Decompression corrective osteotomy of the distal radius for treatment of the DRUJ-incongruency and impingement syndrome with focus on posttraumatic cases.

INTRODUCTION

Posttraumatic or congenital ulna-minus variance with altered shape of the sigmoid notch and increased tension of the distal oblique band of the interosseous membrane (DIOM) can lead to painful impingement in the distal radioulnar joint (DRUJ) during rotation and loading of the forearm. As an operative treatment concept, a new method was described in 2016. Its goal is to restore the osseous congruency, which is required for normal painless function. The hypothesis is based on remodelling of the joint surface and the decompression of the DRUJ by releasing the DIOM. The purpose of this study is to analyze the results of performed operations with detailed focus on posttraumatic cases.

MATERIALS AND METHODS

The indication for the operation is the impingement and incongruency in the DRUJ with ulna-minus variance. The surgical procedure is based on shortening and closed-wedge osteotomy of the distal radius with an ulnar translation of the radial shaft. Fifty-nine operations were performed between 2011 - 2022 on 52 patients (13 men, 39 women). Twenty-four patients were operated on the right side, 21 on the left side and 7 bilaterally. In 45 cases the operation was indicated because of congenital, in 12 cases due to posttraumatic incongruency and in 2 cases because of iatrogenic impingement after previously performed excessive ulnar shortening osteotomy. Modified Mayo-Wrist-Score, patient questioning, VAS and ROM were used to evaluate the results.

RESULTS

Significant reduction of pain on VAS from 7.22 to 1.98 (p < .001) was achieved. The pre- and postoperative range of motion did not show any significant changes (mean total arc of motion 301,94° vs. 295,20°, p = .300). Specific complications we observed included a too distally performed osteotomy, DRUJ instability, de Quervain´s tenosynovitis, persistent pain and conversion into an ulna-plus variance.

CONCLUSION

Under consideration of the indication criteria and correct execution of the osteotomy, in about 90 % of the cases this operation leads to good-to-excellent results with pain reduction and improvement of weight-bearing and power. The preoperative examination, verification of the DRUJ stability and the radiological diagnostics are crucial for a good outcome.