Modification of matched distal ulnar resection for distal radio-ulnar joint arthropathy: Analysis of distal instability and radio-ulnar convergence

Barret, Hugo; Lazerges, Cyril; Chammas, Pierre-Emmanuel; Degeorge, Benjamin; Coulet, Bertrand; Chammas, Michel

doi:10.1016/j.otsr.2020.07.008

Cited by 8 publications

(4 citation statements)

References 26 publications

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“…In this context the method is suitable for the rheumatoid patients, as these patients usually have lower physical demands in comparison to the non-rheumatoid patients. Several modifications of the procedure has been reported, as interposing a tendon or a flap of the extensor retinaculum into the joint, or dorsalisation of the extensor carpi ulnaris, in efforts to increase stability to the ulnar stump and achieve better results also in the non-rheumatoid patient[ 22 , 26 – 28 ]. A relatively high DASH score (31 and 35 respectively) has been reported in combination with a good patient reported outcome measure (PROM) after the Bowers procedure [ 3 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of the distal radioulnar joint with rib perichondrium – midterm follow-up

Muder

Vedung

2022

BMC Musculoskelet Disord

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Background Reconstruction of an osteoarthritic distal radioulnar joint (DRUJ) in patients with high physical demands and a long lifetime expectancy is challenging. A variety of methods like implant surgery and salvage procedures as partial or total ulnar head resection and the Sauve-Kapandji procedure are reasonable options in the elderly patient but not in young individuals since it often compromises manual power and stability and may cause impingement problems. Reconstruction of the DRUJ with rib perichondrium is a new treatment option with promising short-term outcome. The aim the present study was to investigate if the outcome is consistent over time. Methods Four female patients with a mean age of 40.5 years suffered severe unilateral osteoarthritis in the DRUJ. They underwent reconstruction of the joint with rib perichondrium transplants. Preoperatively, mean pain under manual load was 8.5 (range 7–10) and 4.2 (range 2–5) at rest, using the visual analogue scale (VAS). Range of motion (ROM) in forearm rotation was on average 118° and grip strength was 86% in comparison to the contralateral hand. The outcome was assessed at a clinical follow-up in 2016, measuring ROM, grip-strength, pain at rest and under manual load and DASH-score. Radiological examination was performed. An additional follow-up by letter was performed in 2021 using a patient-reported-outcome survey (PROS). The patients were asked to grade the ROM and grip-strength as changed or unchanged in comparison to the clinical follow-up in 2016. Results At clinical follow-up at a mean of 3.1 years (range 1–5) after surgery, pain level had decreased to VAS 1.5 (0–5) under load and all patients were pain free at rest. Forearm rotation was on average 156° (range 100–180) and grip strength was 97% of the unoperated hand. The mean DASH-score was 14.4 (0–45). An additional follow-up by letter was conducted at a mean of 7.5 years (5.5–9.5) after surgery. ROM and grip strength were reported as unchanged by all patients in relation to the previous clinical follow-up. No additional surgery or complications were reported. Conclusion Reconstruction of the osteoarthritic DRU-joint with rib perichondrium transplantation can provide good clinical outcome with perseverance over time. Level of evidence IV.

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Section: Discussionmentioning

confidence: 99%

Reconstruction of the distal radioulnar joint with rib perichondrium – midterm follow-up

Muder

Vedung

2022

BMC Musculoskelet Disord

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“…[25][26][27] Isolated or staged surgical management of concomitant RC and DRUJ arthritides may be preferred due to the challenges inherent to a single-stage surgery to address both arthritides. 25,28,29 Combined surgical procedures to treat the RC and DRUJ arthritides may require multiple incisions, greater soft tissue dissection, and prolonged tourniquet and operating time, which may increase the risk of scarring and infection. However, some studies indicate that positive outcomes can be achieved with combined surgical procedures.…”

