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Distal radioulnar joint hemiresection

86 citationsUpdated Oct 2026
Illustration: Distal radioulnar joint hemiresection

For patients: a plain-language version of this topic is available. See the patient guide.

Overview

Distal radioulnar joint hemiresection arthroplasty is an effective procedure for relieving symptoms and improving function with low morbidity [10]. It serves as a salvage option for patients with chronic post-traumatic dorsal subluxation of the distal ulna [4] and for severely damaged, painful distal radioulnar joints that require reconstruction via resection arthroplasty or hemi- or total arthroplasty [3]. Arthroplasty represents the best surgical option for patients with post-traumatic disorders of the distal radio-ulnar joint [71]. Primary excision of the ulnar head is a reliable and safe procedure for elderly patients with distal ulna fractures associated with distal radius fractures, permitting early mobilization and minimizing complications at the distal radio-ulnar joint [74].

The Darrach distal ulna resection is an excellent operative procedure when indications are appropriate and performed meticulously with the utmost attention to detail [69]. However, this resection creates extreme instability of the forearm with ulnar movement of the radius [197]. In contrast, hemiresection interposition arthroplasty demonstrates significantly less instability compared with Darrach resection results [197]. Pronator quadratus interposition is a safe, relatively effective, and technically straightforward method that can salvage patients who have failed distal radioulnar resection arthroplasties by decreasing pain and improving grip strength [22]. Treatment with diagnostic wrist arthroscopy and Bowers hemiresection resulted in an excellent outcome at 12 months after surgery for traumatic osteonecrosis of the distal ulna [2].

When appropriate patient selection criteria are met, partial and total ulnar head replacement typically produce reliable results [79]. Ulnar head replacement and sigmoid notch resurfacing arthroplasty provides a feasible option for distal radial ulnar joint arthritis, resulting in substantial improvements in pain and function over short-term follow-up [23]. The Eclypse distal radio-ulnar prosthesis is less invasive and preserves the bone and ligaments [76]. Distal radioulnar joint arthroplasty improved functional outcomes in both implant groups, but reoperations were frequent [13]. The introduction of ulnar head and total radio-ulnar joint prostheses has provided a new method for failed ulnar head resection, but there is presently no evidence that these implants produce long-lasting results [198]. In the Sauvé-Kapandji operation, the ulnar resection is performed subperiostically to favor the stability of the proximal stump, avoiding or reducing radio-ulnar convergence [75].

Anatomy & Pathophysiology

Bony Anatomy and Kinematics

The ulnar styloid extends 2 to 6 mm distal to the ulnar head [41]. The shallow sigmoid notch provides approximately 20% of distal radioulnar joint stability through articular surface contact [41]. In the neutral forearm position, the joint permits approximately 1 cm of dorsopalmar translation [41]. During forearm rotation, the ulnar head migrates from a dorsal and distal position in full pronation to a proximal and palmar position in full supination [41]. The thickness of the articular disc exhibits an inverse relationship to the degree of ulnar variance [41]. The relative importance of the distal radioulnar joint in coordinated upper extremity motion and function is gaining greater recognition [7]. Contact area at the joint increases during wrist flexion and decreases during wrist extension and ulnar deviation [107]. Axial loading of the wrist increases ulnar variance [92].

Ligamentous Anatomy and Stability

The triangular fibrocartilage complex comprises the dorsal and volar radioulnar ligaments, ulnar collateral ligament, meniscal homologue, articular disc, ulnolunate ligaments, ulnotriquetral ligaments, and extensor carpi ulnaris sheath [41]. Deep fibers of the complex attach ulnarly at the head of the ulna, known as the “fovea” [41]. Superficial fibers attach to the ulnar styloid tip, where they join the ulnar collateral ligaments [41]. Most distal radioulnar ligaments and the ulnocapitate ligament attach to the fovea at the base of the ulnar styloid [41]. The articular disc spans from the distal margin of the sigmoid notch to the fovea at the base of the ulnar styloid [41]. The extensor carpi ulnaris sheath and portions of the distal radioulnar ligaments attach to the ulnar styloid [41]. The flexor carpi ulnaris and extensor carpi ulnaris muscles act as dynamic stabilizers of the distal radioulnar joint [104]. When the interosseous membrane is disrupted, the dorsal radioulnar ligament is more important than the palmar radioulnar ligament for stabilizing the joint in pronation [56]. Conversely, when the interosseous membrane is disrupted, the palmar radioulnar ligament is more important than the dorsal radioulnar ligament for stabilizing the joint in supination [56]. Dislocation and frequent diastasis of the distal radioulnar joint occur only with sectioning of all four stabilizing structures: the dorsal and palmar radioulnar ligaments, and the interosseous membrane [56]. The wrist's position and the direction of radial translation alter the effectiveness of stabilization provided by reconstructing the interosseous membrane's distal oblique bundle [84].

