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Outcomes of DRUJ Capsular Release for Post Traumatic Rotational Forearm Contracture
Graham King, MD, MSc, FRCSC
1; Alexandra B Munn, MD, MSc, FRCSC
21Hand and Upper Limb Center, Western University, London, ON, Canada; 2Western University, London, ON, Canada
Introduction Posttraumatic limitation of forearm rotation can occur anywhere along the forearm. It is often the result of scar formation at the level of the distal radioulnar joint (DRUJ) or the radiocarpal joint. In previous literature, very little emphasis has been placed on the DRUJ wrist capsule and its role in limiting pronation and supination. A gold standard treatment for management of rotational contracture has not previously been established. Our purpose was to determine the safety and effectiveness of volar, dorsal or combined DRUJ capsular release on restoring forearm rotation in patients with post-traumatic rotational stiffness.
Methods We retrospectively identified 14 patients who had previously undergone a volar, dorsal or combined DRUJ capsular release for post traumatic rotational contracture. Patients were excluded if they had contractures secondary to congenital deformities or underwent revision surgery. Our primary outcome of interest was final supination and pronation in degrees.
Results Between 2011-2023, 14 patients were identified meeting inclusion criteria with an average age of 43 ± 16 years. The mean time from procedure to follow up was 5.9 ± 4.1 years. The initial traumatic injuries were distal radius fractures (n= 8), olecranon fractures (n = 2), monteggia fracture (n= 1), radial neck fracture with ulnar fracture (n = 1), radial head fracture (n= 1) and a complex forearm fracture of radial head, coronoid, proximal and midshaft ulna and distal radius (n= 1). At final clinical follow up, supination and pronation were significantly improved compared to preoperative (p = 0.03; p = 0.009, respectively). Average preoperative supination was measured at 39°± 35.6° and postoperatively was 63°± 23.1°. Average preoperative pronation was measured at 33°± 31.6° and postoperatively was 64°± 30.0°. At final follow up Patient-Rated Wrist Evaluation (PRWE) pain mean was 15 ± 13, PRWE function mean was 9 ± 9 and PRWE total mean was 24 ± 21. Post operative complications included CRPS (n=1) and DRUJ instability requiring an ulnar shortening osteotomy (n=1).
Conclusions DRUJ capsular release is a viable option for rotational contractures of the forearm with a good restoration of range of both pronation and supination, good functional outcomes and a low incidence of complications.
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