dimensional Study In Vivo

The length change of the interosseous membrane (IOM) during forearm rotation has not been fully studied. To explore the meaning of length change in the distal oblique band (DOB), the distal accessory band (DAB), and the proximal, middle, and distal parts of the central band (CBP, CBM, and CBD, respectively), we investigated the length change in these ligaments at maximum pronation, 45° of pronation, neutral position, 45° of supination, and maximum supination invivo. The images of the right forearms from 6 healthy volunteers were obtained by computed tomography scanning at the 5 above-mentioned rotation positions. We created 3-dimensional models of the radius and ulna, DOB, DAB, and central band based on the points of origin and insertion. Finally, the length of each ligament was estimated from the points of insertions and origins registered on the 3-dimensional models. The DAB and CBD lengths increased significantly from maximum pronation to 45° of pronation. The DOB length increased significantly from 45° of pronation to neutral position and decreased significantly from 45°of supination to maximum supination. The DAB and CBM lengths increased significantly from neutral position to 45° of supination. The DAB length decreased significantly from 45° of supination to maximum supination. For the CBP, no difference in length was observed during forearm rotation. The DOB becomes taut at neutral position, and the central band, especially the CBP, is nearly isometric. The findings indicate that the DOB may provide the primary stabilization of the distal radioulnar joint and that the central band is the key stabilizer during forearm rotation. Surgeons may pay attention to the DOB when a patient incurs a distal radioulnar joint injury, and the CBP may be the optimal location for IOM reconstruction.

To study the incidence of missed Distal Radio-Ulnar Joint (DRUJ) injuries, its’ early diagnosis by dynamic C.T. Scan and Management by modified Kapanji method

Background and Method: All the patients coming to the Department of Orthopaedics of Index Medical College Hospital & Research Centre, Indore, with an aim to Study The Incidence of missed Distal Radio-Ulnar Joint (Druj) Injuries, Its’ Early Diagnosis by Dynamic C.T. Scan and Management by Modified Kapanji Method and diagnosed with distal radio-ulnar joint injuries. All the trauma cases were received in the casualty and primary treatment with detailed examination and required imaging studies were done. The x-ray included antero-posterior and posterio-anterior views with dynamic CT scan and CT scan for head injury patient was donr through all investigation operative procedure were planned. The required consent was taken by the patient beforehand. Result: DRUJ injuries are more prevalent among young males than females. In age group 16 to 30 female (45%) is higher than male (38.8%). DRUJ injuries was seen more in left (55%) than right (45%) hand. Fall on out stretched hand (58%) is the major mechanism of DRUJ injuries followed by trivial trauma in 42%. DRUJ injury was missed in 18.33%, chronic in 20%, acute in 38.33% and sub-acute in 23.33%. Conclusion: Present study conclude that DRUJ injuries are more prevalent among young males than females. DRUJ injuries was seen more in left (55%) than right(45%) hand with fall on out stretched hand is the major mechanism. Physical examination is effective in diagnosis; radiological examination suggested for further investigations. Positive symptoms of DRUJ injuries were in 100%, physical examination was positive in 85% and negative in 15%. Positive CT findings in 66.67% and negative in 33.33%. X-ray findings were positive in 71.67% and negative in 28.33%.

Clinical and radiological evaluation of distal radio ulnar joint (DRUJ) in injuries around the wrist joint

Background & Method: This prospective, non randomised cohort study was carried out in the Department of Orthopaedics, Jawaharlal Nehru Medical College & Acharya Vinoba Bhave Rural Hospital, Datta Meghe Institute Of Medical Sciences (Deemed University) Wardha, with an aim to Clinico-radiological evaluation of distal radio ulnar joint (DRUJ) in injuries around the wrist joint. All patients who presented to our hospital were included in the study, Patients with compound wrist injuries were excluded from the study. In standardised format, data concerning patient’s history and clinical examination were collected. Those patients who fulfilled the inclusion criterion and gave a valid informed written consent were recruited in the study. Result: The wrist evaluation in cases of Acute DRUJ disruption were treated primarily along with associated wrist injuries was done after 24 week of treatment. PRWE (Patient Related Wrist Evaluation) score. However in patients of Chronic DRUJ disruption they slao evaluated using Mayo Wrist Score and PRWE Score. Conclusion: In our study total 132 patients of Acute DRUJ disruption and 28 patients of Chronic DRUJ disruptions were studied clinically and radiologically. Clinical and Radiological suspicion of DRUJ disruption should always be kept in mind while dealing with wrist, hand or forearm injuries. Distal Radio Ulnar Joint injury needs to be treated primarily along with the associated wrist, hand or forearm injury to restore near normal function of the Forearm and Wrist.

