J Wrist Surg 2013; 02(01): 013-018
DOI: 10.1055/s-0032-1333062
Special Focus Section: Distal Radioulnar Joint Arthroplasty
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Resection Interposition Arthroplasty for Failed Distal Ulna Resections

Loukia K. Papatheodorou
1   Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
,
James H. Rubright
1   Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
,
Zinon T. Kokkalis
1   Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
,
Dean G. Sotereanos
1   Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
› Author Affiliations
Further Information

Publication History

Publication Date:
08 February 2013 (online)

Abstract

The major complications of distal ulna resection, the Darrach procedure, are radioulnar impingement and instability. High failure rates have been reported despite published modifications of the Darrach procedure. Several surgical techniques have been developed to treat this difficult problem and to mitigate the symptoms associated with painful convergence and impingement. No technique has demonstrated clinical superiority. Recently, implant arthroplasty of the distal ulna has been endorsed as an option for the management of the symptomatic patient with a failed distal ulna resection. However, there are concerns for implant longevity, especially in young, active adults. Resection interposition arthroplasty relies on interposition of an Achilles tendon allograft between the distal radius and the resected distal ulna. Although this technique does not restore normal mechanics of the distal radioulnar joint, it can prevent painful convergence of the radius on the ulna. Achilles allograft interposition arthroplasty is a safe and highly effective alternative for failed distal ulna resections, especially for young, active patients, in whom an implant or alternative procedure may not be appropriate.

