Chronic Distal Radioulnar Joint Instability Reconstruction: A Systematic Review and Meta-Analysis
Arshia Kazerouni, HBSc1; Eric C Mitchell, MD2; Joshua A Gillis, MD, FRCSC3
1Memorial University, St John's, NF, Canada; 2Western University, Roth | McFarlane Hand and Upper Limb Centre, London, ON, Canada; 3Division of Plastic Surgery, Eastern Health, St John's, NF, Canada
Introduction Distal Radioulnar Joint (DRUJ) instability results in wrist pain, weakness, and decreased range of motion. There are numerous approaches used to surgically manage chronic DRUJ instability, including both anatomic and non-anatomic techniques. The purpose of this study was to review the clinical outcomes of anatomic and extra-anatomic chronic DRUJ instability reconstruction techniques.
Materials & Methods A literature search was conducted using PubMed, Embase, Medline, and Cochrane databases by two reviewers based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We included all English language papers from 1980 to January 2022 with 5 or more patients, who underwent reconstruction for chronic DRUJ instability. We excluded articles which included salvage reconstruction and patients under 18 years old. We collected data on demographics, patient-reported outcome scores (PRWE, DASH, quickDASH, Mayo Wrist Score (MWS), VAS), range of motion, and post-op stability. We compared the weighted-means of outcomes between patients who underwent anatomic or non-anatomic reconstruction using t-tests.
Results 898 studies were identified and screened and 27 met our inclusion criteria with a total of 762 patients. The number of patients who underwent anatomic and non-anatomic reconstruction were 583 and 179, respectively. The average patient age was 26.7 years and average time to surgery was 21.0 months. Mean follow-up was 40.8 months (6-120). There was no significant difference between pre and post-operative outcomes within the non-anatomic group. There was a significant difference between pre and post-operative VAS (6.62 vs 2.28, p<0.05), DASH (49.43 vs 9.09, p<0.05), and MWS (54.06 vs 76.46 p<0.05) in the anatomic group. When comparing the anatomic to non-anatomic groups, there was a significant difference in post-op DASH (9.58 vs 38.96, p<0.05), MWS (78.7 vs 92.2, p<0.05), change in flexion (-1.63 vs 12.03, p<0.05), extension (-1.41 vs 12.48, p<0.05) and supination (-1.57 vs 10.41, p<0.05).
Conclusion: Our results suggest anatomic procedures are more effective at improving multiple patient-reported outcomes, which was not seen in non-anatomic techniques. Post-operative range of motion generally worsens after anatomic reconstruction compared to non-anatomic reconstruction, however, comparatively, the anatomic reconstruction group fairs better in patient reported outcome measures.
Back to 2023 Abstracts