Higher-Than-Expected Rates of Distal Radioulnar Joint Fixation in Radial Shaft Fractures: Location of Fracture Matters.

The purpose of this study was to evaluate rates of distal radioulnar joint (DRUJ) fixation based on location of the radial shaft fracture and risk factors associated with postoperative complications following radial shaft open reduction internal fixation (ORIF). Adult patients who underwent isolated radial shaft ORIF from 2014 to 2018 were identified from American College of Surgeons National Surgical Quality Improvement Program database and stratified by fracture location and by the presence or absence of DRUJ fixation. Preoperative patient characteristics and postoperative complications were compared to determine risk factors associated with DRUJ fixation. We identified 1517 patients who underwent isolated radial shaft ORIF, of which 396 (26.1%) underwent DRUJ fixation. Preoperative patient characteristics and postoperative complications were similar between cohorts. Distal radioulnar joint fixation was performed in 50 (30.7%) of 163 distal radial shaft fractures, 191 (21.8%) of 875 midshaft fractures, and 3 (13.0%) of 23 proximal shaft fractures (P = .025). Risk factors for patients readmitted include male sex (odds ratio [OR] = 12.76, P = .009) and older age (OR = 4.99, P = .035). Risk factors for patients with any postoperative complication include dependent functional status (OR = 6.78, P = .02), older age (50-69 vs <50) (OR = 2.73, P = .05), and American Society of Anesthesiologists (ASA) ≥3 (OR = 2.45, P = .047). The rate of DRUJ fixation in radial shaft ORIF exceeded previously reported rates of concomitant DRUJ injury, especially among distal radial shaft fractures. More distally located radial shaft fractures are significantly associated with higher rates of DRUJ fixation. Male sex is a risk factor for readmission, whereas dependent functional status, older age, and ASA ≥3 are risk factors for postoperative complications.

Significance of Co-existing Distal Radio-Ulnar Joint Injuries in the Surgical Management of Distal Radius Malunion

Significance of Co-existing Distal Radio-Ulnar Joint Injuries in the Surgical Management of Distal Radius Malunion

The Functional Outcomes in Treatment of Distal Radio Ulnar Joint Injuries with Distal Radius Fractures

Distal range breaks speak to the 10%-12% of all cracks of the body and as much as 72% of all lower arm cracks. Distal radioulnar joint (DRUJ) shakiness is a significant intricacy of distal span break and is significant reason for ulnar sided wrist torment in distal end sweep cracks. In this forthcoming examination twenty cases with crack distal range with distal radioulnar joint injury were overseen over the previous months between July 2019 and September 2020 in Benha University medical clinic and Shebin Elkom showing emergency clinic .. of 20 patients took on this investigation, Ten patients had been treated by obsession of distal end sweep just or more elbow Splint, and Ten patients had been treated by: obsession distal end range and DRUJ fixed by (cross over distal Radioulnar K.wire or ulna styloid obsession or both). Aftereffects of obsession of DRUJ and styloid ulna was preferable in result over above elbow brace. Ulnar side wrist agony and torment with lively exercises saw in gathering (1) more than gathering (2). Some patient in gathering (1) was griping of elbow solidness after cast evacuation which settled by physiotherapy. intraoperative obsession of DRUJ prescribed to be done after obsession of the distal range break which is in a way that is better than above elbow projecting.

Physeal sparing distal radio-ulnar joint ligament reconstruction in children.

