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19.03.2020 | Handsurgery

Distal radioulnar joint instability: current concepts of treatment

Archives of Orthopaedic and Trauma Surgery
Christian K. Spies, Martin Langer, Lars P. Müller, Johannes Oppermann, Frank Unglaub
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00402-020-03371-0) contains supplementary material, which is available to authorized users.

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Distal radioulnar joint (DRUJ) instability is often an underestimated or missed lesion which may entail fatal consequences. The triangular fibrocartilage complex is a biomechanically very important stabilizer of the DRUJ and guarantees unrestricted range of motion of the forearm. To detect DRUJ instability a systematic examination is of uppermost importance. The contralateral healthy arm will be used for comparison during clinical examination. X-rays are required to exclude osseous lesions or deformities. Computed tomography of both wrists in neutral forearm rotation, supination, and pronation may be necessary to verify DRUJ instability in ambiguous situations. Following a systematic clinical examination wrist and DRUJ arthroscopy detects lesions definitely. Tears of the distal radioulnar ligaments which entail DRUJ instability should be repaired preferably anatomically. Ulnar-sided ligament ruptures which cause instability are detected more often than radial-sided ones. Osseous ligament avulsions are mostly refixated osteosynthetically. Ligamentous tears of the distal radioulnar ligaments may be reconstructed using anchor suture or transosseous refixation. Secondary procedures such as tendon transplants are necessary for anatomical reconstruction in cases of unrepairable ligament tears.

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Supplementary file1 video 1 DRUJ arthroscopy identifies the intact deep fibers of the radioulnar ligaments; copyright Springer (MP4 4675 kb)
Supplementary file2 video 2 multi-directional DRUJ instability; copyright Springer (MP4 2664 kb)
Supplementary file3 video 3 wrist arthroscopy facilitating the 3/4 portal, hook introduced via 6R portal: trampoline test enables examination of the articular disc; video shows an insufficient resilience = negative trampoline test and a positive hook test hint at a tear of the deep radioulnar ligaments: TFCC Lesion Palmer 1b/Atzei 3; copyright Springer (MP4 20233 kb)
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