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Dynamic radio-ulnar convergence after the Darrach procedure
1St Michael's Hospital, Toronto, Canada.
Summary
The Darrach procedure for wrist disorders is generally effective, with most patients satisfied. Dynamic radio-ulnar convergence is common but rarely causes symptoms, supporting distal ulna resection as a reliable option.
Area of Science:
- Orthopedic Surgery
- Hand Surgery
- Wrist Arthroscopy
Background:
- The Darrach procedure involves resecting the distal ulna for wrist pain and dysfunction.
- Post-traumatic wrist disorders often require surgical intervention, with the Darrach procedure being a common option.
Purpose of the Study:
- To evaluate the long-term outcomes and potential complications of the Darrach procedure.
- To assess the incidence and clinical significance of dynamic radio-ulnar convergence after Darrach resection.
Main Methods:
- A retrospective review of 23 patients (25 procedures) who underwent the Darrach procedure.
- In-person assessments included clinical examination, patient satisfaction questionnaires, and standardized radiographs during rest and maximal grip.
Main Results:
- Dynamic radio-ulnar convergence was observed in 14 wrists, with symptomatic impingement in only two.
- Convergence did not correlate with functional outcomes (grip, pinch, range of motion) but was associated with longer ulna excision.
- Nineteen of 23 patients reported satisfaction with the Darrach procedure.
Conclusions:
- Dynamic radio-ulnar convergence is a frequent radiographic finding after Darrach resection but rarely symptomatic.
- The Darrach procedure remains a reliable option for older patients with wrist pain and limited motion.
- Distal ulna excision should be limited to the minimum necessary to restore rotation.