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.
