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.
Keywords
distal radius fracture - distal radioulnar joint (DRUJ) - hemiarthroplasty
