Surgical treatment of posttraumatic distal radioulnar joint instability

Abstract

Introduction. The distal radioulnar joint (DRUJ) is unique as it is not a joint but a continuation of the forearm joint. The incidence of DRUJ instability after a distal radius fracture is reported to be between 10% - 40%. DRUJ instability is an increasingly recognized clinical problem. Most patients experience no symptoms but in some people it can lead to disabling symptoms such as pain and impaired function. There has been an increasing trend to intervene surgically to treat DRUJ instability but with variable result. Aim of the study. To evaluate the intermediate term results (follow up of five years) posttraumatic DRUJ instability according to data from medical records, surgically method used in DRUJ instability, follow-up by Mayo wrist score, Disabilities of the Arm, Shoulder and Hand questionnaire (DASH score). Materials and methods. We have performed a study of patients with DRUJ instability that consecutively was treat in department of Hand Pathology with the application of microsurgical techniques (6 Section) of Traumatology and Orthopedics Clinical Hospital, Chisinau in the period 2013 - 2017. Outcomes was determined by using DASH and Mayo wrist scores. All results were present as mean ± standard deviation (±SD). Results. We found 28 patients with posttraumatic DRUJ instability. The report between sex was 18:10 with predomination of female gender. Exist 3 types of surgically methods: direct, indirect and reconstruction of ligaments of DRUJ. At 26 patients was applied direct surgically procedure from them extrinsic interventions: were 4 – Darrach procedure; correction osteotomies of ulna – 9; correction osteotomies of posttraumatic malunion of distal radius – 12; and one intrinsic procedure Sauve-Kapandji. Stabilization by reconstruction of ligaments of DRUJ instability were treated 2 patients. DASH and Mayo wrist scores showed poor results at patients after Darrach procedure with a mean of 55±2 and 60±1, satisfactory result at Sauve-Kapandji procedure 75 and 80, relatively good results at correction osteotomies of posttraumatic malunion of distal radius 70±2 and 75±1 and excellent result were obtain just at younger patients (6 cases) to which were applied surgically procedure of correction osteotomies of ulna 88±2 and 90±1, in rest was poor result 50±5 and 60±2. Conclusions. Diagnostics of the DRUJ Instability was problematic early in Republic of Moldova. It is necessary to make a study to improve the imaging quality diagnoses of soft tissue pathology, especially for peripheral TFCC tears and TFCC detachment from the fovea for establishing the correct diagnosis and apply an ample reconstruction.