[Stabilization of the Distal Radioulnar Joint According to Adams: Clinical, and Radiological Results]. / Stabilisierung des distalen Radioulnargelenkes nach Adams: Klinische und radiologische Ergebnisse.

BACKGROUND: Stabilization of the distal radioulnar joint (DRUJ) with reconstruction of distal radioulnar ligaments as outlined by Adams is indicated if a refixation of the triangular fibrocartilage complex (TFCC) is no longer possible. There is little information given on the results of these procedures in literature. PURPOSE: The purpose of this retrospective study was to analyze with use of objective and subjective criteria, whether the reconstruction of the radioulnar ligaments according to Adams allows a sufficient re-stabilization of the DRUJ. PATIENTS AND METHODS: 14 patients (9 female, 5 male) with a mean age of 29 (24-62) years underwent an Adams' procedure between 2004 to 2011. After an average follow up of 67 (26-110) months 11 patients could be examined retrospectively regarding functional results and subjective self assessment. As objective parameters assessment of distal radioulnar joint stability, range of forearm rotation and grip strength were measured. Krimmer- and Mayo Wrist Score were evaluated. Subjective parameters as DASH-score, patient's self assessment and pain (verbal and visual analogue scale) were recorded. RESULTS: In 5 patients the DRUJ was stable, in 2 it was lax. According the 4 patients with ongoing instability, one patient reported on improvement, 2 on unchanged instability and one an impaired sensation of instability. In 2 patients clicking during forearm rotation could be provoked. 2 patients suffered from restricted forearm rotation with loss of range of motion of 60 and 70° respectively. Pronation-supination averaged 89% of the opposite side and 99% compared to preoperative. Grip strength averaged 69% of the opposite side. Krimmer-Score was 74, Mayo Wrist-Score 73, and DASH-Score 24 points. Pain at rest on visual analogue scale (0-10) was 3 and 5 with activity. 6 patients had improved, 2 declined and 3 unchanged pain. Patient´s satisfaction rated 0-10 was 8. Eight would undergo again same operation procedure. CONCLUSION: The clinical findings show, that reconstruction of distal radioulnar ligaments according to Adams in patients with DRUJ instability and no repairable parts of TFCC, do not allow to re-stabilize the DRUJ in all patients. There is a need for further investigations trying to re-stabilize the DRUJ.

[Reconstruction of the Distal Radioulnar Ligaments According to Adams: Surgical Technique - A Video]. / Rekonstruktion der distalen radioulnaren Bänder nach Adams: Operationstechnik - ein Video.

This paper describes the surgical technique to reconstruct the distal radioulnar ligaments using the palmaris longus tendon as inaugurated by Brian Adams. A video can be approach online.

[Brachioradialis rerouting for restoration of forearm supination or pronation]. / Rerouting des Musculus brachioradialis zur Verbesserung der Unterarmsupination oder -pronation.

OBJECTIVE: Improvement of active forearm supination or pronation. Reduction of paralytic pronation or supination posture. INDICATIONS: Disability or impairment of active supination or pronation due to cerebral palsy, obstetric palsy or traumatic brachial plexus palsy, quadriplegia or paralysis from other causes. CONTRAINDICATIONS: Inadequate passive range of motion of forearm supination or pronation. Insufficient power of brachioradialis muscle < M4. Insufficient rehabilitation after conservative treatment or neurosurgical intervention with possible improvement of supination or pronation. Lack of patient's cooperation and compliance. SURGICAL TECHNIQUE: Exposure and mobilisation of brachioradialis muscle. Division of brachioradialis tendon distally with Z-plasty. Passing distal tendon through the interosseus space in dorsal to palmar direction for restoration of supination respectively in palmar to dorsal direction for restoration of pronation. Suturing both tendon ends. POSTOPERATIVE MANAGEMENT: Management includes an above elbow cast with the elbow in 70° flexion for 4 weeks. Then active physiotherapy to learn new brachioradialis muscle function for supination or pronation over 1-1.5 years. If needed dynamic orthesis. RESULTS: Özkan et al. performed brachioradialis rerouting to restore supination in 5 children between 4 and 14 years with pronation deformity and to restore pronation in 4 children aged 5-9 years with supination deformity. Mean active gain for supination was 81° (40-140°). Active pronation improved from 28 to 49° (30-75°; Özkan et al., J Hand Surg Br 29:263-268, 2004; Özkan et al., J Hand Surg Am 29:22-27, 2004). Between April 2006 and January 2011 we used this technique in 4 patients aged 7-26 years (mean 14 years). Three patients could be followed up. One patient had preoperative a fixed pronation deformity of the forearm in 80° pronation. In this case active range of motion could be improved to 80/30/0° pronation/supination. One patient improved from preoperative 0/0/90° pronation/supination to 30/0/90° postoperatively. In one case no functional improvement of forearm rotation could be achieved in long-term follow-up. No functional loss in forearm rotation to the opposite direction or of the elbow function was observed. Mean follow-up time was 51 months (21-77 months).