scholarly journals Surgical Reconstruction Methods following Radical Excision of Distal Ulna Osteosarcoma in Both Skeletally Mature and Immature Patients

2020 ◽  
Vol 13 (2) ◽  
pp. 558-568 ◽  
Author(s):  
Samer Abdel Al ◽  
Ahmad M. Shehadeh ◽  
Mohamad K. Abou Chaar ◽  
Wafa Asha ◽  
Nijmeh Alsaadi ◽  
...  
Keyword(s):  
Hand Function ◽  
Distal Radioulnar Joint ◽  
Surgical Reconstruction ◽  
Radical Excision ◽  
Distal Ulna ◽  
Unusual Site ◽  
Rare Type ◽  
Radioulnar Joint ◽  
Reconstruction Methods ◽  
Mature Patient

The distal ulna has always been considered to be expendable and its removal has been advocated for a variety of post-traumatic degenerative and oncological conditions but recent studies showed that the distal radioulnar joint allows supination and protonation of the forearm and is important to one’s grip strength and lifting ability. Several prosthesis models have already been made to replace the mechanical functionality of the distal radioulnar joint. We present two cases of females aged 22 and 12 years, respectively, who presented with wrist pain and swelling without any history of trauma and with terminal degree limitation in wrist movements due to tenderness and swelling. Both of them did not have any distant metastasis upon radiographic staging. The skeletally mature patient underwent radical excision of the distal ulnar osteosarcoma and received a distal radioulnar joint replacement prosthesis (Scheker prosthesis). The other skeletally immature patient underwent radical excision of the involved distal ulnar osteosarcoma with stabilization of the residual ulnar stump using the extensor carpi ulnaris sling in a modified version of the Goldner and Hayes technique. Both of our patients were treated according to the protocols of our multidisciplinary clinic sarcoma team by starting with neoadjuvant chemotherapy, followed by surgery and adjuvant chemotherapy. Both registered an almost complete restoration of the normal wrist and hand function and were in complete remission for 26 and 24 months, respectively. Based on our literature review, these are some of the extremely rare cases in which the osteosarcoma affected an unusual site (the distal ulna where they underwent a rare type of reconstruction status following radical excision of a malignant tumor).

Distal Radioulnar Joint Osteoarthritis: An Update on Treatment Options

2021 ◽  
Author(s):  
Brian M. Katt ◽  
Amr Tawfik ◽  
Nicholas Zingas ◽  
Francis Sirch ◽  
Pedro K. Beredjiklian ◽  
...  
Keyword(s):  
Septic Arthritis ◽  
Distal Radius ◽  
Joint Instability ◽  
Conservative Therapy ◽  
Treatment Options ◽  
Distal Radioulnar Joint ◽  
Surgical Approaches ◽  
Distal Ulna ◽  
Load Bearing ◽  
Radioulnar Joint

AbstractThe distal radioulnar joint (DRUJ), the articulation between the sigmoid notch of the radius and the distal ulna, plays a pivotal role in stability and load bearing and allows for pronation and supination of the forearm. Osteoarthritis (OA) of the DRUJ commonly occurs due to distal radius trauma but may also be the result of conditions such as joint instability, septic arthritis, or primary OA. It is initially managed with conservative therapy, but surgery is often considered when nonoperative methods fail. The surgical approaches available to treat this pathology have grown over the years. The procedures have generally favorable outcomes, each with their own unique complications and considerations. This paper comprises a review of the outcomes and complications for the different procedures commonly used to surgically treat DRUJ OA.

scholarly journals Isolated Distal Ulna Fracture With Distal Radioulnar Joint Dislocation: A Novel Fracture Pattern

