A modified darrach procedure for treatment of the painful distal radioulnar joint

Controversy exists regarding the best treatment for pain and instability of the distal radioulnar joint. Until recently, the Darrach distal ulnar resection had been the standard procedure for this disorder. The Bowers hemiresection interposition arthroplasty, however, and the Watson matched distal ulna resection have been developed to preserve the styloid attachment of the triangular fibrocartilage complex. This article presents a retrospective chart review of a consecutive series of patients who had painful distal radioulnar joints which were treated with a modified Darrach procedure. This procedure was performed to alleviate the problems of impingement and styloid carpal abutment during grip, and provide stabilization. Fifteen patients (16 wrists) were seen during followup for an average of 37 months after resection arthroplasty of the distal ulna was performed; 6 procedures were revisions. The results were uniformly good with marked alleviation of pain in all but 1 patient. Patients experienced consistent improvement toward pain-free pronation/supination and increased grip strength.