Long-term functional outcome after dorsal capsular imbrication for post-traumatic dorsal instability of the distal radio
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ORIGINAL PAPER
Long-term functional outcome after dorsal capsular imbrication for post-traumatic dorsal instability of the distal radioulnar joint Julia M. Unglaub 1,2 & Thomas Heyse 2,3 & Thomas Bruckner 4 & Martin F. Langer 5 & Christian K. Spies 1 Received: 12 February 2020 / Accepted: 3 July 2020 # SICOT aisbl 2020
Abstract Purpose The goal of this study was the assessment of long-term outcome of dorsal capsular imbrication of the distal radioulnar joint (DRUJ) in dorsal instability. Methods The study included ten patients (mean 38.7 years of age) with a mean follow-up time of 11.2 years (9.3 years to 14.3 years). Examination parameters included Disabilities of Arm, Shoulder, and Hand (DASH) questionnaire, modified Mayo Wrist Score (MMWS), determination of range of motion in comparison with the healthy extremity, pre- and post-operative pain level assessment, and examination of DRUJ stability. Results Eight of ten DRUJs proved to be stable after the above-mentioned follow-up. Mean MMWS was 92.5 (65–100; SD: 11.1). Mean DASH Score was 8.8 (0–60; SD: 18.4). Grip strength reached 93.5% of the contralateral unaffected hand. Range of motion did not differ significantly in comparison with the healthy contralateral extremity. Nine of ten patients regarded pain level reduction as excellent. Eight of ten patients regarded DRUJ stability as excellent after surgery. Conclusion Dorsal capsular imbrication of the DRUJ is an efficacious surgical technique for post-traumatic dorsal instability in the long-term. Keywords Distal radioulnar joint . Instability . Triangular fibrocartilage complex . Capsular imbrication . Wrist surgery
Introduction Instability of the distal radioulnar joint (DRUJ) may entail relevant loss of function and therefore may be detrimental to the upper extremity. The dorsal instability of the DRUJ is the most common type of instability, most often caused by the fall with the outstretched, pronated, and hyperextended wrist. In Level of evidence: IV * Christian K. Spies [email protected] 1
Hand Surgery, Vulpius Klinik, Vulpiusstraße 29, 74906 Bad Rappenau, Germany
2
Medical Faculty of the Philipps-University of Marburg, Marburg, Germany
3
ORTHOmedic Frankfurt – Offenbach, Offenbach, Germany
4
Department of Medical Biometry and Informatics, University Heidelberg, Im Neuenheimer Feld 305, 69120 Heidelberg, Germany
5
Department of Traumatology and Hand Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude W1, 48149 Münster, Germany
the clinical context, dorsal instability refers to the distal ulna with respect to the radius. The palmar instability of the DRUJ is caused generally by the fall with the outstretched supinated, and flexed wrist [1]. The triangular fibrocartilage complex (TFCC), the interosseous membrane, the bony configuration of the sigmoid notch, DRUJ capsule, and the extensor carpi ulnaris tendon with subsheath are responsible for joint stability with unrestricted forearm rotation [2–7]. The distal radioulnar ligaments are considered the most important
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