Salvage of the failed Darrach procedure

Area of Science:

• Orthopedic Surgery
• Hand and Wrist Surgery
• Reconstructive Surgery

Background:

• Darrach resection for distal ulna issues can lead to instability and impingement.
• Previous reconstructions have had limited success in addressing complex instability.
• A novel approach is needed to restore both coronal and sagittal stability.

Purpose of the Study:

• To evaluate a three-component reconstruction technique for post-Darrach resection dorsal instability and radioulnar impingement.
• To assess the functional outcomes, including range of motion and grip strength.
• To determine the efficacy in relieving pain and restoring function.

Main Methods:

• Six patients with failed Darrach resection underwent a three-component reconstruction.
• Technique involved extensor carpi ulnaris tenodesis, pronator quadratus transfer, and percutaneous pinning.
• Patients were followed for an average of 20 months (range, 11-39 months).

Main Results:

• Preserved wrist extension-flexion arc with minimal loss of radial/ulnar deviation.
• Forearm rotation arc increased by 24 degrees, achieving 95% of the contralateral wrist.
• Postoperative grip strength improved to 80% of the unoperated extremity, with 4/6 patients returning to work.
• All patients reported pain-free forearm rotation and resolution of mechanical symptoms.

Conclusions:

• The three-component reconstruction is effective in correcting dorsal instability and radioulnar impingement after Darrach resection.
• This technique restores significant forearm rotation and grip strength while alleviating pain.
• It offers a viable solution for patients experiencing persistent symptoms following ulna resection.