J Wrist Surg 2015; 04(03): 179-182
DOI: 10.1055/s-0035-1558832
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Management of a Complex, Multioperated Intra-Articular Distal Radius Fracture

Lolade Giwa
1   Department of Orthopaedics, Southend University Hospital, Prittlewell-Chase, Westcliff-on-Sea, Essex, United Kingdom
,
Kate Spacey
1   Department of Orthopaedics, Southend University Hospital, Prittlewell-Chase, Westcliff-on-Sea, Essex, United Kingdom
,
Greg Packer
1   Department of Orthopaedics, Southend University Hospital, Prittlewell-Chase, Westcliff-on-Sea, Essex, United Kingdom
› Author Affiliations
Further Information

Publication History

Publication Date:
07 August 2015 (online)

Abstract

Background Intra-articular distal radius fractures can have many complications, including radiocarpal osteoarthritis and distal radioulnar joint (DRUJ) dysfunction leading to pain and restricted wrist function.

Case Description We describe the case of a 38-year-old patient who sustained a left distal radius intra-articular fracture, which was treated with volar plating. She developed pain from the radiocarpal joint as a result of intra-articular malunion and was listed for total wrist fusion. On the day of surgery this was converted to a Darrach procedure for minor DRUJ symptoms. This resulted in pain from the DRUJ as a result of instability, in addition to persisting radiocarpal arthritis pain. Due to her subsequent poor wrist function, she presented to the authors and underwent DRUJ arthroplasty with a proximally placed Scheker prosthesis to deal with her DRUJ symptoms and, later, a KinematX radiocarpal hemiarthroplasty for her radiocarpal symptoms. She remains happy with her outcome at 36-month follow-up.

Literature Review The complications of the Darrach procedure include painful radioulnar convergence and wrist instability. The Scheker prosthesis allows restoration of stability of the DRUJ with good outcomes and 100% 5-year survival in one series. Sparing the midcarpal joint, the KinematX hemiarthroplasty allows preservation of the dart thrower's motion arc, which is key in many complex wrist movements and functions.

Clinical Relevance This case highlights the negative consequences of distal ulna resection and shows both the Scheker and KinematX prostheses as viable, effective means to restore function to young, active patients with posttraumatic radiocarpal arthritis and/or instability.

 
  • References

  • 1 Lutz M, Arora R, Krappinger D, Wambacher M, Rieger M, Pechlaner S. Arthritis predicting factors in distal intraarticular radius fractures. Arch Orthop Trauma Surg 2011; 131 (8) 1121-1126
  • 2 Moritomo H, Apergis EP, Garcia-Elias M, Werner FW, Wolfe SW. International Federation of Societies for Surgery of the Hand 2013 Committee's report on wrist dart-throwing motion. J Hand Surg Am 2014; 39 (7) 1433-1439
  • 3 Vance MC, Packer G, Tan D, Crisco JJ, Wolfe SW. Midcarpal hemiarthroplasty for wrist arthritis: rationale and early results. J Wrist Surg 2012; 1 (1) 61-68
  • 4 Culp RW, Bachoura A, Gelman SE, Jacoby SM. Proximal row carpectomy combined with wrist hemiarthroplasty. J Wrist Surg 2012; 1 (1) 39-46
  • 5 Field J, Herbert TJ, Prosser R. Total wrist fusion. A functional assessment. J Hand Surg [Br] 1996; 21 (4) 429-433
  • 6 Papatheodorou LK, Rubright JH, Kokkalis ZT, Sotereanos DG. Resection interposition arthroplasty for failed distal ulna resections. J Wrist Surg 2013; 2 (1) 13-18
  • 7 Bieber EJ, Linscheid RL, Dobyns JH, Beckenbaugh RD. Failed distal ulna resections. J Hand Surg Am 1988; 13 (2) 193-200
  • 8 van Schoonhoven J, Mühldorfer-Fodor M, Fernandez DL, Herbert TJ. Salvage of failed resection arthroplasties of the distal radioulnar joint using an ulnar head prosthesis: long-term results. J Hand Surg Am 2012; 37 (7) 1372-1380
  • 9 Martínez Villén G, García Martínez B, Aso Vizán A. Total distal radioulnar joint prosthesis as salvage surgery in multioperated patients. Chir Main 2014; 33 (6) 390-395
  • 10 Kakar S, Fox T, Wagner E, Berger R. Linked distal radioulnar joint arthroplasty: an analysis of the APTIS prosthesis. J Hand Surg Eur Vol 2014; 39 (7) 739-744
  • 11 Scheker LR. Implant arthroplasty for the distal radioulnar joint. J Hand Surg Am 2008; 33 (9) 1639-1644