Biomechanics and Load Distribution

Loads applied to the distal radiocarpal and ulnocarpal joints are distributed approximately 80% to the distal radius and 20% to the ulna [41]. In an extrinsic grip model, 51% of total forearm force was transmitted through the distal radius [109]. Radial shortening causes the greatest disturbance in kinematics and the most distortion of the triangular fibrocartilage [15]. Only 6 mm of radial shortening has been shown to cause distal radioulnar joint dysfunction [54]. Increasing ulnar variance by 2.5 mm dramatically increases the load borne by the distal ulna [54]. Changes in ulnar variance due to ulnar lengthening or radial shortening dramatically alter force transmission through the distal ulna [117]. All wrists have similar loading across the distal ulna regardless of ulnar variance, while pronation relatively increases loading across the distal ulna [103]. A fracture of the distal radius interferes with the biomechanical integrity of the wrist, limiting range of motion and affecting hand muscle strength [82].

Pathophysiology and Clinical Implications

Positive ulnar variance or protrusion of the ulna distal to its normal articulation can be caused by malunited Colles fracture, malunion or nonunion of the radius, and cessation or abnormality of growth of the distal radius [54]. Dysfunction of the distal radioulnar joint is a frequent source of persistent complaints after distal radial malunions [54]. Characteristic symptoms of distal radioulnar joint dysfunction include pain, decreased forearm rotation, decreased grip strength, and instability [54]. Radioulnar arthrosis has been found to be more common than radiocarpal arthrosis [54]. Approximately 70% of patients who develop radioulnar arthrosis require surgical intervention [54]. Deterioration of the distal radioulnar joint is believed to be caused by shortening and angular deformities of the distal radius [54]. Results for matched distal ulna resection were clearly superior in patients who had isolated problems of the distal radioulnar joint with a well-preserved distal radial articular surface and the absence of other instabilities of the wrist [1]. A matched distal ulnar resection is believed to be the best procedure when treatment of a painful distal radioulnar joint is necessary [5]. The range of motion of the wrist joint and forearm improved postoperatively, and grip strength in all wrists increased following hemiresection-interposition arthroplasty [48]. Rotational malalignment of the wrist has significant effects on carpal, distal radial and distal radioulnar joint measurements [83].

Classification

Fernandez: This classification defines various combinations of injuries to the distal radioulnar joint in distal radius fractures and guides treatment [59]. Type I injuries are stable, characterized by articular congruity and intact or minimally disrupted radioulnar ligaments [59]. Type II injuries are unstable despite adequate reduction of the distal radius and require surgical intervention [59]. Type III injuries involve disruption of the joint surface at the sigmoid notch or the ulnar head and require reduction and stabilization [59]. Stability of the distal radioulnar joint depends on the integrity of the sigmoid notch and the dorsal and volar radioulnar ligaments of the triangular fibrocartilage complex [59].

Frykman: This system identifies individual involvement of the radiocarpal and radioulnar joints and the presence or absence of a fracture of the ulnar styloid process [53]. It does not allow quantification of the extent or direction of initial fracture displacement, degree of comminution, or shortening of the distal fragment [53].

Older et al.: This classification system grades dorsal angulation, presence and extent of comminution, direction and extent of displacement, and identifies shortening of the distal radial fragment in relation to the distal ulna [53].

Bado: This classification system distinguishes four types of Monteggia lesions based on the mechanism of injury, treatment, and results [146]. Type I Monteggia lesions involve a fracture of the ulnar diaphysis with anterior angulation and an associated anterior dislocation of the radial head [146]. Type II Monteggia lesions involve a fracture of the ulnar diaphysis with posterior angulation and a posterolateral dislocation of the radial head [146]. Type III Monteggia lesions involve a fracture of the ulnar metaphysis with a lateral or anterolateral dislocation of the radial head [146]. Type IV Monteggia lesions involve a fracture of the proximal third of the radius and ulna at the same level with an anterior dislocation of the radial head [146].

Other Considerations: Early classifications of distal radial fractures were based on the fracture line, direction of displacement, degree of displacement, extent of articular involvement, and involvement of the distal radioulnar joint [53]. Contemporary classification systems for distal radius fractures include the systems of Older et al., the Comprehensive Classification of fractures, the Melone intra-articular classification system, and that of Fernandez [140]. None of the classification systems for distal radius fractures is ideal [142]. A new intra-articular distal radius fracture classification was proposed based on the affection condition of the volar or dorsal side [176]. The shape of the distal radioulnar joint in the midcoronal plane should be considered in the decision-making stage for ulnar impaction syndrome [72]. Following shortening of the ulna, the extent of joint contact decreased in all distal radioulnar joint types [169]. The maximum radioulnar separation and reduction in area of contact following ulnar shortening occurred in distal radioulnar joint types IB and IIB [169].

