Distal radioulnar joint constrained arthroplasty.

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering
• Reconstructive Surgery

Background:

• The distal radioulnar joint (DRUJ) is crucial for wrist function, enabling weight-bearing and complex motion.
• Instability or absence of the DRUJ can result from trauma, resection, or congenital anomalies.
• Current treatment options for severe DRUJ pathology are limited, especially when the sigmoid notch is absent or soft tissues are compromised.

Purpose of the Study:

• To present the indications, contraindications, surgical pearls, and potential pitfalls of constrained total distal radioulnar joint (TDRUJ) replacement.
• To evaluate the functional outcomes and patient return to activity following TDRUJ implantation.
• To provide a comprehensive overview of this reconstructive technique for complex DRUJ problems.

Main Methods:

• Retrospective case review of patients undergoing constrained TDRUJ implantation.
• Detailed analysis of surgical technique, including implant selection and fixation.
• Assessment of patient-reported outcomes, range of motion, and return to daily and recreational activities.
• Radiographic evaluation and 5-year follow-up data collection.

Main Results:

• Constrained TDRUJ replacement is indicated for DRUJ instability due to sigmoid notch absence, poor soft tissues, or excessive ulnar resection.
• The procedure demonstrated successful restoration of DRUJ function and stability in the studied cohort.
• Patients reported a significant ability to return to regular activities, with functional outcomes maintained at 5-year follow-up.

Conclusions:

• Constrained TDRUJ replacement is a viable reconstructive option for complex DRUJ pathologies where other treatments may fail.
• Careful patient selection and surgical technique are paramount for successful outcomes.
• This implant provides a durable solution, allowing patients to regain functional wrist use and return to their desired activities.