[Stabilization of the Distal Radioulnar Joint According to Adams: Clinical, and Radiological Results]

Abstract

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.