Clinical Presentation

Disorders of the distal radioulnar joint are a common source of ulnar-sided wrist pain [28]. The relative importance of this joint in coordinated upper extremity motions and function is gaining greater recognition [7]. A thorough knowledge of the anatomy and kinematics of the distal radioulnar joint is necessary to manage pathologic conditions [6]. Hand surgeons are better equipped to tailor specific treatment regimens to specific diagnoses based on current understanding of anatomy and biomechanics [16]. Distal radioulnar joint instability is often an underestimated lesion requiring systematic clinical examination and imaging for detection [55]. Untreated distal radioulnar joint injuries can give rise to long lasting complaints [9]. Post-traumatic abnormality of the distal radioulnar joint presents a therapeutic challenge, primarily due to failure to diagnose injuries early resulting in chronic disorders [58].

Symptoms and Physical Findings

Symptoms can be caused by malunion of fractures into the sigmoid notch, injuries to the triangular fibrocartilage complex, and palmarly displaced malunions of ulnar styloid fractures [54]. Significant extraarticular deformities of the distal radius adversely affect distal radioulnar joint function [54]. In patients with a symptomatic failed distal ulna resection, the presentation typically includes incapacitating pain over the distal stump of the ulna, aggravated by forearm rotation and grip [50]. These patients also report a sensation of instability and complaints of grip weakness [50]. Painful grinding and mechanical limitations to forearm rotation lead to painful disuse of the upper extremity in symptomatic failed distal ulna resections [50]. The diagnosis of symptoms as secondary to a failed distal ulna resection and subsequent radio-ulnar impingement or instability is clinical [50]. History and physical exam findings are usually diagnostic for failed distal ulna resection and are supported by plain radiographs [50]. While radioulnar convergence is common following excision of the distal ulna, not all patients are symptomatic [50]. Synovial chondromatosis must be considered in the differential diagnosis in a patient presenting with pain and swelling of the distal radioulnar joint [152]. The distal radio-ulnar joint is rarely involved in synovial chondromatosis [17].

Imaging and Assessment

Clinical assessment alone of distal radioulnar joint instability following a distal radius fracture appears not to be reliable [29]. In the clinical situation, a true lateral view of the wrist is often not obtainable [60]. A diagnostic test is required for dynamic ulnar impingement because the condition is so frequently missed and to assist in the differential diagnosis of distal forearm pain [132]. Imaging the distal radioulnar joint requires knowledge of the complex bony, muscular, and ligamentous anatomy that contribute to this unique joint [134]. Standard well-positioned radiography is always the appropriate first step in any imaging evaluation of the wrist [134]. CT with multiplanar reformatting is the most helpful test for assessing congruity of the distal radioulnar joint after trauma [134].

Investigations

Plain radiography: Conventional radiography is the first-line imaging modality to exclude or diagnose wrist pathology [159]. To assess radioulnar variance, a "neutral position" plain posteroanterior view is obtained with the elbow flexed 90 degrees, the shoulder in neutral flexion-extension and radioulnar deviation, and the forearm and hand flat on the cassette [41]. A satisfactory lateral projection is obtained with the arm by the side, the elbow flexed 90 degrees, and the wrist in a neutral position [41]. Two new radiographic views of the wrist joint show tangential views of the articular surface of the distal radius in the antero-posterior and medio-lateral directions [67]. MRI should be used to validate radiographs in those that appear to be reverse oblique, as the true inclination might be different [173].

MRI: When conventional radiography is inconclusive, high-resolution 3 Tesla MRI is advised [159]. Improvements in imaging techniques have increased the usefulness of MRI in the evaluation of the distal radioulnar joint (DRUJ), especially tears of the triangular fibrocartilage complex (TFCC) [41]. MRI is a useful adjunct for determining the cause of ulnar wrist pathologies, but findings are often discordant when compared with diagnostic arthroscopy [189]. There is substantial surgeon-to-surgeon variation in interpreting MRI signal changes and arthroscopic findings in the distal radioulnar ligaments and central disc [167]. For young subjects, MRI is valuable for diagnosing ulnar detachment, although the ability to distinguish between proximal and distal laminae remains questionable [170]. Reconstructed animation from four-phase grip MRI demonstrated impairment of the articular disc and longitudinal instability of the distal radioulnar joint simultaneously [168].

CT: CT may clarify fractures of the sigmoid notch and is helpful in assessing distal radioulnar joint (DRUJ) instability [41]. Dynamic CT imaging shows promise for evaluating the distal radioulnar joint during wrist motion [181].

Bone scan: Bone scanning provides minimal information about the DRUJ [41].

