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Distal radioulnar joint instability: trans-osseous flexible stabilization using nylon tape

  • Original Article
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European Orthopaedics and Traumatology

Abstract

Introduction

Distal radioulnar joint (DRUJ) instability causes pain, dysfunction, and weak grip. Casting may cause joint stiffness and osteopenia and cannot guarantee stability. Surgery includes a direct or indirect radioulnar tether and radioulnar ligament reconstruction. We hypothesized that nylon tape provides a direct intrinsic tether, restores joint stability and forearm function, and avoids tendon harvest.

Methods

Five patients with chronic and one case with acute DRUJ instability were recruited, with mean age of 32.1 years (22–49) and average follow-up of 37 months (6–59). Unstable ulnar head was confirmed in all cases. Under general anesthesia and C-arm control, two tunnels were created across radius and ulna. Nylon tape was passed within the ulna, across the DRUJ, through the radius, and then tied over a bone bridge. Functional assessment included pain evaluation, range of motion, and patient-rated wrist evaluation score (PRWES). Radiographs were used to assess maintenance of reduction.

Results

Five patients reported improved grip strength. Forearm rotation was satisfactory in four cases and with mild painful limitation in two. PRWES improved from 77 to 24.1 points. Patient satisfaction was 83.3 %. No foreign body reactions were reported until final follow-up. Radiographs showed maintenance of reduction in four cases and minimal dorsal displacement of the ulna in two cases.

Conclusion

This simple procedure, requiring no hardware removal, is a direct tether passing within the joint. Being strictly within bone, no soft tissues are violated. It provides immediate stability, maintains forearm rotation and allows restored grip strength and may be considered as a new treatment option.

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Conflict of interest

The authors declare that no funding or grant was received for the study and that they have neither a conflict of interest nor financial or personal relationship related to the study.

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Authors and Affiliations

  1. Orthopaedic Surgery Department, Ain Shams University Hospitals, Ain Shams University, Abbassia, Cairo, Egypt

    Sherif A. El Ghazaly, Ahmed N. Atiyya & Wael S. Abdel Magied

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  1. Sherif A. El Ghazaly
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  2. Ahmed N. Atiyya
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  3. Wael S. Abdel Magied
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Correspondence to Sherif A. El Ghazaly.

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El Ghazaly, S.A., Atiyya, A.N. & Magied, W.S.A. Distal radioulnar joint instability: trans-osseous flexible stabilization using nylon tape. Eur Orthop Traumatol 6, 323–329 (2015). https://doi.org/10.1007/s12570-015-0304-4

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  • DOI: https://doi.org/10.1007/s12570-015-0304-4

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