Physeal sparing distal radio-ulnar joint ligament reconstruction in children

Area of Science:

• Orthopedic Surgery
• Pediatric Orthopedics
• Sports Medicine

Background:

• Distal radio-ulnar joint (DRUJ) injuries are frequently under-reported in pediatric patients.
• Chronic instability of the DRUJ in children presents unique challenges due to the immature skeleton.
• Existing literature lacks specific guidance on DRUJ reconstruction methods for immature patients with chronic instability.

Purpose of the Study:

• To present a novel physeal sparing ligamentoplasty technique for chronic distal radio-ulnar joint instability in pediatric patients.
• To describe the outcomes of this technique in two pediatric cases.
• To evaluate the effectiveness of the technique in restoring DRUJ stability and forearm function.

Main Methods:

• A physeal sparing ligamentoplasty was performed on two pediatric patients with chronic DRUJ instability.
• A palmaris longus tendon graft was utilized, tunneled through the distal radius epiphysis and wrapped around the ulnar neck.
• The graft was secured in a neutral forearm position after failure of previous triangular fibrocartilage complex repair.

Main Results:

• Both patients achieved successful DRUJ stability following the ligamentoplasty.
• Grip strength averaged 90% of the contralateral uninjured side.
• Pronation-supination range of motion averaged 88% and 86% of the healthy side, respectively.
• No intraoperative or postoperative complications were reported.

Conclusions:

• The described physeal sparing ligamentoplasty is an effective technique for regaining distal radio-ulnar joint stability in pediatric patients with chronic instability.
• The technique demonstrated a minimal impact on pronation-supination range of motion.
• Further biomechanical studies are warranted to validate the effectiveness of this novel approach.