Hand ◽  
2019 ◽  
Vol 15 (4) ◽  
pp. NP57-NP62
Author(s):  
Matthew Ciminero ◽  
Nick Yohe ◽  
Garret Garofolo-Gonzalez ◽  
Jack Choueka
Keyword(s):  
Kirschner Wire ◽  
Distal Radioulnar Joint ◽  
Fracture Pattern ◽  
Radius Fracture ◽  
Distal Ulna ◽  
Radioulnar Joint ◽  
Ulna Fracture ◽  
Kirschner Wire Fixation ◽  
Treatment Plans ◽  
Equivalent Strength

Background: Galeazzi fractures composed of a middle to distal third radius fracture with dislocation and/or instability at the distal radioulnar joint (DRUJ) have been well described for decades. However, the inverse scenario has seldom if ever been described in the literature. Methods: We explore the case of a 25-year-old active patient who experienced a traumatic distal ulna fracture with dislocation of the DRUJ without a distal radius fracture. Results: It was successfully treated with open reduction and Kirschner wire fixation. The patient regained equivalent strength and range of motion compared with the contralateral uninjured extremity. Conclusion: We feel this patient’s successful postoperative course can guide future treatment plans for orthopedic surgeons who encounter similar fractures.

scholarly journals A Misdiagnosis of Traumatic Hypersupination of the Distal Radioulnar Joint: A Case Report

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Vipin Asopa ◽  
Robert J. Douglas ◽  
Andrew D. Saies ◽  
James S. Church
Keyword(s):  
Case Report ◽  
Anatomical Variation ◽  
Distal Radioulnar Joint ◽  
Review Of The Literature ◽  
Ulnar Styloid ◽  
Distal Ulna ◽  
Radiological Investigation ◽  
Rare Injury ◽  
Radioulnar Joint ◽  
Triangular Fibrocartilage

Traumatic hypersupination injury of the distal radioulnar joint is a rare injury, and occurs when sufficient supination force is applied to the joint so as to tear the volar radioulnar ligament, resulting in separation of the triangular fibrocartilage complex, and subluxation of the tendon of extensor carpi ulnaris. This allows the distal ulna to rotate such that the ulnar styloid comes to lie adjacent to the ulna notch of the radius. Treatment of this injury requires manipulation of the joint, under anaesthesia or sedation. We describe a case where posttraumatic radiological investigation of a patient with an anatomical variation of the wrist when in supination resembled a traumatic hypersupination injury of the distal radioulnar joint. A review of the literature has revealed this to be the first reported case of this type.

The Load-Bearing Characteristics of the Forearm: Pattern of Axial and Bending Force Transmitted Through Ulna and Radius

2006 ◽  
Vol 31 (3) ◽  
pp. 274-279 ◽  
Author(s):  
H. SHAABAN ◽  
G. GIAKAS ◽  
M. BOLTON ◽  
R. WILLIAMS ◽  
P. WICKS ◽  
...  
Keyword(s):  
Distal Radius ◽  
Axial Loading ◽  
Distal Radioulnar Joint ◽  
Biomechanical Study ◽  
Strain Gauges ◽  
Force Transmission ◽  
Distal Ulna ◽  
Radioulnar Joint ◽  
Bending Force ◽  
Ulnar Head

A biomechanical study was performed on 12 cadaveric arms to define the normal profiles of force transmission through the ulna and radius and demonstrate the effect on these of simulated injury of the distal radioulnar joint (DRUJ). Strain gauges were used to measure the axial and bending forces transmitted through each bone. Axial force transmitted through the ulna is, broadly, reciprocal to that seen in the radius, with the greatest force seen in supination. In all 12 arms, axial loading of the hand created an anterior bending force (to create a posterior convexity) in the distal radius. Axial loading of the hand created an anterior bending force in the distal ulna for half the specimens and a posterior bending force in the remaining half. Division and division with reconstruction of either the volar or the dorsal distal radioulnar ligament (DRUL) had no significant effect on force transmission through the ulna and radius, while excision of the ulnar head significantly disrupted the profiles of the axial and bending forces.

