Abstract
Background Chronic, dynamic bidirectional instability in the distal radioulnar joint (DRUJ)
is diagnosed clinically, based on the patient's complaints and the finding of abnormal
laxity in the vicinity of the distal ulna. In cases where malunion is ruled out or
treated and there are no signs of osteoarthritis, stabilization of the DRUJ may offer
relief. To this end, several different techniques have been investigated over the
past 90 years.
Materials and Methods In this article we outline the procedure for a new technique using a tendon graft
to reinforce the distal edge of the interosseous membrane.
Description of Technique A percutaneous technique is used to harvest the palmaris longus tendon and to create
a tunnel, just proximal to the sigmoid notch, through the ulna and radius in an oblique
direction. By overdrilling the radial cortex, the knotted tendon can be pulled through
the radius and ulna and the knot blocked at the second radial cortex, creating a strong
connection between the radius and ulna at the site of the distal oblique bundle (DOB).
The tendon is fixed in the ulna with a small interference screw in full supination,
preventing subluxation of the ulna out of the sigmoid notch during rotation.
Results Fourteen patients were treated with this novel technique between 2011 and October
2013. The QuickDASH score at 25 months postoperatively (range 16–38 months) showed
an improvement of 32 points. Similarly, an improvement of 33 points (67–34 months)
was found on the PRWHE. Only one recurrence of chronic, dynamic bidirectional instability
in the DRUJ was observed.
Conclusion This simple percutaneous tenodesis technique between radius and ulna at the position
of the distal edge of the interosseous membrane shows promise in terms of both restoring
stability and relieving complaints related to chronic subluxation in the DRUJ.
Keywords
distal radioulnar joint - distal oblique bundle - instability - posttraumatic wrist
disorder
