Distal Radioulnar Joint Arthritis / 대한정형외과학회잡지

The distal radioulnar joint (DRUJ) is a complex structure that enables sufficient, painless forearm rotation and provides weight-bearing capabilities of the upper extremity. Arthritis of DRUJ is multifactorial; the most common causes are trauma, congenital anomalies, as well as degenerative and inflammatory diseases. Congenital etiologies, as well as degenerative and inflammatory causes of arthritis are more common in women. Conventionally, initial management of symptomatic DRUJ arthritis is nonsurgical; surgery is generally reserved for patients with refractory pain. Moreover, advanced arthritis arising from trauma can be prevented by early interventions in the form of corrective osteotomy for malunited distal radius and distal ulna fractures, repair/reconstruction of the triangular fibrocartilage complex, and ulnar shortening osteotomy. Although the outcomes are typically positive following excision of the distal ulna in definitive arthritis, postoperative complications, such as instability and impingement of the residual distal ulna stump, can be serious. Procedures managing unstable residual ulna include soft tissue stabilization techniques and DRUJ implant arthroplasty.

Outcomes of the Sauve-Kapandji Procedure in Patients with Advanced Rheumatoid Arthritis

PURPOSE: We evaluated the clinical and radiographic outcomes of the Sauve-Kapandji procedure for the treatment of advanced rheumatoid arthritis. METHODS: Twenty-severn wrists in twenty-two patients were treated for advanced rheumatoid arthritis with Sauve-Kapandji procedure. Patients were evaluated in terms of wrist pain, bony union, instability of the ulnar proximal stump, ulnar stump pain, range of motion and other complications. Pain was evaluated using a visual analog scale. Radiographic evaluation included calculation of the carpal translation index to assess the extent of ulnar translation of the carpus. RESULTS: The average visual analogue scale score improved from 4+/-1.85 preoperatively to 0.78+/-0.91 at the last follow-up (p=0.003). Bone unions in distal radioulnar joint were obtained in all 22 patients, 27 wrists at mean 10.74 weeks (range, 6-28 weeks) after operation. The supination/pronation range of motion was changed from 55/50 degrees preoperatively to 79/73 degrees at postoperative 6 months follow up (p=0.32). The mean carpal translation index did not change after the operation. CONCLUSION: The Sauve-Kapandji procedure is a reliable methods of relieving pain, preserving range of motion (supination/pronation) and preventing ulnar translation of the carpus in managements of the severely destroyed distal radioulnar joints in rhematoid arthritis.

Factors Affecting the Occurrence of Distal Radioulnar Joint Arthritis after Ulnar Shortening Osteotomy

PURPOSE: Ulnar shortening osteotmy is a common operation for the treatment of ulnar impaction syndrome. The purpose of this study was to evaluate factors that may affect the occurrence of distal radioulnar joint (DRUJ) arthritis after ulnar shortening osteotomy. METHODS: From September 2005 to August 2012, we performed 81 ulnar shortening osteotomies for ulnar impaction syndrome, and evaluated occurrence or deterioration of DRUJ arthritis in 58 patients with a minimum follow-up of 1 year. We analyzed potential factors that may affect the occurrence of DRUJ arthritis, such as, age, sex, hand dominance, pre- and postoperative ulnar variance, preexisting DRUJ arthritis, types of radial sigmoid notch, amount of ulnar shortening, and follow up period. RESULTS: DRUJ arthritis occurred or deteriorated in 32 out of the 58 patients. Regression analysis indicated a significant correlation between the type of radial sigmoid notch (type 1) and DRUJ arthritis. Other factors were not found to be correlated with occurrence or deterioration of DRUJ arthritis. CONCLUSION: This study suggests that patients with type 1 radial sigmoid notch (ulnar inclination of more than 10 degrees) are more likely to develop DRUJ arthritis after ulnar shortening osteotomy.