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Semiconstrained distal radioulnar joint prosthesis.

ABSTRACT: Distal radioulnar joint (DRUJ) problems can occur as a result of joint instability, abutment, or incongruity. The DRUJ is a weight-bearing joint; the ulnar head is frequently excised either totally or partially, and in some cases it is fused, because of degenerative, rheumatoid, or posttraumatic arthritis. Articles about these procedures report the ability to pronate and supinate, but they rarely discuss grip strength, and even less do they address lifting capacity. We report the long term results of the first 35 patients who underwent total DRUJ arthroplasty with the Aptis DRUJ prosthesis after 5 years follow-up. Surgical indications were all causes of dysfunctional DRUJ (degenerative, posttraumatic, autoimmune, congenital). We recorded data for patient demographics, range of motion (ROM), strength, and lifting capacity of the operated and of the nonoperated extremity. Pain and functional assessments were also recorded. The Aptis DRUJ prosthesis, a bipolar self-stabilizing DRUJ endoprosthesis that restores forearm function, consists of a semiconstained and modular implant designed to replace the function of the ulnar head, the sigmoid notch of the radius, and the triangular fibrocartilage ligaments. The surgical technique is presented in detail. The majority of the patients regained adequate ROM and improved their strength and lifting capacity to the operated side. Pain and activities of daily living were improved. Twelve patients experienced complications, most commonly being extensor carpi ulnaris (ECU) tendinitis, ectopic bone formation, bone resorption with stem loosening, low-grade infection, and need for ball replacement. The Aptis total DRUJ replacement prosthesis is an alternative to salvage procedures that enables a full range of motion as well as the ability to grip and lift weights encountered in daily living activities.

SUBMITTER: Savvidou C

PROVIDER: S-EPMC3656582 | biostudies-other | 2013 Feb

REPOSITORIES: biostudies-other

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Project description:RationaleHabitual volar dislocation of the ulnar head with a locked distal radioulnar joint (DRUJ) is a rare complication after distal radius fracture. We present a case of habitual volar dislocation of the ulnar head in a woman with a dorsally displaced malunited distal radius fracture.Patient concernsA 72-year-old woman presented with occasional painful locking of the forearm in full supination. She had fractured the left distal radius in a fall 6 months previously. The fracture had been treated non-surgically with wrist immobilization in a long and short arm cast for 6 weeks. Physical examination showed no swelling of the left hand. The wrist locked when the forearm was fully supinated, and the patient was not able to pronate her forearm without reducing the ulna by pressing the left ulna down toward the DRUJ. She experienced sharp pain during the reduction procedure and pronation of the left forearm. The affected wrist had 91% motion compared with the contralateral wrist.DiagnosisRadiography and computed tomography showed 28° dorsally angulated malunion of the distal radius and ulnar head subluxation with respect to the radius. Magnetic resonance imaging revealed disruption of the ulnar-side triangular fibrocartilage complex (TFCC) from the ulna fovea.InterventionsThe patient desired surgery to address the painful click during full supination of her left wrist and the limitations in her activities of daily living. Corrective osteotomy of the distal radius and arthroscopic repair of the ulnar-side tear of the TFCC were performed. The TFCC was arthroscopically repaired to the ulnar fovea to stabilize the DRUJ.OutcomesAt 1 year postoperatively, radiography showed complete union of the radius. The affected side had 97% wrist motion compared with the contralateral wrist and a full range of forearm rotation without pain or clicking. The grasp strength was 100% compared with the normal wrist.LessonsMalunited distal radius fracture with concomitant TFCC injury can result in habitual volar dislocation of the ulnar head due to severely dorsally angulated malunion of the radius and avulsion of the ulnar-side TFCC from the ulna fovea. This condition required corrective osteotomy plus TFCC repair.

Project description:Instability of the distal radioulnar joint (DRUJ) is a complication that can occur following distal radius fracture or malunion. We have observed that residual radial translation of the distal radius, relative to the radial shaft, may be a causal factor of DRUJ instability, even once the traditional radiographic parameters (volar tilt, radial inclination, and ulnar variance) have been restored. Residual radial translation of the distal fragment may cause detensioning of the distal interosseous membrane (IOM) and pronator quadratus with poor apposition between the ulnar head and sigmoid notch. This may potentially lead to persistent instability of the ulnar head following internal fixation. Residual radial translation deformity is at risk of being overlooked by the wrist surgeon as there is no existing radiographic parameter that accurately measures this deformity.In this study, 100 normal wrist radiographs were reviewed by three fellowship-trained orthopedic surgeons to develop a simple and reproducible technique to measure radial translation.Utilizing the method described, the point of intersection between the ulnar cortex of the shaft of the radius and the lunate left a mean average of 45.48% (range 25–73.68%) of the lunate remaining on the radial side. In the majority of cases more of the lunate resided ulnar to this line. High levels of agreement with inter-rater (intraclass coefficients = 0.967) and intra-rater (intraclass coefficients = 0.79) reliability was observed.The results of this study can be used to define a normal standard against which residual radial translation can be measured to assess the reduction of distal radius fractures. This new parameter aids in the development of surgical techniques to correct residual radial translation deformity. In addition, awareness and correction of this potential malreduction at the time of surgery may decrease the need for other procedures on the ulnar side of the wrist to improve DRUJ stability, such as ulnar styloid fixation, TFCC repair, or ligamentous grafting [corrected].

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Semiconstrained distal radioulnar joint prosthesis.

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