Distal radio-ulnar joint (DRUJ) injuries are under-reported in the paediatric population. No single study has discussed methods of DRUJ reconstruction in immature patients with chronic instability. We present a physeal sparing ligamentoplasty for chronic DRUJ instability and describe the outcomes in two patients. Two consecutive children with chronic DRUJ instability were treated using physeal sparing ligamentoplasy. After the failure of triangular fibrocartilage complex repair, reconstruction was done using palmaris longus tendon graft that was tunnelled through the distal radius epiphysis and wrapped subperiosteally around the ulnar neck. Graft was tied in a neutral forearm position. DRUJ stability was achieved in both patients. Grip strength averaged 90% of the healthy side. Prono-supination range of motion (ROM) averaged 88 and 86%, respectively, of the healthy side, without intraoperative nor postoperative complications. Our novel technique was effective in the regain of DRUJ stability with minor effect on the prono-supination ROM. Further studies are planned to experiment the biomechanical effectiveness of our technique. Level of evidence: Therapeutic IV.

Unusual Wrist Injury Presentation in a Football Player

HISTORY: 17-year-old high school football player presented for sideline evaluation with right wrist pain. The injury occurred when he was tackled and had his wrist twisted and caught under another player. His coach kept him in the game and after one more play, his teammates called out for medical attention. He had diffuse swelling and pain along the ulnar aspect of the distal forearm and wrist. He was placed in a volar splint and sent to the emergency department where x-ray imaging of the wrist was read by radiologist as normal. The athlete followed up in clinic four days later. He continued to have pain, restricted range of motion, and decreased strength. Review of systems was otherwise normal. Past medical history was unremarkable. PHYSICAL EXAMINATION: Wrist examination showed moderate diffuse swelling but no ecchymosis or deformity. He had tenderness along the ulnar aspect of the distal wrist. There was no tenderness at the anatomic snuff box or scaphoid tubercle. Range of motion was limited in all directions, especially in supination. Strength was 4+/5 in all motions except for supination, which was 3+/5. Special tests including triangular-fibrocartilage complex grind, Watson’s, and Finkelstein’s were equivocal. Sensation to light touch was intact. Radial pulses were equally palpable bilaterally. DIFFERENTIAL DIAGNOSIS: 1) Ulnar styloid or hook of hamate fracture. 2) Distal radioulnar joint injury. 3) TFCC injury. 4) Scapholunate or lunotriquetral dissociation. TESTS AND RESULTS: Initial x-rays at ED were read as normal. Repeat x-rays were concerning for volar ulna dislocation. MRI without contrast showed volar dislocation of the ulna. FINAL/WORKING DIAGNOSIS: Radioulnar joint dislocation with volar displacement of ulna. TREATMENT AND OUTCOMES: 1. Orthopedic hand surgery referral. Given the length of time since initial injury, closed reduction was performed under general anesthesia. 2. Long arm cast with the forearm in supination position for 4 weeks. Repeat x-rays demonstrated maintenance of reduction. After cast removal, the patient returned to football with a removal wrist splint.

Effects of axial forearm instability on force transmission across the elbow

The interosseous membrane (IOM) and distal radioulnar joint (DRUJ) provide axial stability to the forearm. Our hypothesis was that injury to these structures alters force transmission through the elbow. A custom-designed apparatus that applies axial loads from the wrist to the elbow was used to test 10 cadaveric upper limbs under the following simulated conditions (1) intact, (2) DRUJ injury, (3) IOM injury, or (4) IOM + DRUJ injury. IOM injury was simulated by osteotomies of the IOM attachment to the radius, and DRUJ injury was simulated by distal ulnar oblique osteotomy. We applied 160 N of axial force during cyclic and functional range of forearm rotation (40o pronation/40o supination), and force, contact pressure, and contact area through the elbow joint were measured simultaneously. The force across the radiocapitellar joint was significantly higher in the IOM + DRUJ injury and the IOM injury groups than in the intact and DRUJ injury groups. The mean force across the radiocapitellar joint was not significantly different between the intact and DRUJ injury groups or between the IOM + DRUJ injury and the IOM injury groups. Forces across the ulnohumeral joint showed an inverse pattern to those in the radiocapitellar joint. These findings suggest that injury to the IOM contributes more to the disruption of the normal distribution of axial loads across the elbow than injury to the DRUJ.

