Ulnotriquetral augmentation tenodesis: A reconstructive procedure for dorsal subluxation of the distal radioulnar joint

doi:10.1016/S0363-5023(82)80171-8

The Journal of Hand Surgery

Volume 7, Issue 3, May 1982, Pages 230-236

https://doi.org/10.1016/S0363-5023(82)80171-8 Get rights and content

Isolated posttraumatic dorsal subluxation of the distal ulna was surgically treated in eight patients by reduction of the subluxation and by a tenodesing procedure that used a tendon slip of flexor carpi ulnaris. The repair also imbricated the dorsal radioulnar ligament upon itself, and the forearm was secured in supination by a Kirschner wire. All patients had improved stability of the distal radioulnar joint; five had complete and three had satisfactory relief of pain. Slight residual joint laxity was noted in three patients and mild residual limitation of pronation in all, although the patients did not consider the limitation to be functionally important. All patients returned to improved functional activity.

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Cited by (129)

Stabilization for acute distal radioulnar instability: A novel surgical technique
2021, Injury
Instability of the distal radioulnar joint (DRUJ) commonly results from traumatic disruption of the distal radioulnar ligaments of the triangular fibrocartilage complex (TFCC). Treatment of this rupture typically requires immobilization of the wrist and elbow for a period of 6 to 8 weeks. This study evaluated the hypothesis that treatment of DRUJ instability with dynamic stabilization would allow early mobilization of both the radiocarpal and distal radioulnar joints by the first postoperative week without compromising restoration of TFCC integrity.
Between September 2017 and January 2019, a retrospective study was conducted on 22 patients presenting with DRUJ instability confirmed by intraoperative Ballottement testing. Once instability was confirmed, dynamic surgical stabilization was performed, followed by one week of short cast immobilization. Arthrographic computed tomography (CT) of each patients’ affected wrist was performed 4 months later to evaluate TFCC integrity. The recovery of patients was monitored at 1, 3, 6, and 12 months after surgery using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, Ballottement test, and evaluation of radioulnar join range of motion (ROM), pain, and complications.
All patients were followed postoperatively for a mean of 13.5 months. After 1 month, all patients exhibited satisfactory range of motion and DRUJ stability. By 3 months, Ballottement tests were negative in 21 of 22 patients, with instability persisting in only 1 patient. At 4 months, CT arthrography contrast leakage (indicative of a TFCC tear) was observed in 5 of 20 patients. Upon reexamination a mean of 10.5 months later, the TFCC tears of these patients had healed in 2 cases (with foveal tears), while no difference in contrast leakage was observed for the other 3 cases (with horizontal or central tears). Revision surgery for implant related complications was performed in 2 cases.
Acute DRUJ instability treated with dynamic stabilization led to satisfactory clinical outcomes in terms of range of motion, pain relief and joint stability, allowing DRUJ movement from the first postoperative week. This technique represents a simple, reproducible and minimally invasive procedure with a low rate of implant related complications.
Distal Radius Fracture and the Distal Radioulnar Joint
2021, Hand Clinics
Chronic DRUJ Instability After Distal Radius Fractures
2021, Distal Radius Fractures: Evidence-Based Management
TFCC injuries are frequently associated with distal radius fractures. Peripheral tears of the triangular fibrocartilage complex (TFCC) can cause pain and distal radioulnar joint (DRUJ) instability if the proximal component formed by the radioulnar ligaments is affected.
In chronic nonrepairable TFCC tears with clinical DRUJ instability in which the articular cartilage is in good condition, ligament reconstruction with tendon graft is the treatment of choice, either by open or arthroscopy-assisted surgery.
Wrist arthroscopy is the most reliable method for diagnosis and decision-making in this type of injury, and also enables treatment by ligament reconstruction.
The open ligament reconstruction described by Adams remains a valid and reproducible technique for the treatment of chronic DRUJ instability but the improvement of the arthroscopic techniques allows to perform arthroscopically assisted procedures or all-arthroscopic reconstructions with good results and less soft tissue impairment.
Chronic Distal Radioulnar Joint Instability
2020, Hand Clinics
Acute Distal Radioulnar Joint Instability: Evaluation and Treatment
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The ulnar side of the wrist: Clinically relevant anatomy and biomechanics
2016, Journal of Hand Therapy
In the hectic environment of a hand therapy clinic, the opportunity to carefully consider the relationships among pathology, pathomechanics, surgical repair techniques, tissue healing, postoperative management, and rehabilitation program development and progression is limited. Clinicians often default to seeking a protocol, a recipe to follow.
Using the ulnar side of the wrist as an example, relevant anatomy and biomechanics are directly related to several commonly seen pathologies, including fractures, ligament injuries, and instability.
Armed with knowledge of anatomy, biomechanics, and surgical procedures, the need for a protocol disappears. Each patient can be individually managed according to his or her unique set of variables and responses to injury, repair, healing, and recovery of function.

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Ulnotriquetral augmentation tenodesis: A reconstructive procedure for dorsal subluxation of the distal radioulnar joint

Am J Surg

J Hand Surg

Traumatic dislocation of the distal radio-ulnar joint

Clin Orthop

Fractures and dislocations: Immediate management, after-care, and convalescent treatment with special reference to the conservation and restoration of function

Laxity of the radio-ulnar joint following Colles' fracture

Arch Surg

Fractures and dislocations of the wrist

Anterior dislocation of the ulna at the inferior radio-ulnar joint: Case reports, with a discussion of the anatomy of rotation of the forearm

J Bone Joint Surg [Br]

Isolated traumatic dislocation of the distal end of the ulna or distal radioulnar joint

J Bone Joint Surg [Am]

Subluxation of the distal radio-ulnar joint by hyperpronation

J Bone Joint Surg [Am]

Dislocation of the distal radioulnar joint: Anatomy and clues to prompt diagnosis

Clin Orthop

Surgery of the hand

An operation for recurrent inferior radioulnar dislocation

Ann Surg

Uncomplicated dislocation of the inferior radioulnar joint

J Bone Joint Surg

The use of fascial and tendon grafts in certain fractures and dislocations

Ann Surg