Trends in MCP joint arthrodesis and arthroplasty incidence in the U.S. from 2009 to 2019
Erica Smearman, MD PhD1; Anthony Karzon, MD2; Zaamin Hussain, MD3; Andrew M Gabig, MD2; Hayden Cooke, BS2; Michael B. Gottschalk, MD3; Eric R. Wagner, MD3
1Emory University School of Medicine, Atlanta, GA; 2Emory School of Medicine, Atlanta, GA; 3Emory University, Atlanta, GA"
Introduction: The purpose of this study was to assess the long-term patient-reported, clinical, and radiographic outcomes after distal ulnar resection (the Darrach procedure) in young adults. We hypothesized that the Darrach procedure would produce good functional outcomes with high satisfaction and pain relief in the long-term.
Materials & Methods: A retrospective chart review identified all adult patients who underwent the Darrach procedure at 40 years of age or younger (mean 32 years, range 20-40 years) and had minimum of 5-year follow-up (mean 18 years, range 7-26 years). Twenty-two patients (24 wrists) were available for final follow-up. Fifteen patients (16 wrists) returned for in-person evaluation, while the remaining 7 patients (8 wrists) completed questionnaires by phone. Questionnaires included the Patient-Rated Wrist Examination (PRWE) and the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH). Subjective outcomes consisted of the visual analog scale (VAS) for pain (0-4) and for satisfaction (0-4). During in-person evaluation, range of motion, grip strength, and x-rays (including Scheker view) were obtained.
Results: Mean PRWE and QuickDASH scores were 32 (SD 24) and 34 (SD 21), respectively. Mean VAS for pain at rest was 0.2 (SD 0.6) and 1.1 (SD 1.2) with activity. Mean satisfaction score was 3.3 (SD 1.2). In 88% of cases (21/24), patients reported they would have the same surgery again. Of those who were employed preoperatively, 81% (13/16) returned to work. Wrist flexion was a mean of -15?, wrist extension -18?, radial deviation +16?, ulnar deviation -8?, pronation -2?, and supination -11? compared to the unaffected wrist. Grip strength was 64% of the contralateral side. Radioulnar convergence occurred in all patients but only 3 (23%) were symptomatic.
Conclusion: The Darrach procedure reflects good long-term patient-reported outcomes. Overall, patients can expect low pain scores, high satisfaction and return to work rates, and low reoperations following distal ulnar resection. Radioulnar convergence occurs universally but is asymptomatic in most cases. Therefore, the Darrach procedure may be a viable surgical option for DRUJ pathology in younger, more active adults, especially when other options are unavailable.
Level of Evidence: Therapeutic IV.
Keywords: Darrach procedure, distal ulnar resection, radioulnar convergence.
Back to 2023 Abstracts