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Stabilizing Effect of Ulnar Shortening Procedure for DRUJ Instability
Toshiyasu Nakamura, MD, PhD; Koji Abe, MD
International University of Health and Welfare, Tokyo, Japan

Ulnar shortening is widely indicated for ulnocarpal abutment syndrome. It also stabilizes the distal radioulnar joint (DRUJ), as long as either the dorsal or palmar portion of the radioulnar ligament (RUL) attached to the ulnar fovea. We retrospectively analyzed our case series.
Method: There were 663 wrists of 624 patients, who underwent ulnar shortening procedure done by single surgeon. Among them, 70 wrists of 68 patients indicated mild to severe DRUJ instability. There were 34 males and 34 females, with 36 right, 30 left, and 2 bilateral wrists. Age ranged 19-63, with an average of 34 years. Preoperative ulnar variance indicated 2.0 mm (range: 0-6.5). All wrists indicated pain, while there was no limitation of pronosupination range. Mild DRUJ instability, which indicated more instability compared to the intact contralateral side, was noted in 11 wrists, moderate instability indicating no endpoint either in dorsal or palmar direction in 41, severe DRUJ instability demonstrating instability without endpoints both in dorsal or palmar direction in 18. Arthroscopic examination including DRUJ exploration was done before shortening of the ulna. The ulna was shortened by average 2.4 mm (range: 2-6.5). If there was still DRUJ instability, additional open repair or reconstruction of the DRUJ using ECU half-slip tendon was performed. We evaluated arthroscopic findings, clinical results using our original DRUJ evaluation system.
Results: There were Palmer 2A tear in 43, Palmer 2C tear in 3, and Palmer 1B tear in 8 wrists through radiocarpal arthroscopy. DRUJ arthroscopy revaluated partial dorsal tear of the RUL in 9 and complete avulsion of the RUL at the fovea in 10 wrists. We added open TFCC repair in 7 wrists of complete avulsion of the RUL and 3 wrists needed reconstruction of the TFCC. Overall clinical results obtained were 59 excellent, 9 good, 1 fair and 1 poor. Eleven wrists with mild DRUJ instability all obtained excellent clinical results only with ulnar shortening. In 41 wrists with moderate DRUJ instability, ulnar shortening obtained 40 excellent and 1 poor clinical results. However, in severe DRUJ instability wrists, we obtained 8 excellent, 9 good and 1 fair clinical results even with additional procedure.
Conclusion: Ulnar shortening obtained excellent clinical results in the wrists with mild to moderate DRUJ instability. When the RUL was avulsed from the ulnar fovea completely, ulnar shortening could no longer restabilize the DRUJ. In such case, repair or reconstruction of the RUL is necessary.


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