Reconstruction of Radioscaphocapitate Ligament in Treatment of Ulnar Translation

Abstract

Background This article measures the life quality, clinical, and functional outcomes of a patient who had undergone reconstruction of the radioscaphocapitate ligament (RSL), using brachioradialis tendon in the treatment of ulnar translation of the carpus.

Case Description We present a 36-year-old man with ulnar translation in his left, nondominant wrist, after fall accident. Reconstruction of the RSL was performed. One year later, the patient experienced good evaluation. Wrist flexion was 70 degrees, extension was 60 degrees, radial deviation was 20 degrees, and ulnar deviation was 30 degrees. Forearm pronation was 85 degrees and supination was 90 degrees and digit motion was full. Disabilities of the Arm, Shoulder and Hand score of 5, Visual Analog Scale of 0, and grip strength of 82% were obtained compared with the unaffected side. Wrist radiographic aspects showed radiocarpal joint congruency. The period of fixator treatment was 8 weeks. Good stability and joint congruency of the radiocarpal joint were obtained. Good radiographic, clinical, and functional results were obtained improving the quality of life of the patient.

Literature Review The treatment of ulnar translation is difficult and complicated. There is no consensus to the overall management. As there is still a lack of long-term results, the indications for surgery, various surgical options, and the type of intervention have been a matter of controversy in the literature. Would radiocarpal joint be stable when reconstruction of the RSL using brachioradialis tendon was obtained? Is it possible to reduce an ulnar translation with this technique?

Clinical Relevance We would like to suggest that the radiocarpal ligament reconstruction will improve the outcome. We believe that this technique will make the wrist more stable and functional. We agree that the best time to perform the corrections is early. The authors prefer to first reconstruct the RSL and then the radiocarpal ligament suture or radioscapholunate arthrodesis.

Keywords

ulnar translation - forearm deformity - wrist deformity - ligament reconstruction - radiocarpal ligaments

Ethical Approval

This case presentation was approved by, and followed the ethical standards of, the Faculdade de Medicina do ABC Ethics Committee on human experimentation (no. 1750176). An informed consent document was provided to the patient, who willingly read and signed it.

• References

• 1 Rutgers M, Jupiter J, Ring D. Isolated posttraumatic ulnar translocation of the radiocarpal joint. J Hand Microsurg 2009; 1 (02) 108-112
• 2 Maschke SD, Means Jr KR, Parks BG, Graham TJ. A radiocarpal ligament reconstruction using brachioradialis for secondary ulnar translation of the carpus following radiocarpal dislocation: a cadaver study. J Hand Surg Am 2010; 35 (02) 256-261
• 3 DiBenedetto MR, Lubbers LM, Coleman CR. A standardized measurement of ulnar carpal translocation. J Hand Surg Am 1990; 15 (06) 1009-1010
• 4 Jebson PJ, Adams BD, Meletiou SD. Ulnar translocation instability of the carpus after a dorsal radiocarpal dislocation: a case report. Am J Orthop 2000; 29 (06) 462-464
• 5 Aita MA, Mallozi RC, Ozaki W, Ikeuti DH, Consoni DAP, Rugiero GM. Ligamentous reconstruction of the interosseous membrane of the forearm in the treatment of instability of the DRUJ. Rev Bras Ortop 2018; 53 (02) 184-191