Other Considerations: Arthroscopy is the gold standard for detection of TFCC tears [43]. The arthroscopic trampoline test is performed to assess TFCC resiliency by balloting the central portion with a small probe [43]. The arthroscopic hook test can be used to demonstrate peripheral detachment of the TFCC [43]. The arthroscopic suction test can show laxity of the TFCC when peripherally scarred in or foveal detachment when the DRUJ is clinically unstable [43]. Arthrographic findings of TFCC perforation do not correlate with clinical findings [41].

Treatment

Non-Operative

Most ulnar-sided wrist problems associated with distal radial fractures can be treated non-operatively initially, typically for over a year, in anticipation of substantial improvement with time [26]. A period of conservative treatment for distal radioulnar joint instability will not hinder future outcomes if symptomatic improvement is not achieved with conservative means and surgical intervention is then pursued at a later date [19]. In a survey of surgeons, distal radioulnar joint treatment was recommended in 67% (404 of 607) of scenarios, most commonly cast immobilization in 41% (247 of 607) [36]. Circumferential bracing that attempts to maintain the relationship between the distal radius and ulnar during forearm pronosupination can be effective for some patients with chronic distal radioulnar joint instability [124].

Operative

Indications: Matched distal ulna resection results are superior in patients with isolated distal radioulnar joint problems, a well-preserved distal radial articular surface, and the absence of other wrist instabilities [1]. The Darrach procedure is indicated for patients with distal radial-ulnar arthritis and a normal-to-decreased radial inclination angle [192]. The procedure is best suited for post-traumatic patients in whom distal radioulnar joint arthrosis is the primary cause of pain [20]. Distal radioulnar joint arthroplasty is considered the best surgical option for patients with post-traumatic disorders of the distal radio-ulnar joint [71]. Primary excision of the ulnar head is a reliable and safe procedure for elderly patients with distal ulna fractures associated with distal radius fractures, permitting early mobilization and minimizing complications at the distal radio-ulnar joint [74]. Other techniques for distal ulna resection are restricted to cases where the distal radio ulnar joint has been impaired [11]. The Wafer distal ulna resection is not indicated if instability or degenerative arthritis of the distal radioulnar joint is present or if there is carpal instability [12].

Surgical Approach / Technique: The Darrach distal ulna resection is an excellent operative procedure when indications are appropriate and performed with meticulous attention to detail [69]. In the Sauvé-Kapandji operation, the ulnar resection is performed subperiostically to favor the stability of the proximal stump and avoid or reduce radio-ulnar convergence [75]. If decreased forearm rotation persists after a distal radioulnar joint procedure, the problem may lie in the proximal radioulnar joint of the elbow, which may require debridement or radial head resection [88].

Implant Selection: The Herbert ulnar head prosthesis was a safe method of treatment and provided satisfactory midterm results for selected cases of distal radioulnar joint disorders [183]. Ulnar head replacement and sigmoid notch resurfacing arthroplasty provides a feasible option for distal radioulnar joint arthritis, resulting in substantial improvements in pain and function over short-term follow-up [23].

Adjuncts: In rheumatoid arthritis, meticulous soft tissue reconstruction and ECU rebalancing is paramount to the success of any operation involving the distal radioulnar joint [88]. The ulnar limb of the extensor retinaculum is used for dorsal capsular reconstruction and is sutured over the distal ulna palmar to the reduced ECU tendon in rheumatoid arthritis cases [88]. The proximal half of the radial aspect of the extensor retinaculum may be used as a sling around the ECU tendon and sutured to the more distal portion of the retinaculum to create a loose sling rather than a noose [88]. ECRL to ECU transfer is indicated in patients with MCP ulnar drift, a passively correctable wrist radial deviation deformity, and a spared radiocarpal joint [88]. ECRL to ECU transfer is useful in patients who lack the ability or can only weakly actively ulnar deviate the wrist [88].

Outcomes and Efficacy: Distal ulnar hemiresection arthroplasty is an effective procedure in relieving symptoms and improving function, with low morbidity [10]. The Darrach procedure provides reliably good long-term subjective and objective results for the treatment of a symptomatic distal radioulnar joint after a distal radius fracture [194]. In the long term, excision of the distal ulna in rheumatoid patients results in an improvement in some aspects of hand function [30].

Salvage and Revision Procedures: Pronator quadratus interposition is a safe, relatively effective, and technically straightforward method which can salvage some patients who have failed distal radioulnar resection arthroplasties by decreasing pain and improving grip strength [22]. Stabilization of the ulnar stump seems to alleviate pain and improve forearm rotation and functional outcomes, although no direct correlation exists between radioulnar convergence and patient outcomes [193]. A number of salvage options have been described for the painful unstable distal ulnar stump in patients who have tried many other non-operative and operative treatment options [120]. The painful distal radio-ulna impingement can be avoided by creating a long upper ulna segment in the Kapandji-Sauvé procedure [31].

