Comparative Analysis of Treatment Outcomes: Modified Ulnar Gutter Slab vs. Sugar Tong Slab for Distal Radioulnar...

Area of Science:

• Orthopedic Surgery
• Upper Extremity Reconstruction
• Sports Medicine

Background:

• Distal radioulnar joint (DRUJ) instability often requires surgical repair of the triangular fibrocartilage complex (TFCC).
• Traditional post-operative immobilization using a sugar tong slab can lead to significant elbow stiffness.
• There is a need for splinting techniques that maintain necessary immobilization while preserving joint mobility.

Purpose of the Study:

• To compare the efficacy of a modified ulnar gutter slab versus a traditional sugar tong slab for post-operative immobilization after arthroscopic TFCC repair.
• To evaluate the impact of each splinting technique on elbow mobility, forearm and wrist range of motion (ROM), and DRUJ stability.
• To assess patient-reported outcomes using the Disabilities of Arm, Shoulder, and Hand (DASH) score and identify any complications.

Main Methods:

• A prospective randomized controlled trial was conducted with 23 patients undergoing arthroscopic TFCC repair for DRUJ instability.
• Patients were randomly assigned to receive either a modified ulnar gutter slab or a sugar tong slab for post-operative immobilization.
• Outcomes measured included DASH scores, elbow, forearm, and wrist ROM, DRUJ stability assessments, and complication monitoring at 4 and 6 weeks.

Main Results:

• No significant difference was found in DASH scores between the two groups at 4 and 6 weeks.
• The modified ulnar gutter slab demonstrated a statistically significant improvement in elbow extension range of motion at 4 weeks (p = 0.011).
• Post-operative DRUJ stability was comparable between groups, with one case of complex regional pain syndrome (CRPS) in the sugar tong slab group.

Conclusions:

• The modified ulnar gutter slab is a viable post-operative alternative for TFCC repair.
• This technique effectively immobilizes the forearm and wrist while promoting enhanced elbow mobility.
• Utilizing the modified ulnar gutter slab may help mitigate post-operative elbow stiffness following DRUJ instability surgery.