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Reconstruction of distal radioulnar joint instability

      Abstract

      The distal radioulnar joint has a unique architecture that simultaneously allows a wide arc of forearm rotation but requires the coordination of a primary ulnoradial ligament and secondary supporting structures to maintain stability. Office examination must focus on correlating the mechanism of the original injury, details of the patient’s symptoms related to activity, and a manual stress examination for ulnoradial instability. Surgical reconstruction of the stabilizing ligaments is an appropriate strategy if the symptoms are attributable primarily to traumatic instability and the patient has failed nonsurgical treatment. Both the primary ulnoradial ligament and secondary capsular ligaments can be anatomically reconstructed with a free tendon graft. During the rehabilitation process, remodeling of the tendon graft must take place to achieve the simultaneous goals of joint stability and full motion. Patients can be expected to return to manual labor, sports, and other demanding activities after complete graft incorporation and a conditioning program.
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      References

        • Tolat A.R
        • Stanley J.K
        • Trail I.A
        A cadaveric study of the anatomy and stability of the distal radioulnar joint in the coronal and transverse planes.
        J Hand Surg [Br]. 1996; 21: 587-594
        • af Ekenstam F
        • Hagert C.G
        Anatomical studies on the geometry and stability of the distal radioulnar joint.
        Scand J Plast Reconstr Surg. 1985; 19: 17-25
        • Ward L.D
        • Ambrose C.G
        • Masson M.V
        • Levaro F.L
        The role of the distal radioulnar ligaments, interosseous membrane, and joint capsule in distal radioulnar joint stability.
        J Hand Surg [Am]. 2000; 25: 341-351
        • Nakamura T
        • Yabe Y
        • Horiuchi Y
        Functional anatomy of the triangular fibrocartilage complex.
        J Hand Surg [Br]. 1996; 21: 581-586
        • Berger R.A
        The anatomy of the ligaments of the wrist and distal radioulnar joints.
        Clin Orthop. 2001; 383: 32-40
        • King G.J
        • McMurty R.Y
        • Rubenstein J.D
        • Gertzbein S.D
        Kinematics of the distal radioulnar joint.
        J Hand Surg [Am]. 1986; 11: 711-717
        • Acosta R
        • Hnat W
        • Scheker L.R
        Distal radioulnar ligament motion during supination and pronation.
        J Hand Surg [Br]. 1993; 18: 502-505
        • Kihara H
        • Short W.H
        • Werner F.W
        • Fortino M.D
        • Palmar A.K
        The stabilizing mechanism of the distal radioulnar joint during pronation and supination.
        J Hand Surg [Am]. 1995; 20: 930-936
        • Schuind F
        • An K.N
        • Berglund L
        • et al.
        The distal radioulnar ligaments.
        J Hand Surg [Am]. 1991; 16: 1106-1114
        • Van der Heijden E.P
        • Hillen B
        A two-dimensional kinematic analysis of the distal radioulnar joint.
        J Hand Surg [Br]. 1996; 21: 824-829
        • Stuart P.R
        • Berger R.A
        • Linscheid R.L
        • An K.N
        The dorsopalmar stability of the distal radioulnar joint.
        J Hand Surg [Am]. 2000; 25: 689-699
        • Breen T.F
        • Jupiter J.B
        Extensor carpi ulnaris and flexor carpi ulnaris tenodesis of the unstable distal ulna.
        J Hand Surg [Am]. 1989; 14: 612-617
        • Hui F.C
        • Linscheid R.L
        Ulnotriquetral augmentation tenodesis.
        J Hand Surg. 1982; 7: 230-236
        • Tsai T.M
        • Stillwell J.H
        Repair of chronic subluxation of the distal radioulnar joint (ulna dorsal) using flexor carpi ulnaris tendon.
        J Hand Surg [Br]. 1984; 9: 289-293
        • Petersen M.S
        • Adams B.D
        Biomechanical evaluation of distal radioulnar reconstructions.
        J Hand Surg. 1993; 18A: 328-334
        • Adams B.D
        Anatomic reconstruction of the distal radioulnar ligaments for DRUJ instability.
        Op Tech Hand Upper Extrem Surg. 2000; 4: 154-160
        • Adams B.D
        • Berger R.A
        An anatomic reconstruction of the distal radioulnar ligaments for posttraumatic distal radioulnar joint instability.
        J Hand Surg [Am]. 2002; 27: 243-251
        • Johnston-Jones K
        • Sanders W.E
        Posttraumatic radioulnar instability.
        Orthop Trans. 1995; 19 (abstr) 1996: 832
        • Scheker L.R
        • Belliappa P.P
        • Acosta R
        • German D.S
        Reconstruction of the dorsal ligament of the triangular fibrocartilage complex.
        J Hand Surg [Br]. 1994; 19: 310-318