Complications

Instability: Serious potential postoperative complications following excision of the distal ulna include instability and potentially painful impingement of the residual distal ulnar stump [195]. In a series of six cases of distal ulna resection performed via a volar approach, dorsal instability was not encountered [33]. The decision for reconstruction of chronic instability at both proximal and distal radioulnar joints may be difficult due to unpredictable outcomes [14].

Impingement and Incongruity: Symptomatic distal radioulnar joint incongruity and/or residual ulnocarpal abutment represent the most-likely reason for an unsatisfactory outcome after a corrective osteotomy is performed [61].

Other Considerations: Reoperations were frequent in patients undergoing distal radioulnar joint arthroplasty [13]. Attritional rupture of finger extensor tendons has been reported as a rare complication of nonsurgical management of Madelung deformity [135]. The ulnar-sided digital extensor tendons are most commonly involved in attritional rupture associated with Madelung deformity [135]. This rupture is caused by repeated mechanical irritation of the digital extensor tendons over the dorsal prominence of the subluxated ulnar head [135]. Pronator quadratus interposition can salvage some patients who have failed distal radioulnar resection arthroplasties by decreasing pain and improving grip strength [22].

Recovery

Light activity (weeks): The provided evidence does not specify a typical week range for the resumption of desk work, driving, or light activities of daily living.

Full activity (months): The provided evidence does not specify a month range for the return to manual work, sport, or full range of motion and strength.

Complete recovery / outcome plateau (months): The provided evidence does not specify a month range for the stabilization of pain, strength, and final functional outcomes.

Rehabilitation protocol: The provided evidence does not detail specific physical therapy phasing, immobilisation duration, weight-bearing or range-of-motion progression schedules, or sling and brace removal timing.

Functional milestones: Adams–Berger ligament reconstruction demonstrates favorable short-term restoration of distal radioulnar joint stability with clinically meaningful improvement in strength and patient-reported outcomes at 12 months [77]. Over short-term follow-up, ulnar head replacement and sigmoid notch resurfacing arthroplasty provides a feasible option for distal radioulnar joint arthritis, resulting in substantial improvements in pain and function [23].

Other Considerations: At a mean follow-up of 29.2 months, distal radioulnar joint stability was corrected in 97.2% of cases following arthroscopic TFCC reinsertion [32]. In a series of six cases involving volar approach distal ulna resection, no dorsal instability was encountered, and full restoration of forearm rotation occurred seemingly sooner than in cases where resection was performed through a dorsal or medial approach [33]. Mid- to long-term follow-up of patients after salvage allograft interposition arthroplasty of the distal radioulnar joint resulted in minimal functional improvement in terms of arc of motion and grip strength [184]. Early recognition of longitudinal radioulnar dissociation can aid in timely treatment and improved outcomes, with success rates around 80% for acute cases [18].

