Clin Orthop Surg.  2009 Sep;1(3):138-145. 10.4055/cios.2009.1.3.138.

Anatomic Reconstruction of the Distal Radioulnar Ligament for Posttraumatic Distal Radioulnar Joint Instability

• Seo KN
• Park MJ
• Kang HJ

• KMID: 999392
• DOI: http://doi.org/10.4055/cios.2009.1.3.138

Abstract

BACKGROUND
To analyze clinical outcomes after anatomical reconstruction of distal radioulnar ligaments in patients with chronic post-traumatic instability of the distal radioulnar joint. METHODS: Anatomical reconstruction was performed in 16 patients with subluxation or dynamic instability of distal radioulnar joint following trauma. Osteotomy was performed simultaneously in 10 patients with radial malunion. The average follow-up period was 18.9 months. For clinical outcome assessment, we performed the anteroposterior stress test, measured the range of motion and grip strength, and performed radiological examination. For assessment of the pain and function, we used the Patient Rated Wrist Evaluation, the Disabilities of the Arm, Shoulder and Hand, and the Modified Mayo Wrist Score. RESULTS: Anteroposterior stress test performed at the last follow-up showed normal in 12 patients, mild laxity in 3, and residual subluxation in one. The average Patient Rated Wrist Evaluation was 9.1 for pain and 11.2 for function. The average Disabilities of the Arm, Shoulder and Hand score was 10.5. The average Modified Mayo Wrist Score was 92.8; there were 10 excellent, 5 good, and 1 poor case. The average grip strength improved from 69.7 1b to 80.9 1b. A revision osteotomy was performed on the patient with residual subluxation in order to obtain normal alignment of the joint. CONCLUSIONS: Anatomical reconstruction of the distal radioulnar ligaments is recommended to restore distal radioulnar joint stability. In addition to ligament reconstruction, realignment of the distal radioulnar joint seems critical when the instability is combined with malunion of the radius.

Keyword

Distal radioulnar joint; Instability; Ligament reconstruction

MeSH Terms

Adolescent
Adult
Female
Hand Strength
Humans
Joint Instability/*surgery
Ligaments, Articular/*surgery
Male
Middle Aged
Osteotomy/methods
Pain Measurement
Radius/surgery
Range of Motion, Articular
Treatment Outcome
Ulna/surgery
Wrist Injuries/*surgery
Wrist Joint/*surgery
Young Adult

Figure

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  Fig. 1 Preoperative radiographs of a 24 year-old woman shows distal radioulnar joint subluxation associated with radial malunion (A & B). This patient was treated with osteotomy and distal radioulnar ligament reconstruction using the palmaris longus tendon (C). Radiographs obtained two years after surgery show restored alignment. Note that the bone tunnels for ligament reconstruction in the distal radius and ulnar head are visible (D & E).

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  Fig. 2 A 15 year-old boy with volar subluxation of the ulnar head following radial malunion (A) had been treated with osteotomy and distal radioulnar ligament reconstruction. Residual instability was present due to insufficient restoration of distal radioulnar joint alignment (B). Redo-osteotomy improved the alignment, resulting in subsidence of subluxation with mild laxity (C).

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