Section: Discussionmentioning

confidence: 99%

“…25,28,29 Barret et al reported on 21 patients who underwent TWA plus a modified matched distal ulna hemiresection. 28 At a mean of 6.6 years, 67% (14 of 21) of patients were pain free and 86% (18 of 21) of patients stated they would undergo the same procedure again. A study by Grawe et al compared patients who underwent distal ulna resection with or without TWA and found that there was no statistically significant difference in outcome measures between the two groups of patients.…”

Section: Discussionmentioning

confidence: 99%

“…However, some studies indicate that positive outcomes can be achieved with combined surgical procedures. 25 28 29 Barret et al reported on 21 patients who underwent TWA plus a modified matched distal ulna hemiresection. 28 At a mean of 6.6 years, 67% (14 of 21) of patients were pain free and 86% (18 of 21) of patients stated they would undergo the same procedure again.…”

Section: Discussionmentioning

confidence: 99%

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Outcome of Preoperative Asymptomatic or Minimally Symptomatic DRUJ Arthritis after Total Wrist Arthrodesis: A Single-Institution Case Series

2022

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Background Concomitant severe radiocarpal (RC) arthritis with asymptomatic or minimally symptomatic distal radioulnar joint (DRUJ) arthritis can be debilitating for patients. Surgical management of these combined arthritides can pose a dilemma for surgeons and patients. The purpose of this study was to evaluate patients with concomitant RC and DRUJ arthritides who underwent only total wrist arthrodesis (TWA) to determine the need for subsequent surgical management of preoperative asymptomatic/minimally symptomatic DRUJ arthritis. Materials and Methods All patients who underwent TWA between 2008 and 2018 at a single institution were evaluated. Those patients who underwent TWA for degenerative, inflammatory, or posttraumatic arthritis with concomitant asymptomatic or minimally symptomatic DRUJ arthritis preoperatively were included. A retrospective review was performed for demographic variables, TWA indications, pre- versus post-TWA DRUJ symptoms, and severity of DRUJ arthritis on radiographs. Primary outcome measure was survivorship from subsequent DRUJ surgery for development of symptomatic arthritis after initial TWA. Results One hundred and eighty-three patients underwent TWA during the study period, of which 39 wrists met inclusion criteria. Indications for TWA included posttraumatic arthritis (n = 22), avascular necrosis of the lunate (n = 10), and inflammatory arthritis (n = 7). The mean clinical follow-up was 5.7 years (range: 1.5–12.7 years). Four patients (10%) who underwent TWA ultimately required a subsequent procedure to address DRUJ arthritis at a mean time of 20 months (range: 3–60 months) after initial TWA. The initial indication for TWA in these patients included symptomatic posttraumatic arthritis (n = 3) and lunate avascular necrosis (n = 1). Conclusion In patients with symptomatic RC and asymptomatic or minimally symptomatic DRUJ arthritides undergoing TWA alone, 10% in this series required subsequent surgical management for progressive DRUJ arthritis. Clinical Relevance Surgical management of concomitant symptomatic RC and asymptomatic/minimally symptomatic DRUJ arthritides with TWA alone is a reasonable initial approach. Patients should be counseled preoperatively that subsequent surgical management of progressive DRUJ arthritis may be necessary in ∼10% of patients.

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Distal Radioulnar Joint: Resection Arthroplasty or Prosthetic Arthroplasty

Fox

Groarke²

2022

Controversies in Orthopedic Surgery of the Upper Limb

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Modification of matched distal ulnar resection for distal radio-ulnar joint arthropathy: Analysis of distal instability and radio-ulnar convergence

Cited by 8 publications

References 26 publications

Reconstruction of the distal radioulnar joint with rib perichondrium – midterm follow-up

Reconstruction of the distal radioulnar joint with rib perichondrium – midterm follow-up

Outcome of Preoperative Asymptomatic or Minimally Symptomatic DRUJ Arthritis after Total Wrist Arthrodesis: A Single-Institution Case Series

Distal Radioulnar Joint: Resection Arthroplasty or Prosthetic Arthroplasty

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