Ulnar Head Replacement and Related Biomechanics

Michael Sauerbier; Annika Arsalan-Werner; Elena Enderle; Miriam Vetter; Daniel Vonier

doi:10.1055/s-0032-1333464

Journal of Wrist Surgery, Table of Contents

J Wrist Surg 2013; 02(01): 027-032
DOI: 10.1055/s-0032-1333464

Special Focus Section: Distal Radioulnar Joint Arthroplasty

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Ulnar Head Replacement and Related Biomechanics

Michael Sauerbier

¹Department for Plastic, Hand and Reconstructive Surgery, Main-Taunus-Hospitals GmbH, Cooperation Hospital of the University Hospital Frankfurt, Academic Hospital of the University of Frankfurt am Main, Bad Soden am Taunus, Germany

,

Annika Arsalan-Werner

¹Department for Plastic, Hand and Reconstructive Surgery, Main-Taunus-Hospitals GmbH, Cooperation Hospital of the University Hospital Frankfurt, Academic Hospital of the University of Frankfurt am Main, Bad Soden am Taunus, Germany

,

Elena Enderle

²Departement for Orthopedic Trauma and Reconstructive Surgery, Asklepios Hospital St. Georg, Hamburg, Germany

,

Miriam Vetter

³Medical Approval Departement, Karlsruhe, Germany

,

Daniel Vonier

¹Department for Plastic, Hand and Reconstructive Surgery, Main-Taunus-Hospitals GmbH, Cooperation Hospital of the University Hospital Frankfurt, Academic Hospital of the University of Frankfurt am Main, Bad Soden am Taunus, Germany

› Author Affiliations

Abstract

A stable distal radioulnar joint (DRUJ) is mandatory for the function and load transmission in the wrist and forearm. Resectional salvage procedures such as the Darrach procedure, Bowers arthroplasty, and Sauvé-Kapandji procedure include the potential risk of radioulnar instability and impingement, which can lead to pain and weakness. Soft tissue stabilizing techniques have only limited success rates in solving these problems. In an attempt to stabilize the distal forearm mechanically following ulnar head resection, various endoprostheses have been developed to replace the ulnar head. The prostheses can be used for secondary treatment of failed ulnar head resection, but they can also achieve good results in the primary treatment of osteoarthritis of the DRUJ. Our experience consists of twenty-five patients (follow-up 30 months) with DRUJ osteoarthritis who were treated with an ulnar head prosthesis, with improvement in pain, range of motion, and grip strength. An ulnar head prosthesis should be considered as a treatment option for a painful DRUJ.

Keywords

distal radioulnar joint (DRUJ) - osteoarthritis - arthroplasty - ulnar head resection - ulnar head prosthesis

