Functional Effects of the Adams Procedure: A Retrospective Intervention Study

Abstract

Background Injury to the distal radioulnar joint (DRUJ) causes swelling and ulnar-sided wrist pain. The Adams procedure stabilizes the DRUJ and shows promising short-term results.

Purpose We studied the long-term functional outcome in patients who underwent the Adams procedure. We also tested the null hypothesis that there would be no difference in range of motion (ROM) and grip strength between the operated wrist compared to the unaffected side.

Patients and Methods We identified 74 consecutive patients that were operated from March 2005 to February 2014. Twenty-three patients responded to our invitation and underwent clinical follow-up. Three patients had a re-do of the Adams procedure after presenting with postoperative DRUJ instability, one was excluded due to additional wrist surgery not related to the initial procedure. Wrist functionality in the remaining 22 patients was examined by measuring ROM in all planes and grip strength of the operated and non-operated hand. Functional outcome was measured by asking patients to complete the Disabilities of the Arm, Shoulder, and Hand (DASH) outcome measure and the Patient-Rated Wrist and Hand Evaluation (PRWHE).

Results After a mean follow-up time of 5.0 years (standard deviation [SD] 2.0), we found that supination, pronation, and grip strength were significantly decreased in the operated wrist. Postoperative DASH and PRWHE-scores averaged 13.1 (SD 18.6) and 20.3 (SD 15.1), respectively.

Conclusion The Adams procedure affects, but largely restores pronation and supination, and clinical examination, DASH, and PRWHE scores indicate that the Adams procedure leaves patients with upper extremity functionality comparable to a healthy population.

Level of Evidence Level IV.

Keywords

function - long term - Adams procedure - DRUJ - reconstruction - DASH - PRWHE

Note

This work was performed at the Division of Plastic Surgery, Universitair Medisch Centrum Utrecht, Universiteit Utrecht, Utrecht, the Netherlands.

Ethical Approval

This study was approved by the Institutional Review Board.

• References

• 1 Fujitani R, Omokawa S, Akahane M, Iida A, Ono H, Tanaka Y. Predictors of distal radioulnar joint instability in distal radius fractures. J Hand Surg Am 2011; 36 (12) 1919-1925
• 2 Scheker LR, Belliappa PP, Acosta R, German DS. Reconstruction of the dorsal ligament of the triangular fibrocartilage complex. J Hand Surg [Br] 1994; 19 (03) 310-318
• 3 Bain GI, Pourgiezis N, Roth JH. Surgical approaches to the distal radioulnar joint. Tech Hand Up Extrem Surg 2007; 11 (01) 51-56
• 4 Atzei A. New trends in arthroscopic management of type 1-B TFCC injuries with DRUJ instability. J Hand Surg Eur Vol 2009; 34 (05) 582-591
• 5 Atzei A, Rizzo A, Luchetti R, Fairplay T. Arthroscopic foveal repair of triangular fibrocartilage complex peripheral lesion with distal radioulnar joint instability. Tech Hand Up Extrem Surg 2008; 12 (04) 226-235
• 6 Bombaci H, Polat A, Deniz G, Akinci O. The value of plain X-rays in predicting TFCC injury after distal radial fractures. J Hand Surg Eur Vol 2008; 33 (03) 322-326
• 7 Wijffels M, Brink P, Schipper I. Clinical and non-clinical aspects of distal radioulnar joint instability. Open Orthop J 2012; 6: 204-210
• 8 Thomas BP, Sreekanth R. Distal radioulnar joint injuries. Indian J Orthop 2012; 46 (05) 493-504
• 9 Lawler E, Adams BD. Reconstruction for DRUJ instability. Hand (NY) 2007; 2 (03) 123-126
• 10 Adams BD, Lawler E. Chronic instability of the distal radioulnar joint. J Am Acad Orthop Surg 2007; 15 (09) 571-575
• 11 Palmer AK, Werner FW. The triangular fibrocartilage complex of the wrist--anatomy and function. J Hand Surg Am 1981; 6 (02) 153-162
• 12 Adams BD, Berger RA. An anatomic reconstruction of the distal radioulnar ligaments for posttraumatic distal radioulnar joint instability. J Hand Surg Am 2002; 27 (02) 243-251
• 13 Adams BD. Anatomic Reconstruction of the Distal Radioulnar Ligaments for DRUJ Instability. Tech Hand Up Extrem Surg 2000; 4 (03) 154-160
• 14 MacDermid JC, Turgeon T, Richards RS, Beadle M, Roth JH. Patient rating of wrist pain and disability: a reliable and valid measurement tool. J Orthop Trauma 1998; 12 (08) 577-586
• 15 Hudak PL, Amadio PC, Bombardier C. ; The Upper Extremity Collaborative Group (UECG). Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. Am J Ind Med 1996; 29 (06) 602-608
• 16 Gugger Y, Mühldorfer M, Prommersberger KJ, van Schoonhoven J. [Stabilization of the distal radioulnar joint according to Adams: clinical, and radiological results]. Handchir Mikrochir Plast Chir 2015; 47 (05) 297-303
• 17 Jester A, Harth A, Germann G. Measuring levels of upper-extremity disability in employed adults using the DASH Questionnaire. J Hand Surg Am 2005; 30 (05) 1074.e1-1074.e10
• 18 Cardenas-Montemayor E, Hartl JF, Wolf MB. , et al. Subjective and objective results of arthroscopic debridement of ulnar-sided TFCC (Palmer type 1B) lesions with stable distal radio-ulnar joint. Arch Orthop Trauma Surg 2013; 133 (02) 287-293
• 19 Henry M. Anatomic reconstruction of the radioulnar ligament. Hand (NY) 2012; 7 (04) 413-419
• 20 Brink PRG, Hannemann PFW. Distal oblique bundle reinforcement for treatment of DRUJ instability. J Wrist Surg 2015; 4 (03) 221-228