Stabilization for acute distal radioulnar instability: A novel surgical technique

• Published in: Injury 2021-07, Vol.52, p.S137-S144
• Main Authors: Pajares, Samuel, Martínez-Catalán, Natalia, Novo-Rivas, Ulrike
• Format: Article
• Language: English
• Subjects: Distal radioulnar joint; Stabilization; TFCC; Triangular fibrocartilage complex
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2021.02.043

•Instability of the distal radioulnar joint typically presents as a chronic problem rather than being diagnosed acutely after an injury.•Regardless of the treatment performed most authors recommend immobilization of the wrist and elbow for at least 4 to 8 weeks.•This period of immobilization may compromise the patient's recovery after radius surgery and limit the radioulnar range of motion.•An extra-articular system construct using FiberWire and two anchors would restore DRUJ stability by restricting the direction of rotation where the instability occurs and stabilizing dorsopalmar translation movement and joint opening.•Dynamic stabilization of DRUJ could enable proper healing of the TFCC with mobilization of the wrist. 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 i