Key Evidence

  • [L4] Results were clearly superior in patients who had isolated problems of the distal radioulnar joint with a well-preserved distal radial articular surface and the absence of other instabilities of the wrist. [1] (10.1016/0363-5023(92)90324-i)
  • [L4] Treatment with diagnostic wrist arthroscopy and Bowers hemiresection resulted in an excellent outcome at 12 months after surgery. [2] (10.1016/j.jhsa.2021.05.019)
  • [L5] Severely damaged and painful distal radioulnar joints can be reconstructed by resection arthroplasty or by hemi- or total arthroplasty. [3] (10.1016/j.hcl.2020.07.008)
  • [L4] We consider hemiresection-interposition arthroplasty to be a salvage procedure for patients with chronic post-traumatic dorsal subluxation of the distal ulna. [4] (10.1016/0363-5023(93)90064-a)
  • [L4] A matched distal ulnar resection is believed to be the best procedure when treatment of a painful distal radioulnar joint is necessary. [5] (10.1016/s0363-5023(86)80228-3)
  • [L5] A thorough knowledge of the anatomy and kinematics of the distal radioulnar joint is necessary to manage pathologic conditions. [6] (10.1016/j.hcl.2005.08.002)
  • [Paper] The relative importance of the distal radioulnar joint in the coordinated upper extremity motions and function is finally gaining greater recognition. [7] (10.1097/bth.0b013e318033d96f)
  • [L5] Untreated distal radioulnar joint (DRUJ) injuries can give rise to long lasting complaints. [9] (10.2174/1874325001206010204)
  • [L4] We have found the operation of distal ulnar hemiresection arthroplasty to be an effective procedure in relieving symptoms and improving function, with low morbidity. [10] (10.1016/s0266-7681(05)80263-3)
  • [L4] The other techniques will be restricted to cases where the distal radio ulnar joint has been impaired. [11] (10.1016/j.main.2006.07.008)
  • [L4] The procedure is not indicated if instability or degenerative arthritis of the distal radioulnar joint is present or if there is carpal instability. [12] (10.1016/0363-5023(92)90325-j)
  • [L4] Distal radioulnar joint arthroplasty improved functional outcomes in both the implant groups, but reoperations were frequent. [13] (10.1016/j.jhsa.2022.02.014)
  • [Case_report] The decision for reconstruction of chronic instability at both proximal and distal radioulnar joints may be difficult due to unpredictable outcomes. [14] (10.1007/s00402-007-0456-y)
  • [L5] Radial shortening caused the greatest disturbance in kinematics and the most distortion of the triangular fibrocartilage. [15] (10.1016/0363-5023(93)90098-n)
  • [L5] Hand surgeons are better equipped to tailor specific treatment regimens to specific diagnoses based on current understanding of anatomy and biomechanics. [16] (10.1016/j.jhsa.2008.11.016)
  • [L5] The distal radio-ulnar joint is rarely involved. [17] (10.1016/j.jhsb.2006.02.004)
  • [L5] Early recognition of longitudinal radioulnar dissociation can aid in timely treatment and improved outcomes, with success rates around 80% for acute cases. [18] (10.1016/j.hcl.2007.01.005)
  • [L5] A period of conservative treatment for distal radioulnar joint instability will not hinder future outcomes if symptomatic improvement is not achieved with conservative means and surgical intervention is then pursued at a later date. [19] (10.1016/j.arthro.2022.01.018)
  • [L4] The procedure is best suited for post-traumatic patients in whom distal radioulnar joint arthrosis is the primary cause of pain. [20] (10.1054/jhsb.1999.0288)
  • [L4] Pronator quadratus interposition is a safe, relatively effective, and technically straightforward method which can salvage some patients who have failed distal radioulnar resection arthroplasties by decreasing pain and improving grip strength. [22] (10.1016/s0363-5023(96)80154-7)
  • [L4] Over short-term follow-up, the procedure provides a feasible option for distal radial ulnar joint arthritis, resulting in substantial improvements in pain and function. [23] (10.1177/1753193419850116)
  • [L5] Most ulnar-sided wrist problems associated with distal radial fractures can be treated non-operatively initially, typically for over a year, in anticipation of substantial improvement with time. [26] (10.1177/17531934221140238)
  • [L5] Disorders of the distal radioulnar joint are a common source of ulnar-sided wrist pain, but increased understanding of anatomy and pathology has facilitated accurate diagnosis and successful treatment in most cases. [28] (10.5435/00124635-199503000-00005)
  • [L3] Clinical assessment alone of distal radioulnar joint instability following a distal radius fracture appears not to be reliable. [29] (10.1177/17531934211016668)
  • [L4] In the long term, excision of the distal ulna in rheumatoid patients results in an improvement in some aspects of hand function. [30] (10.1016/j.jhsa.2010.04.034)
  • [L4] The painful distal radio-ulna impingement can be avoided by creating a long upper ulna segment. [31] (10.1016/s0363-5023(03)80392-1)
  • [L4] At a mean follow-up of 29.2 months, distal radioulnar joint (DRUJ) stability was corrected in 97.2% of cases. [32] (10.1016/j.hansur.2019.10.023)
  • [L4] In their series of six cases, they did not encounter dorsal instability, and full restoration of forearm rotation occurred seemingly sooner than in cases where resection was performed through a dorsal or medial approach. [33] (10.1097/00130911-199809000-00008)