Clinical efficacy analysis of distal ulna resection with periosteum preservation

Objective To explore the feasibility and clinical efficacy of distal ulna resection with periosteum preservation to enhance the stability of ulnar stump. Methods A retrospective study was conducted on 26 cases of old distal radioulnar joint dislocation or total carpal arthritis treated with distal ulna resection with periosteum preservation. The joint pain, active rotation range of forearm and the X-ray radiograph were evaluated postoperatively to observe the clinical efficacy. The feasibility, indications and key points of the method for stabilizing ulnar stump were analyzed. Results All the patients were follow-up for 3 to 39 months with an average of 8.5 months. All the wounds all achieved primary healing. The postoperative visual analogue scale (VAS) and active rotation range of forearm were improved significantly (P<0.05) . The significant ossification of ulnar stump was found in 10 cases and it was limited within the reserved periosteum. The length of ossification was significantly positively correlated with the length of the osteotomy of the ulnar distal part (P<0.05) . The radioulnar convergence was found in 6 cases in different degrees, but no radioulnar impingement was identified. The reserved periosteum played a stable role in the suspension of the ulnar stump. No volar or distal deviation and excessive osteogenesis of the ulnar stump was observed from the X-ray film. Conclusion The distal ulna resection with periosteum preservation can significantly improve the joint pain as well as the function of forearm rotation in the patients with distal radioulnar joint injuries. The reserved periosteum has a good stabilizing effect on the ulnar stump, which can effectively avoid the occurrence of related complications. The ossification of ulnar stump has no influence on the forearm function. Key words: Retrospective studies; Treatment outcome; Periosteum preservation; Distal ulna resection

A short term prospective study of the functional outcome of comminuted displaced intra-articular fracture of the distal radius treated with volar locking compression plate

Distal radius fracture accounts for approximately 17% of all fractures. More than half of these fractures are intra-articular and associated with Distal Radio Ulnar Joint (DRUJ) injuries. Several treatment modalities have been described like plaster cast, external fixation and open reduction and internal fixation with plate osteosynthesis. Superiority of open reduction and internal fixation with plate osteosynthesis has been established well, as it provide angular stability and allow for early mobilization, thereby achieving early functional recovery. In this prospective study, done over a period of 36 months and with a minimal follow-up of at least 12 months, we were able to recruit 56 patients conforming to our inclusion criteria. We had followed the Melone Classification and had operated all cases using the Ellis approach with distal radius volar side specific locking compression plates. We had evaluated the functional outcome of wrist function using the Demerit point system of Gartland and Werley at the end of 12 months of follow-up. Our study concluded that ORIF is an effective surgical management protocol for unstable intra-articular distal radius fracture. In our short term study the overall complication rate was 17.86%. The functional outcome excellent to good in 75% of cases, it was fair in 17.9% of cases and poor in only 7.1% of cases.

Ulnar-sided wrist pain in the athlete (TFCC/DRUJ/ECU).

The goal of this manuscript is to review key historic and recent literature regarding extensor carpi ulnaris (ECU), triangular fibrocartilage complex (TFCC) and distal radioulnar joint (DRUJ) injuries, particularly in athletes. Many recent studies examining the ECU focus on clinical and radiographic diagnosis. Several physical exam findings are described in addition to the use of MRI and US. Imaging studies must be clinically correlated due to high incidence of findings in asymptomatic patients. In regard to the TFCC/DRUJ, there are numerous recent studies that support the use of MRA as an adjunctive diagnostic study. There are also a number of repair constructs that are described for the various different kinds of TFCC pathology reviewed here. In summary, there are a number of options for the diagnosis and treatment of ulnar-sided wrist pain. Patient factors, especially in the athletic population, must be taken into account when approaching any patient with these pathologies.

Traumatic Triangular Fibrocartilage Complex Injuries and Instability of the Distal Radioulnar Joint

Traumatic triangular fibrocartilage complex (TFCC) injuries require multidisciplinary approach and plan. Trauma to TFCC can lead to instability of the distal radioulnar joint (DRUJ). Injury to TFCC is classified as a stable type that does not cause unstable lesions for DRUJ or unstable type that can cause instability of DRUJ. According to the location and severity of the injury, arthroscopic debridement or arthroscopic repair may be considered. In the ulnar side avulsion of TFCC, which could cause DRUJ instability, arthroscopic examination should be performed to identify an accurate location of the damaged structures, followed by arthroscopic debridement and repair. In the event of TFCC and DRUJ injuries with ulnar positive variance, arthroscopic TFCC repair or ulnar shortening osteotomy after arthroscopic debridement could be considered to solve the instability and ulnar side pain. However, if peripheral TFCC tear with ulnar impaction syndrome and DRUJ instability, it combined operation of ulnar shortening osteotomy and TFCC foveal fixation could be considered. An accurate classification of TFCC and DRUJ injuries is necessary. It is important to resolve and prevent recurrence of ulnar wrist pain caused by instability.