 
  • References

  • 1 Darrach W. Anterior dislocation at the head of the ulna. Ann Surg 1912; 56: 802-803
  • 2 Field J, Majkowski RJ, Leslie IJ. Poor results of Darrach's procedure after wrist injuries. J Bone Joint Surg Br 1993; 75 (1) 53-57
  • 3 McKee MD, Richards RR. Dynamic radio-ulnar convergence after the Darrach procedure. J Bone Joint Surg Br 1996; 78 (3) 413-418
  • 4 Sauerbier M, Berger RA, Fujita M, Hahn ME. Radioulnar convergence after distal ulnar resection: mechanical performance of two commonly used soft tissue stabilizing procedures. Acta Orthop Scand 2003; 74 (4) 420-428
  • 5 Kleinman WB, Graham TJ. Distal ulnar injury and dysfunction. In: Peimer CA, , ed. Surgery of the Hand and Upper Extremity. New York, NY: McGraw-Hill; 1996: 667-709
  • 6 Bell MJ, Hill RJ, McMurtry RY. Ulnar impingement syndrome. J Bone Joint Surg Br 1985; 67 (1) 126-129
  • 7 Bieber EJ, Linscheid RL, Dobyns JH, Beckenbaugh RD. Failed distal ulna resections. J Hand Surg Am 1988; 13 (2) 193-200
  • 8 Noble J, Arafa M. Stabilisation of distal ulna after excessive Darrach's procedure. Hand 1983; 15 (1) 70-72
  • 9 Greenberg JA. Reconstruction of the distal ulna: instability, impaction, impingement, and arthrosis. J Hand Surg Am 2009; 34 (2) 351-356
  • 10 Garcia-Elias M. Failed ulnar head resection: prevention and treatment. J Hand Surg [Br] 2002; 27 (5) 470-480
  • 11 Jupiter JB. Tendon stabilization of the distal ulna. J Hand Surg Am 2008; 33 (7) 1196-1200
  • 12 Sotereanos DG, Leit ME. A modified Darrach procedure for treatment of the painful distal radioulnar joint. Clin Orthop Relat Res 1996; 325 (325) 140-147
  • 13 Syed AA, Lam WL, Agarwal M, Boome R. Stabilization of the ulna stump after Darrach's procedure at the wrist. Int Orthop 2003; 27 (4) 235-239
  • 14 Chu PJ, Lee HM, Hung ST, Shih JT. Stabilization of the proximal ulnar stump after the Darrach or Sauvé-Kapandji procedure by using the extensor carpi ulnaris tendon. Hand (NY) 2008; 3 (4) 346-351
  • 15 Minami A, Iwasaki N, Ishikawa J, Suenaga N, Kato H. Stabilization of the proximal ulnar stump in the Sauvé-Kapandji procedure by using the extensor carpi ulnaris tendon: long-term follow-up studies. J Hand Surg Am 2006; 31 (3) 440-444
  • 16 Johnson RK. Stabilization of the distal ulna by transfer of the pronator quadratus origin. Clin Orthop Relat Res 1992; 275 (275) 130-132
  • 17 Kleinman WB, Greenberg JA. Salvage of the failed Darrach procedure. J Hand Surg Am 1995; 20 (6) 951-958
  • 18 Wolfe SW, Mih AD, Hotchkiss RN, Culp RW, Keifhaber TR, Nagle DJ. Wide excision of the distal ulna: a multicenter case study. J Hand Surg Am 1998; 23 (2) 222-228
  • 19 Greenberg JA, Yanagida H, Werner FW, Short WH. Wide excision of the distal ulna: biomechanical testing of a salvage procedure. J Hand Surg Am 2003; 28 (1) 105-110
  • 20 Watson HK, Brown RE. Ulnar impingement syndrome after Darrach procedure: treatment by advancement lengthening osteotomy of the ulna. J Hand Surg Am 1989; 14 (2 Pt 1) 302-306
  • 21 van Schoonhoven J, Fernandez DL, Bowers WH, Herbert TJ. Salvage of failed resection arthroplasties of the distal radioulnar joint using a new ulnar head prosthesis. J Hand Surg Am 2000; 25 (3) 438-446
  • 22 Berger RA, Cooney III WP. Use of an ulnar head endoprosthesis for treatment of an unstable distal ulnar resection: review of mechanics, indications, and surgical technique. Hand Clin 2005; 21 (4) 603-620 , vii
  • 23 Fernandez DL, Joneschild ES, Abella DM. Treatment of failed Sauvé-Kapandji procedures with a spherical ulnar head prosthesis. Clin Orthop Relat Res 2006; 445: 100-107
  • 24 Willis AA, Berger RA, Cooney III WP. Arthroplasty of the distal radioulnar joint using a new ulnar head endoprosthesis: preliminary report. J Hand Surg Am 2007; 32 (2) 177-189
  • 25 Herbert TJ, van Schoonhoven J. Ulnar head replacement. Tech Hand Up Extrem Surg 2007; 11 (1) 98-108
  • 26 Scheker LR. Implant arthroplasty for the distal radioulnar joint. J Hand Surg Am 2008; 33 (9) 1639-1644
  • 27 Herzberg G. Periprosthetic bone resorption and sigmoid notch erosion around ulnar head implants: a concern?. Hand Clin 2010; 26 (4) 573-577
  • 28 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
  • 29 Sotereanos DG, Göbel F, Vardakas DG, Sarris I. An allograft salvage technique for failure of the Darrach procedure: a report of four cases. J Hand Surg [Br] 2002; 27 (4) 317-321
  • 30 Greenberg JA, Sotereanos D. Achilles allograft interposition for failed Darrach distal ulna resections. Tech Hand Up Extrem Surg 2008; 12 (2) 121-125
  • 31 Hartz CR, Beckenbaugh RD. Long-term results of resection of the distal ulna for post-traumatic conditions. J Trauma 1979; 19 (4) 219-226
  • 32 Minami A, Iwasaki N, Ishikawa J, Suenaga N, Yasuda K, Kato H. Treatments of osteoarthritis of the distal radioulnar joint: long-term results of three procedures. Hand Surg 2005; 10 (2-3) 243-248
  • 33 Glowacki KA. Hemiresection arthroplasty of the distal radioulnar joint. Hand Clin 2005; 21 (4) 591-601
  • 34 Daecke W, Martini AK, Schneider S, Streich NA. Amount of ulnar resection is a predictive factor for ulnar instability problems after the Sauvé-Kapandji procedure: a retrospective study of 44 patients followed for 1–13 years. Acta Orthop 2006; 77 (2) 290-297
  • 35 Sauerbier M, Hahn ME, Berglund LJ, An KN, Berger RA. Biomechanical evaluation of the dynamic radioulnar convergence after ulnar head resection, two soft tissue stabilization methods of the distal ulna and ulnar head prosthesis implantation. Arch Orthop Trauma Surg 2011; 131 (1) 15-26
  • 36 Sauerbier M, Hahn ME, Fujita M, Neale PG, Berglund LJ, Berger RA. Analysis of dynamic distal radioulnar convergence after ulnar head resection and endoprosthesis implantation. J Hand Surg Am 2002; 27 (3) 425-434