Linked distal radioulnar joint arthroplasty: an analysis of the APTIS prosthesis

2014 ◽  
Vol 39 (7) ◽  
pp. 739-744 ◽  
Author(s):  
S. Kakar ◽  
T. Fox ◽  
E. Wagner ◽  
R. Berger
Keyword(s):  
Functional Outcomes ◽  
Distal Radioulnar Joint ◽  
Joint Arthroplasty ◽  
Medium Term ◽  
Viable Option ◽  
Distal Ulna ◽  
Radioulnar Joint ◽  
Number Of Patients ◽  
Good Pain Relief

Painful radioulnar convergence following resection of the distal ulna can produce substantial disability and prove a challenging surgical problem, particularly in the revision setting. The purpose of this study was to evaluate the outcome of a series of patients with chronic distal radioulnar joint instability or multiple prior procedures treated with linked distal radioulnar joint arthroplasty with the APTIS prosthesis. A series of ten patients were identified with a mean follow up of 4.0 years. At final follow-up nine of ten implants survived free from revision or removal, with patients experiencing good pain relief and functional outcomes, with reasonable overall satisfaction in all seven patients who returned the questionnaires. Despite the medium-term follow-up and small number of patients, our results suggest the linked distal radioulnar joint arthroplasty may be a viable option for treating painful radioulnar convergence following multiple failed procedures at the distal radioulnar joint.

scholarly journals Change of wrist motion before and after fixation of the distal radioulnar joint and resection of the distal ulna in a cadaveric model

2021 ◽  
pp. 1-7
Author(s):  
Taku Suzuki ◽  
Yukinori Terasaka ◽  
Kato Tomoyuki ◽  
Takeshi Hagiwara ◽  
Shusuke Masuda ◽  
...  
Keyword(s):  
Distal Radioulnar Joint ◽  
Distal Ulna ◽  
Wrist Motion ◽  
Radioulnar Joint ◽  
Before And After ◽  
Cadaveric Model

Extensor Retinaculum Reconstruction of the Distal Radioulnar Joint in Adolescents

Hand ◽  
2020 ◽  
pp. 155894472096670
Author(s):  
Andrea S. Bauer ◽  
Stella J. Lee ◽  
Michael D. Smith ◽  
Donald S. Bae ◽  
Peter M. Waters
Keyword(s):  
Distal Radius ◽  
Distal Radioulnar Joint ◽  
Surgical Reconstruction ◽  
Extensor Retinaculum ◽  
Radioulnar Joint ◽  
Druj Instability ◽  
Outcome Scores ◽  
High Level ◽  
Age Range ◽  
Prior Injury

Background This study characterizes the outcomes and complications of surgical reconstruction of distal radioulnar joint (DRUJ) instability using the extensor retinaculum (Herbert sling). Our hypothesis was that extensor retinaculum reconstruction is a reliable method of DRUJ stabilization in adolescents. Methods This was a retrospective study of pediatric patients treated surgically using the Herbert sling for DRUJ instability at a single institution. We identified 22 subjects who underwent surgery at an average of 16.2 years of age (range, 12-18 years). Medical records and available imaging were reviewed for all subjects, and patients were contacted to participate in the prospective completion of the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire. Results Preoperative symptoms were more commonly pain (95%) than feelings of DRUJ instability (45%), although 100% had instability on physical examination. Eight (36%) patients demonstrated limited supination preoperatively. Twenty-one subjects (95%) noted prior injury to that wrist, 15 of which were distal radius fractures. Surgery consisted of stabilization of the DRUJ using extensor retinaculum, in concert with other procedures to address all potential causes of wrist pain. Postoperatively, DRUJ stability was maintained in 21 of 22 subjects. Of the 12 patients who provided functional outcome scores, median QuickDASH score was 7.6 (range, 0-45). Conclusions Distal radioulnar joint instability in adolescents is often preceded by fracture of the distal radius. Surgeons must maintain a high level of suspicion to appropriately diagnose DRUJ instability, which is often not an isolated pathoanatomical problem. The Herbert sling technique using extensor retinaculum can successfully confer DRUJ stability in this population.

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