  • [L4] Surgeons recommended distal radioulnar joint treatment in 67% (404 of 607) of the scenarios, most commonly cast immobilization in 41% (247 of 607). [36] (10.1177/17531934261449057)
  • [L4] The range of motion of the wrist joint and forearm improved postoperatively, and grip strength in all wrists increased. [48] (10.1016/s0363-5023(10)80077-2)
  • [L4] [50] (10.1055/s-0032-1333062)
  • [L5] [53] (10.1016/0020-1383(95)90125-6)
  • [L5] Distal radioulnar joint instability is often an underestimated lesion requiring systematic clinical examination and imaging for detection. [55] (10.1007/s00402-020-03371-0)
  • [L5] [56] (10.1016/s0363-5023(05)80139-x)
  • [L5] Post-traumatic abnormality of the distal radioulnar joint (DRUJ) presents a therapeutic challenge, primarily due to failure to diagnose injuries early resulting in chronic disorders. [58] (10.1016/s0020-1383(02)00286-3)
  • [L5] [59] (10.1016/j.hcl.2021.02.011)
  • [L5] In the clinical situation, however, a true lateral view of the wrist is often not obtainable. [60] (10.1016/s0363-5023(83)80046-x)
  • [L4] Symptomatic distal radioulnar joint incongruity and/or residual ulnocarpal abutment represent the most-likely reason for an unsatisfactory outcome after a corrective osteotomy is performed. [61] (10.1097/00130911-200203000-00006)
  • [L4] The authors describe two new radiographic views of the wrist joint which show the tangential views of the articular surface of the distal radius in the antero-posterior and the medio-lateral directions. [67] (10.1016/s0020-1383(01)00155-3)
  • [L5] The Darrach distal ulna resection is an excellent operative procedure when indications are appropriate and when performed in a meticulous fashion requiring the utmost attention to detail. [69] (10.1016/s0363-5023(96)80220-6)
  • [L4] We believe that arthroplasty represents the best surgical option for patients with post-traumatic disorders of the distal radio-ulnar joint. [71] (10.1016/0266-7681(92)90201-c)
  • [L4] The shape of the distal radioulnar joint in the midcoronal plane should be considered in the decision-making stage. [72] (10.1177/1558944716660555hz)
  • [L4] Primary excision of the ulnar head for distal ulna fracture associated with distal radius fracture is a reliable and safe procedure for elderly patients, which permits early mobilization and minimizes complications at the distal radio-ulnar joint. [74] (10.1177/1753193413504160)
  • [L4] The ulnar resection is performed subperiostically; this favours the stability of the proximal stump, avoiding or reducing radio-ulnar convergence. [75] (10.1016/0266-7681(94)90172-4)
  • [L4] This distal radio-ulnar arthroplasty is less invasive and preserves the bone and ligaments. [76] (10.1016/j.otsr.2016.01.012)
  • [L2] Adams–Berger ligament reconstruction demonstrated favorable short-term restoration of distal radioulnar joint stability with clinically meaningful improvement in strength and patient-reported outcomes at 12 months. [77] (10.1016/j.jhsa.2026.07.008)
  • [L4] When appropriate patient selection criteria are met, partial and total ulnar head replacement typically produce reliable results. [79] (10.1177/1753193417693177)
  • [L3] These results supported the initial hypothesis that a fracture of the distal radius interferes with the biomechanical integrity of the wrist, limiting range of motion and affecting hand muscle strength. [82] (10.1177/1758998315574352)
  • [L4] Rotational malalignment of the wrist has significant effects on carpal, distal radial and distal radioulnar joint measurements. [83] (10.1177/1753193408090393)
  • [L5] However, the wrist's position and the direction of radial translation seem to alter the stabilization's effectiveness. [84] (10.1016/j.otsr.2020.03.041)
  • [L5] [88] (10.1016/j.hcl.2005.08.009)
  • [L2] Axial loading of the wrist increases ulnar variance. [92] (10.1055/s-0038-1627458)
  • [L5] The results show that all wrists have similar loading across the distal ulna regardless of ulnar variance, while pronation relatively increases loading across the distal ulna. [103] (10.1016/j.jhsa.2014.10.001)
  • [L4] The flexor carpi ulnaris and extensor carpi ulnaris muscles serve as dynamic stabilizers of the distal radioulnar joint. [104] (10.1177/17531934231168299)
  • [L4] The contact area of the DRUJ increases during wrist flexion and decreases during wrist extension and ulnar deviation. [107] (10.1016/j.jhsa.2015.07.027)
  • [L3] Fifty-one percent of the total forearm force was transmitted through the distal radius in this model. [109] (10.1053/jhsu.2000.6915)
  • [L5] Changes in ulnar variance of a forearm due to ulnar lengthening or radial shortening do, however, dramatically alter the force transmission. [117] (10.1016/0363-5023(92)90342-m)
  • [L5] [120] (10.1142/s2424835516500168)
  • [L5] [124] (10.1016/j.jht.2016.03.012)
  • [L4] A diagnostic test is required because the condition is so frequently missed and also to assist in the differential diagnosis of distal forearm pain in this particular clinical context. [132] (10.1016/s0266-7681(97)80264-1)
  • [L5] [134] (10.1016/j.hcl.2010.07.001)
  • [L5] [135] (10.5435/00124635-201306000-00007)