ДИАГНОСТИКА И ЛЕЧЕНИЕ ПОВРЕЖДЕНИЙ ДИСТАЛЬНОГО ЛУЧЕЛОКТЕВОГО СУСТАВА

We present the experience of treatment of 169 patients with distal radioulnar joint injuries, operated in specialized hand surgery department of the Clinic of traumatology and orthopedics of Russian State Medical University on the base of Moscow city clinical hospital № 4. We have carried out the following operations: closed osteoclasia of the distal epimetaphys fractures, osteotomy of the radius with the external fixator application in 97 (57,4%) patients, percutaneous 2 Kirschner wires fixation of the ulna head to the radius after reposition of dislocation - 38 (22,5%) patients, lavsanoplasty of DRUJ ligaments - 12 (7,1%), fixation of the ulna head to the radius by pin - 7 (4,1%), open reposition of dislocation of the ulna head and K-wire fixation - 8 (4,8%), osteotomy of synostosis of forearm bones, W. Darrach and Sauve-Kapandji operations - 7 (4,1%). Complications were observed in 13 (7,7%) cases. Postponed results (1 year after operation) were studied in 110 patients. We got good results in 95 (86,4%) cases, satisfactory - in 12 (10,9%) cases, unsatisfactory - in 3 (2,7%) cases.

Effect of ulnar styloid fracture on outcomes after conservative treatment of distal radius fracture.

This study aims to investigate the effect of accompanying ulnar styloid fracture (USF) on clinical outcomes and hand-wrist muscle strength in conservatively treated active patients after displaced distal radius fracture (DRF). The retrospective study, which was conducted November 2012 and September 2016, included 56 patients (34 males, 22 females; mean age 28.8 years; range 20 to 40 years) with displaced DRF treated with closed reduction and casting. Patients were divided into three groups according to ulnar styloid status as group A (intact ulnar styloid), group B (USF non-union), and group C (healed USF). Grip strength, quick-disabilities of the arm, shoulder and hand (DASH) score, and joint range of motions were evaluated; the results were combined with measurements of isokinetic muscle strengths of hand-wrist region. Magnetic resonance imaging was performed to evaluate the accompaniment of distal radioulnar joint injury and triangular fibrocartilage complex (TFCC) lesion. There were no significant differences between the groups regarding joint range of motion, grip strength, and quick-DASH scores. However, the peak torque and total work of supination was better in group A compared to group B (p=0.008 and p=0.006, respectively). According to the magnetic resonance imaging findings, of the 10 patients with detected TFCC lesion, four were in group C, five in group B, and one was in group A. Results of this study suggest that USF should not be the focus of attention during initial treatment of DRF and surgical intervention might be considered in case of an accompanying TFCC lesion.

Arthroscopic-assisted repair of triangular fibrocartilage complex foveal avulsion in distal radioulnar joint injury.

Background:Disruption of the triangular fibrocartilage complex (TFCC) foveal insertion can lead to distal radioulnar joint (DRUJ) instability accompanied by ulnar-sided pain, weakness, snapping, and limited forearm rotation. We investigated the clinical outcomes of patients with TFCC foveal tears treated with arthroscopic-assisted repair.Materials and Methods:Twelve patients underwent foveal repair of avulsed TFCC with the assistance of arthroscopy between 2011 and 2013. These patients were followed up for an average of 19 months (range 14–25 months). The avulsed TFCC were reattached to the fovea using a transosseous pull-out suture or a knotless suture anchor. At the final followup, the range of motion, grip strength and DRUJ stability were measured as objective outcomes. Subjective outcomes were assessed using the Visual Analog Scale (VAS) for pain, patient rated wrist evaluation (PRWE), Disabilities of the Arm, Shoulder and Hand questionnaire (DASH score) and return to work.Results:Based on the DRUJ stress test, 5 patients had normal stability and 7 patients showed mild laxity as compared with the contralateral side. Postoperatively, the mean range of pronation supination increased from 141° to 166°, and the mean VAS score for pain decreased from 5.3 to 1.7 significantly. The PRWE and DASH questionnaires also showed significant functional improvement. All patients were able to return to their jobs. However, two patients complained of persistent pain.Conclusions:Arthroscopically assisted repair of TFCC foveal injury can provide significant pain relief, functional improvement and restoration of DRUJ stability.

