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.
Cultures were acquired from 125 cases of flap reconstruction. Specimens were collected from the wound beds at the time of wound closure. Fifty-one cases (41%) had negative cultures and 74 (59%) had positive cultures. The positive culture patients had a higher complication rate than the negative culture patients (49% vs. 7.8%, p <.004). Patients with positive cultures coincidentally receiving effective antibiotics relative to their wound cultures had a complication rate statistically comparable to negative culture patients. These findings suggest that wound bed cultures could be incorporated into operative sequence strategies, wound management outcome assessments, and surveillance analyses that could provide guidelines for perioperative antibiotics administration.
It is not uncommon for longitudinal forearm instability to be recognized quite late after the injury. Frequently, this injury is not appreciated until there have already been changes at both the wrist (ulnar carpal abutment) and the elbow (radiocapitellar abutment). These late cases frequently require an ulnar shortening osteotomy, as well as radial head prosthesis and/or reconstruction of the interosseous ligament. If continued problems result and there are degenerative changes or chronic pain at the radial capitellar joint, a radiocapitellar prosthesis can be considered. The fi nal treatment for some patients may require creation of a one-bone forearm. This prevents any further longitudinal instability of the forearm; however, it obviously results in loss of forearm rotation. These injuries are best treated early and aggressively, as later reconstructive options will usually result in decreased function of the extremity. This chapter goes through the different reconstructive options that are available to the reoperative surgeon.
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