  • [L5] This review highlights a number of contemporary classification systems for distal radius fractures, including the systems of Older et al., the Comprehensive Classification of fractures, the Melone intra-articular classification system, and that of Fernandez. [140] (10.1016/s0363-5023(97)80110-4)
  • [L5] None of the classification systems for distal radius fractures is ideal. [142] (10.1016/j.hansur.2016.02.012)
  • [L5] [146] (10.1016/j.hcl.2007.01.008)
  • [L5] Although rare in the wrist, synovial chondromatosis must be considered in the differential diagnosis in a patient presenting with pain and swelling of the distal radioulnar joint. [152] (10.1016/s0363-5023(97)80056-1)
  • [L2] Conventional radiography should be the first imaging modality to exclude or diagnose wrist pathology; when inconclusive, high resolution 3 Tesla MRI is advised. [159] (10.1177/1753193416683876)
  • [L5] There is substantial surgeon-to-surgeon variation in interpreting MRI signal changes and arthroscopic findings in the distal radioulnar ligaments and central disc, raising concerns about overdiagnosis and overtreatment versus underdiagnosis. [167] (10.1177/17531934241254705)
  • [L4] Reconstructed animation from four-phase grip MRI demonstrated impairment of the articular disc and longitudinal instability of the distal radioulnar joint simultaneously and should be of value in investigating dynamic pathophysiology causing ulnar wrist pain. [168] (10.1177/1753193413476979)
  • [L5] Following shortening of the ulna, the extent of joint contact decreased in all DRUJ types, with the maximum radioulnar separation and reduction in area of contact occurring in DRUJ type IB and IIB. [169] (10.1016/s0266-7681(00)80006-6)
  • [L3] For young subjects, MRI is still valuable, especially in diagnosing ulnar detachment, although the ability to distinguish between proximal and distal laminae remains questionable. [170] (10.1177/17531934221141986)
  • [L4] MRI should be used to validate radiographs in those that appear to be reverse oblique, as the true inclination might be different, thereby removing one possible contraindication to ulnar shortening. [173] (10.1302/0301-620x.99b3.38051)
  • [L3] A new intra-articular distal radius fractures classification was proposed based on the affection condition of volar or dorsal side. [176] (10.1186/s12891-024-08215-1)
  • [L4] Dynamic CT imaging shows promise for evaluating the distal radioulnar joint during wrist motion. [181] (10.1177/17531934251397297)
  • [L4] The Herbert ulnar head prosthesis was a safe method of treatment and provided satisfactory midterm results for selected cases of distal radioulnar joint disorders. [183] (10.1016/j.jhsa.2015.06.100)
  • [L4] Mid- to long-term follow-up of patients after salvage allograft interposition arthroplasty of the DRUJ resulted in minimal functional improvement in terms of arc of motion and grip strength. [184] (10.1016/j.jhsa.2021.12.014)
  • [L2] While MRI is a useful adjunct for determining the cause of ulnar wrist pathologies, findings are often discordant when compared with diagnostic arthroscopy. [189] (10.1016/j.jhsa.2024.04.015)
  • [L4] It is indicated for use in patients who have distal radial-ulnar arthritis, and a normal-to-decreased radial inclination angle. [192] (10.1016/0363-5023(91)90011-y)
  • [L5] Stabilization of the ulnar stump seems to alleviate pain and improve forearm rotation and functional outcomes, although no direct correlation exists between radioulnar convergence and patient outcomes. [193] (10.1016/j.hcl.2014.12.003)
  • [L4] The Darrach procedure provides reliably good long-term subjective and objective results for the treatment of a symptomatic DRUJ after a distal radius fracture. [194] (10.1016/j.jhsa.2012.08.044)
  • [L5] Although outcomes are typically favorable following excision of the distal ulna, serious potential postoperative complications include instability and potentially painful impingement of the residual distal ulnar stump. [195] (10.5435/00124635-201210000-00002)
  • [L5] The Darrach resection created extreme instability of the forearm with ulnar movement of the radius, whereas the hemiresection interposition arthroplasty demonstrated significantly less instability compared with the Darrach results. [197] (10.1054/jhsb.2002.0763)
  • [L5] The introduction of ulnar head and total radio-ulnar joint prostheses has provided a new method, but there is presently no evidence that these implants produce long-lasting results. [198] (10.1054/jhsb.2002.0815)

See Also

References

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[2] Traumatic Osteonecrosis of the Distal Ulna. The Journal of Hand Surgery. 2022. DOI: 10.1016/j.jhsa.2021.05.019

[3] Solutions for the Unstable and Arthritic Distal Radioulnar Joint. Hand Clinics. 2020. DOI: 10.1016/j.hcl.2020.07.008

[4] Treatment of chronic post-traumatic dorsal subluxation of the distal ulna by hemiresection-interposition arthroplasty. The Journal of Hand Surgery. 1993. DOI: 10.1016/0363-5023(93)90064-a

[5] Matched distal ulnar resection. The Journal of Hand Surgery. 1986. DOI: 10.1016/s0363-5023(86)80228-3

[6] Hemiresection Arthroplasty of the Distal Radioulnar Joint. Hand Clinics. 2005. DOI: 10.1016/j.hcl.2005.08.002

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3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

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