Galeazzi fractures: Is DRUJ instability predicted by current guidelines?

IntroductionClinically significant distal radioulnar joint (DRUJ) injuries can occur with radial shaft fractures. Several radiographic methods of diagnosis, such as radial shortening of >5mm or fracture line within 7.5cm from the lunate facet, have been proposed but not clinically validated. The purpose of this study was to compare radiographic measurements of radial shaft fractures associated with and without clinically significant DRUJ injury (i.e., true Galeazzi fracture-dislocation) in order to evaluate the predictive value of reported parameters of DRUJ injury. Patients and methodsA retrospective record and radiographic review was performed of 66 consecutive skeletally mature patients with isolated radial shaft fractures from 2004 to 2014 treated at one level 1 academic trauma center. Intraoperatively determined DRUJ instability after radial shaft fixation was used as the gold standard for diagnosis of a Galeazzi fracture-dislocation. ResultsAverage age was 34 years old (range: 18–90). By thirds, there were 10 proximal (15%), 27 middle (41%), and 29 distal (44%) fractures. 13 (20%) had an associated ulnar styloid fracture. 7 (11%) patients had DRUJ instability after radial fixation. Radial shortening averaged 4.4±5.2mm (−2.6–22), and 21 had shortening of >5mm. Twenty-six (39%) fractures were within 7.5cm of the wrist joint. Previous guidelines were only moderately accurate. Even greater shortening did not predict instability (3/7 patients with >10mm shortening had a true injury). Four out of 7 cases with instability had ulnar styloid fractures (p=0.02). Discussion and conclusionsUsing a larger data set than has historically been evaluated, previously reported radiographic guidelines are only moderately accurate. The presence of an ulnar styloid fracture can be helpful. Surgeons should be aware of these associations but rely primarily on intraoperative assessment of the DRUJ after radial fixation to determine treatment.

Outcome Assessment after Aptis Distal Radioulnar Joint (DRUJ) Implant Arthroplasty.

Conventional treatments after complicated injuries of the distal radioulnar joint (DRUJ) such as Darrach and Kapandji-Sauvé procedures have many drawbacks, which may eventually lead to a painful unstable distal ulna. The development of DRUJ prosthesis has significantly evolved over the past years. In this study, we assessed the outcome results of patients after DRUJ implant arthroplasty using the Aptis (Scheker) prosthesis. We identified 13 patients with 14 prosthesis during the past 10 years. Patients underwent DRUJ arthroplasty due to persistent symptoms of instability, chronic pain, and stiffness. Records and follow-up visits were reviewed to find the final post-operative symptoms, pain, range of motion, and grip strength with a mean follow-up of 12 months (range: 2-25 months). Also, patients were contacted prospectively by phone in order to administer the disabilities of the arm shoulder and hand (DASH), patient rated wrist evaluation (PRWE), and visual analogue scale (VAS), and to interview regarding satisfaction and progress in daily activities. Eleven patients out of 13 could be reached with a median follow-up time of 60 months (range: 2 to 102 months). No patient required removal of the prosthesis. Only two patients underwent secondary surgeries in which both required debridement of the screw tip over the radius. The median DASH score, PRWE score, VAS, and satisfaction were 1.3, 2.5, 0, and 10, respectively. The mean range of flexion, extension, supination, and pronation was 62, 54, 51, and 64, respectively. Distal radioulnar joint injuries are disabling and patients usually undergo one or more salvage surgeries prior to receiving an arthroplasty. The Scheker prosthesis has shown satisfactory results with 100% survival rate in all reports. The constrained design of this prosthesis gives enough stability to prevent painful subluxation.