Extensor carpi ulnaris and flexor carpi ulnaris tenodesis of the unstable distal ulna

Breen, Thomas F.; Jupiter, Jesse B.

doi:10.1016/0363-5023(89)90176-7

Cited by 184 publications

(86 citation statements)

References 13 publications

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“…The most common techniques are the pronator quadratus-interposition flap (Johnson procedure) 20 and the extensor carpi ulnaris (ECU)-flexor carpi ulnaris (FCU) tenodesis (Breen-Jupiter tenodesis). [21][22][23] Biomechanical studies, however, show that these procedures do not provide adequate stabilization of the distal ulna. 24 Ulnar head prostheses have also been developed to restore the integrity of the DRUJ, which has been shown experimentally 6 and clinically.…”

mentioning

confidence: 99%

Ulnar Head Replacement and Related Biomechanics

Sauerbier¹,

Arsalan-Werner

Enderle³

et al. 2013

Jnl Wrist Surg

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Up to 30% of patients after distal radius fractures suffer from ulnar-sided wrist pain. 1 This is manifested in the form of wrist pain, restricted movement, weakness, and instability, even after correct reduction of the fracture and bony union. The integrity of the distal radioulnar joint (DRUJ) is necessary for stability and load transfer from the forearm to the wrist. [2][3][4] Osteoarthritis of the DRUJ may occur after trauma due to a bony deformity, a ligamentous injury, or combination of both. 1,5,16 In the surgical treatment of osteoarthritis, "salvage operations" are often necessary, in which the ulnar head is resected partially or completely. 7-10 Numerous clinical studies have demonstrated a reduction of painful clinical symptoms for all these techniques. 11-14 Biomechanically, even a partial resection of the distal ulna destabilizes the wrist, and clinically, it may lead to instability of the distal ulnar stump and the radius. 15,16 Distal radioulnar impingement occurs because the distal support of the radius for rotation and the "cam effect" of the distal ulna have been ablated. As a result, instability of the DRUJ may again lead to restriction of motion and strength as well as to increased pain. [17][18][19] To reduce DRUJ instability, various "soft tissue stabilization operations" have been developed. The most common techniques are the pronator quadratus-interposition flap (Johnson procedure) 20 and the extensor carpi ulnaris (ECU)-flexor carpi ulnaris (FCU) tenodesis (Breen-Jupiter tenodesis). [21][22][23] Biomechanical studies, however, show that these procedures do not provide adequate stabilization of the distal ulna. 24 Ulnar head prostheses have also been developed to restore the integrity of the DRUJ, which has been shown experimentally 6 and clinically. [25][26][27][28] Keywords ► distal radioulnar joint (DRUJ) ► osteoarthritis ► arthroplasty ► ulnar head resection ► ulnar head prosthesis AbstractA stable distal radioulnar joint (DRUJ) is mandatory for the function and load transmission in the wrist and forearm. Resectional salvage procedures such as the Darrach procedure, Bowers arthroplasty, and Sauvé-Kapandji procedure include the potential risk of radioulnar instability and impingement, which can lead to pain and weakness. Soft tissue stabilizing techniques have only limited success rates in solving these problems. In an attempt to stabilize the distal forearm mechanically following ulnar head resection, various endoprostheses have been developed to replace the ulnar head. The prostheses can be used for secondary treatment of failed ulnar head resection, but they can also achieve good results in the primary treatment of osteoarthritis of the DRUJ. Our experience consists of twenty-five patients (follow-up 30 months) with DRUJ osteoarthritis who were treated with an ulnar head prosthesis, with improvement in pain, range of motion, and grip strength. An ulnar head prosthesis should be considered as a treatment option for a painful DRUJ.

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mentioning

confidence: 99%

Ulnar Head Replacement and Related Biomechanics

Sauerbier¹,

Arsalan-Werner

Enderle³

et al. 2013

Jnl Wrist Surg

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“…Tenodesis using weaves of a proximally-based strip of extensor carpi ulnaris (ECU) and a distally-based strip of flexor carpi ulnaris (FCU) tendon can successfully stabilize a symptomatically unstable ulna (78) and is thought to be superior than using either ECU or FCU alone (79,80). The use of Achilles tendon allograft as an interposition graft has also shown success in a small series (81)(82)(83)(84).…”

Section: Complications and Management: Arthroplastymentioning

confidence: 99%

“…This is especially the case in patients with RA who have a high incidence of progressing to DRUJ arthritis following TWA, and those with significant radiocarpal disease that has resulted in positive ulnar variance, as preparation of the distal radius for TWA will only worsen the variance (3,4,106). The incidence of symptomatic ulnar stump instability is much lower in patients with TWA than those with isolated resection arthroplasties, but if needed soft tissue interposition and ECU/FCU tenodesis can be performed (78)(79)(80). Finally, the simultaneous use of DRUJ and total wrist implants have been performed sparingly with little data at this time, but there is concern for metal on metal wear that may develop between the two implants.…”

Section: Complications and Management: Arthroplastymentioning

confidence: 99%

Management of Complications of Wrist Arthroplasty and Wrist Fusion

2015

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“…Ligamentous injuries can be repaired by either extra-articular or intra-acricular approaches. The extra-articular approach is technicnically an easier surgery and is achieved by a direct radioulnar tether (Fulkerson and Watson 1978) or an indirect radioulnar link (with the use of a ulnocarpal sling or tenodesis) (Breen and Jupiter 1989). An intra-articular repair, though a more demanding procedure, can reconstitute the original ligamentous anatomy and can yield very satisfactory results (Scheker, Belliappa et al 1994).…”

Section: Osteoarthritis Of the Distal Radioulnar Jointmentioning

confidence: 99%