Ligamentous Reconstruction for Post Traumatic Chronic Instability of Distal Radio Ulnar Joint (DRUJ)

Marimuthu, S (2006) Ligamentous Reconstruction for Post Traumatic Chronic Instability of Distal Radio Ulnar Joint (DRUJ). Masters thesis, Madurai Medical College, Madurai.


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INTRODUCTION: Although our understanding of human anatomy has grown rapidly, the distal radioulnar joint (DRUJ) remains one of the least understood joints in the body. Problems of the DRUJ have been called by Palmer as the “Low back pain of the wrist”. The disorder of this joint may be due to trauma or arthritis. Injury to this joint may result in pure ligamentous disruption, fractures or both. Darrach’s description in 1912 of a chronic DRUJ dislocation and its treatment with an ulna head resection is one of the earliest reports about the DRUJ. Over the last 15 years, there has been a tremendous surge in research involving the anatomy, function and treatment of DRUJ pathology. Chronic instability of the distal radio ulnar joint is a relatively common clinical problem. Yet its pathogenesis is complex and often poorly understood. Ligament disruption of this joint result in acute instability which if left untreated leads to chronic instability. Many reconstructive and salvage procedures have been described in an attempt to restore stability. AIM OF THE STUDY: To analyze the clinical and functional results of Ligamentous reconstruction in cases of post traumatic chronic instability of distal radio ulna joint. MATERIALS AND METHODS: In our Hand surgery unit, we selected 21 cases of chronic instability of distal radio ulnar joint for this prospective study. Among 21 patients 14 were males and 7 were females. The age group varied from a minimum of 21 years to a maximum of 45 years. The mean age group being 31.3 years. The duration of the study was from August 2003 to February 2006. The mean follow up was 11.5 months. Dominant hand (Right side) was involved in 6 patients and in 15 patients the non-dominant (left side) was involved. Among 21patients, 10 patients had dorsal instability alone, whereas 11 patients had both dorsal and volar instability. All patients gave history of injury. Nine patients had initial treatment by plaster immobilization for 10 days to 2 weeks. Two patients had associated Colle’s fracture treated by ‘K’ wire fixation elsewhere. Rest of cases was treated as just sprains elsewhere. RESULTS: BUNNELL – BOYES PROCEDURE - There was no intraoperative complication. Post operatively, one patient developed transient parasthesia and altered sensation in the distribution of the dorsal cutaneous branch of the ulnar nerve, but this resolved spontaneously a month after surgery. This was probably caused by retraction of the nerve during surgery. ADAM’S PROCEDURE - There was no intra operative complication. Post operatively, one patient had prolonged stiffness following postoperative immobilization for 12 weeks, having failed to return for removal of the cast at 6 weeks. He was lost to follow up after 13 weeks. Out of 10 patients, 4 patients had excellent wrist scores and 4 patients had good wrist score. All these patients had good stability, pain free good range of pronation and supination movement. In the two cases of old colle’s fracture the patients had pain during extreme range of pronation and supination movements and recurrence of instability of DRUJ during follow up (fair grade). Possible causes of failure in these two patients are insufficient tensioning of the graft and rupture or loosening of the graft during initial mobilization. These patients were not willing for any further surgical procedures. CONCLUSION: The goals of chronic instability of DRUJ management are to restore stability and pain free rotation. Ligamentous reconstruction achieves these goals. The Bunnell Boyes procedure is ideal for dorsal instability. The Adam’s procedure gives better results for dorsal and volar instability.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Ligamentous Reconstruction ; Post Traumatic Chronic Instability ; Distal Radio Ulnar Joint(DRUJ).
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 16 Sep 2017 15:09
Last Modified: 17 Sep 2017 02:23

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