Stabilization for acute distal radioulnar instability: A novel surgical technique

Pajares, S.; Martínez-Catalán, Natalia; Novo‐Rivas, Ulrike

doi:10.1016/j.injury.2021.02.043

Cited by 1 publication

(5 citation statements)

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“…Our technique also offers the theoretical advantage of being a potentially minimally invasive, extra-articular technique capable of stabilizing both volar and dorsal DRUJ instability if used in the clinical setting, unlike other described SBS techniques. 12,17 It also obviates the need for a tendon graft 25 or prolonged immobilization 26 required for other techniques.…”

Section: Discussionmentioning

confidence: 99%

“…In theory, an SBS technique that would provide sufficient stability to allow an immediate range of motion (compared with any current treatment options) and obviate the risk of pin site infection and need for a secondary procedure for pin removal (compared with external K-wire) would improve the current treatment paradigm. However, concerns over device cost, 27 stress shielding, 28 and potential complications such as stiffness, recurrent instability, infection, 29 implant failure, 12,30 or iatrogenic fracture 31 represent potential limitations of our technique because these have been reported in other SBS constructs used in the upper extremity.…”

Section: Discussionmentioning

confidence: 99%

“…10 Historically, treatment options for acute DRUJ instability have included casting, radioulnar pinning, and TFCC repair. 11,12 Although each of these methods can be successful in stabilizing the DRUJ, they may require the wrist to be immobilized for a prolonged period, occasionally resulting in wrist stiffness. Additional complications include pin site infection and the need for secondary implant removal.…”

mentioning

confidence: 99%

“…11 Recently, suture-based stabilization (SBS) strategies have emerged to augment ligamentous repairs and facilitate faster rehabilitation in the hand and wrist 13,14 with biomechanical 13,[15][16][17] and clinical success. 12,18,19 Pajares et al recently published promising clinical results utilizing a suture tape and anchor construct for unilateral acute DRUJ instability. 12 However, complications such as stiffness, recurrent instability, and implant failure were reported.…”

mentioning

confidence: 99%

“…12,18,19 Pajares et al recently published promising clinical results utilizing a suture tape and anchor construct for unilateral acute DRUJ instability. 12 However, complications such as stiffness, recurrent instability, and implant failure were reported. Therefore, the purpose of this study is to quantify the range of motion and biomechanical stability provided by a novel SBS technique utilizing a suture button construct for multidirectional instability and compare it to uninjured specimens to serve as a foundation for clinical application.…”

mentioning

confidence: 99%

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Suture-Based Distal Radioulnar Joint Stabilization: A Biomechanical Evaluation in a Cadaveric Model

Graf,

Ahmed,

Thompson

et al. 2024

J Wrist Surg

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Purpose Management of acute distal radioulnar joint (DRUJ) instability is complex and controversial. Common treatment options include prolonged immobilization, stabilization with wires, and acute triangular fibrocartilage complex repair. However, none of these permits an early range of motion. The purpose of this study is to investigate the feasibility of a suture-based stabilization (SBS) technique for acute DRUJ instability to permit early active motion. Methods A biomechanical study utilizing eight cadaveric arms was performed. All specimens were tested in the intact state prior to the creation of bidirectional DRUJ instability. For the SBS group, 2-mm suture tapes with suture button fixation were utilized to recreate the respective contributions of distal oblique bundle and volar and dorsal radioulnar ligaments to DRUJ stability. All specimens were cyclically loaded with a simulated ballottement stress of 20N in forearm positions of neutral, 60 degrees of pronation and 60 degrees of supination. Range of motion and total translation were measured and then compared between the two groups. Results The average range of motion in the intact and SBS specimens was 174 and 175 degrees, respectively. There were no significant differences in displacement between the intact and SBS group in neutral and in supination. However, the SBS group had less translation than the intact group in pronation. Conclusions For acute DRUJ instability, the described SBS technique provides similar stability to the native intact DRUJ without compromising the range of motion in a cadaveric model. Future comparative studies are warranted prior to translation into the clinical arena. Clinical Relevance This is a biomechanical study investigating a treatment technique for acute DRUJ instability that would allow an early range of motion.

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Section: Discussionmentioning

confidence: 99%