Full Text

References

References
1 Cooney III WP, Dobyns JH, Linscheid RL. Complications of Colles' fractures. J Bone Joint Surg Am 1980; 62 (4) 613-619
2 af Ekenstam F, Hagert CG. Anatomical studies on the geometry and stability of the distal radio ulnar joint. Scand J Plast Reconstr Surg 1985; 19 (1) 17-25
3 af Ekenstam F. Anatomy of the distal radioulnar joint. Clin Orthop Relat Res 1992; (275) 14-18
4 af Ekenstam F. Osseous anatomy and articular relationships about the distal ulna. Hand Clin 1998; 14 (2) 161-164
5 Linscheid RL. Biomechanics of the distal radioulnar joint. Clin Orthop Relat Res 1992; 275 (275) 46-55
6 Palmer AK, Werner FW. Biomechanics of the distal radioulnar joint. Clin Orthop Relat Res 1984; (187) 26-35
7 Bowers WH. Distal radioulnar joint arthroplasty: the hemiresection-interposition technique. J Hand Surg Am 1985; 10 (2) 169-178
8 Darrach W. Partial excision of lower shaft ulna deformity following Colles fracture. Ann Surg 1913; 57: 764-765
9 Kapandji IA. The Kapandji-Sauvé operation. Its techniques and indications in non rheumatoid diseases. Ann Chir Main 1986; 5 (3) 181-193
10 Watson HK, Ryu JY, Burgess RC. Matched distal ulnar resection. J Hand Surg Am 1986; 11 (6) 812-817
11 Carter PB, Stuart PR. The Sauve-Kapandji procedure for post-traumatic disorders of the distal radio-ulnar joint. J Bone Joint Surg Br 2000; 82 (7) 1013-1018
12 Faithfull DK, Kwa S. A review of distal ulnar hemi-resection arthroplasty. J Hand Surg [Br] 1992; 17 (4) 408-410
13 Lichtman DM, Ganocy TK, Kim DC. The indications for and techniques and outcomes of ablative procedures of the distal ulna. The Darrach resection, hemiresection, matched resection, and Sauvé-Kapandji procedure. Hand Clin 1998; 14 (2) 265-277
14 Millroy P, Coleman S, Ivers R. The Sauvé-Kapandji operation. Technique and results. J Hand Surg [Br] 1992; 17 (4) 411-414
15 Sauerbier M, Fujita M, Hahn ME, Neale PG, Berger RA. The dynamic radioulnar convergence of the Darrach procedure and the ulnar head hemiresection interposition arthroplasty: a biomechanical study. J Hand Surg [Br] 2002; 27 (4) 307-316
16 Sauerbier M, Hahn ME, Fujita M, Neale PG, Berglund LJ, Berger RA. Analysis of dynamic distal radioulnar convergence after ulnar head resection and endoprosthesis implantation. J Hand Surg Am 2002; 27 (3) 425-434
17 Bell MJ, Hill RJ, McMurtry RY. Ulnar impingement syndrome. J Bone Joint Surg Br 1985; 67 (1) 126-129
18 Bieber EJ, Linscheid RL, Dobyns JH, Beckenbaugh RD. Failed distal ulna resections. J Hand Surg Am 1988; 13 (2) 193-200
19 Field J, Majkowski RJ, Leslie IJ. Poor results of Darrach's procedure after wrist injuries. J Bone Joint Surg Br 1993; 75 (1) 53-57
20 Johnson RK, Shrewsbury MM. The pronator quadratus in motions and in stabilization of the radius and ulna at the distal radioulnar joint. J Hand Surg Am 1976; 1 (3) 205-209
21 Breen TF, Jupiter JB. Extensor carpi ulnaris and flexor carpi ulnaris tenodesis of the unstable distal ulna. J Hand Surg Am 1989; 14 (4) 612-617
22 Breen TF, Jupiter J. Tenodesis of the chronically unstable distal ulna. Hand Clin 1991; 7 (2) 355-363
23 Tsai TM, Shimizu H, Adkins P. A modified extensor carpi ulnaris tenodesis with the Darrach procedure. J Hand Surg Am 1993; 18 (4) 697-702
24 Sauerbier M, Hahn ME, Berglund LJ, An KN, Berger RA. Biomechanical evaluation of the dynamic radioulnar convergence after ulnar head resection, two soft tissue stabilization methods of the distal ulna and ulnar head prosthesis implantation. Arch Orthop Trauma Surg 2011; 131 (1) 15-26
25 Mühldorfer-Fodor M, Pillukat T, Pausch T, Prommersberger KJ, van Schoonhoven J. Rekonstruktion des distalen Radioulnrgelenks mit der HerbertUlnakopfprothese [in German]. Oper Orthop Traumatol 2011; 23 (2) 86-97
26 Scheker LR. Implant arthroplasty for the distal radioulnar joint. J Hand Surg Am 2008; 33 (9) 1639-1644
27 van Schoonhoven J, Fernandez DL, Bowers WH, Herbert TJ. Salvage of failed resection arthroplasties of the distal radioulnar joint using a new ulnar head prosthesis. J Hand Surg Am 2000; 25 (3) 438-446
28 Willis AA, Berger RA, Cooney III WP. Arthroplasty of the distal radioulnar joint using a new ulnar head endoprosthesis: preliminary report. J Hand Surg Am 2007; 32 (2) 177-189
29 Hagert CG. The distal radioulnar joint in relation to the whole forearm. Clin Orthop Relat Res 1992; 275 (275) 56-64
30 De Smet L, Fabry G. Orientation of the sigmoid notch of the distal radius: determination of different types of the distal radioulnar joint. Acta Orthop Belg 1993; 59 (3) 269-272
31 Schuind F, An KN, Berglund L , et al. The distal radioulnar ligaments: a biomechanical study. J Hand Surg Am 1991; 16 (6) 1106-1114
32 Hagert CG. Distal radius fracture and the distal radioulnar joint—anatomical considerations. Handchir Mikrochir Plast Chir 1994; 26 (1) 22-26
33 Haugstvedt JR, Berger RA, Nakamura T, Neale P, Berglund L, An KN. Relative contributions of the ulnar attachments of the triangular fibrocartilage complex to the dynamic stability of the distal radioulnar joint. J Hand Surg Am 2006; 31 (3) 445-451
34 Masaoka S, Longsworth SH, Werner FW, Short WH, Green JK. Biomechanical analysis of two ulnar head prostheses. J Hand Surg Am 2002; 27 (5) 845-853
35 Berger RA, Cooney III WP. Use of an ulnar head endoprosthesis for treatment of an unstable distal ulnar resection: review of mechanics, indications, and surgical technique. Hand Clin 2005; 21 (4) 603-620 , vii
36 Fernandez DL, Joneschild ES, Abella DM. Treatment of failed Sauvé-Kapandji procedures with a spherical ulnar head prosthesis. Clin Orthop Relat Res 2006; 445: 100-107
37 Kalb KH, Ludwig A, Tauscher A, Landsleitner B, Wiemer P, Krimmer H. Behandlungsergebnisse nach operativer Handgelenkversteifung [in German]. Handchir Mikrochir Plast Chir 1999; 31 (4) 253-259
38 Cooney WP, Bussey R, Dobyns JH, Linscheid RL. Difficult wrist fractures. Perilunate fracture-dislocations of the wrist. Clin Orthop Relat Res 1987; (214) 136-147
39 van Schoonhoven J, Herbert TH, Krimmer H. Neue Konzepte der Endoprothetik des distalen Radioulnargelenkes [in German]. Handchir Mikrochir Plast Chir 1998; 30 (6) 387-392
40 Yen Shipley N, Dion GR, Bowers WH. Ulnar head implant arthroplasty: an intermediate term review of 1 surgeon's experience. Tech Hand Up Extrem Surg 2009; 13 (3) 160-164
41 van Schoonhoven J, Mühldorfer-Fodor M, Fernandez DL, Herbert TJ. Salvage of failed resection arthroplasties of the distal radioulnar joint using an ulnar head prosthesis: long-term results. J Hand Surg Am 2012; 37 (7) 1372-1380
42 Herzberg G. Periprosthetic bone resorption and sigmoid notch erosion around ulnar head implants: a concern?. Hand Clin 2010; 26 (4) 573-577
43 De Smet L, Peeters T. Salvage of failed Sauvé-Kapandji procedure with an ulnar head prosthesis: report of three cases. J Hand Surg [Br] 2003; 28 (3) 271-273
44 Vonier D, Enderle E, Sauerbier M. Die Behandlung der Arthrose des distalen Radioulnargelenks [in German]. Unfallchirurg 2012; 115 (7) 589-597