Skip to main content
Log in

Die dorsale Kapseldoppelung zur Therapie der dorsalen Instabilität des distalen Radioulnargelenks

Dorsal capsular imbrication for dorsal instability of the distal radioulnar joint

  • Operative Techniken
  • Published:
Operative Orthopädie und Traumatologie Aims and scope Submit manuscript

Zusammenfassung

Operationsziel

Wiederherstellung der Stabilität des distalen Radioulnargelenks (DRUG) durch eine dorsale Kapseldoppelung bei dorsaler Instabilität mit dem Ziel der Schmerzreduktion und Vermeidung einer posttraumatischen Arthrose.

Indikationen

Posttraumatische dorsale Instabilität des distalen Radioulnargelenks mit klinisch fehlendem Anschlag bei Translation im DRUG oder Subluxation während aktiver Unterarmdrehbewegung. Auch indiziert bei bereits fehlgeschlagenen anderen stabilisierenden Techniken, wie z. B. Diskusnähten.

Kontraindikationen

Arthrose im DRUG, mehrfache Voroperationen im Kapselbereich des DRUG. Knochenbedingte Instabilitäten (fehlverheilte Frakturen und Pseudarthrosen) sollten bereits versorgt sein.

Operationstechnik

Dorsaler Zugang mit Eröffnung des 5. Strecksehnenfachs und Darstellen der dorsalen Kapsel des DRUG. Längsinzision der Kapsel mit Belassen radial und ulnar suffizienten Kapselgewebes zur Kapselraffung und Vorlegen von 2 U-Nähten mit „Fiber-wire“-Fadenmaterial. Reposition der Fehlstellung und Einstellung des Unterarms in Supination. Anziehen der vorgelegten Kapselnähte und Naht des Retinakulums mit einer fortlaufenden überwendlichen resorbierbaren Naht.

Weiterbehandlung

Oberarmgips in Supinationsstellung für 4 Wochen, gefolgt von einer Unterarmschiene zur Einschränkung der Pronation/Supination auf 45° für weitere 4 Wochen. Vollbelastung nach 12 Wochen möglich.

Ergebnisse

Die Nachuntersuchung von 20 Patienten ergab gute, zufriedenstellende Ergebnisse der Operationsmethode ohne wesentliche Komplikationen. Der durchschnittliche DASH-Wert („disabilities of the arm, shoulder and hand“) betrug 15,8 Punkte. Eine Schmerzreduktion konnte bei 17 der 20 Patienten (85 %) beobachtet werden. Die Instabilität war bei 18 Patienten (90 %) reduziert. Die Pronation/Supination war postoperativ nicht eingeschränkt.

Abstract

Objective

To stabilize the distal radioulnar joint (DRUJ) by performing dorsal capsular imbrication in patients presenting with dorsal instability. The goal was to reduce pain and prevent the occurrence of posttraumatic arthrosis.

Indications

Posttraumatic dorsal instability of the DRUJ with missing block while performing translational activities in the DRUJ or subluxation while actively rotating the forearm. Cases, in which other stabilizing techniques, such as, sutures of the triangular fibrocartilage complex failed.

Contraindications

DRUJ arthrosis, previous surgical interventions to the capsule area of the DRUJ, instabilities due to osseous reasons (malposition or pseudarthrosis) should already have been treated.

Surgical technique

Dorsal approach and opening of the 5th extensor compartment to expose the dorsal joint capsule. A longitudinal division of the capsule was performed and sufficient tissue on the radial and ulnar border was retained to ensure a solid suture technique. Then 2 U-shaped sutures using FiberWire suture material were made. Correction of the malposition and repositioning the forearm into supination. Tightening of the prepared capsule sutures and closing of the retinaculum with a resorbable suture.

Postoperative management

Patients wore a long-arm cast with the forearm being in supination for a period of 4 weeks. Following cast removal, patients wore a forearm splint for a period of 4 weeks to limit forearm pronation/supination at 45°. Full load on the wrist was allowed after 12 weeks.

Results

The subjective and functional outcomes of 20 patients having received capsular imbrication using this technique were good and entailed no significant complications. The postoperative DASH was 15.8 points. Of the 20 patients, 17 patients (85 %) had a reduction of pain. Symptoms of DRUJ instability could be reduced in 18 patients (90 %). Pronation/supination of the wrist was not restricted postoperatively.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5

Literatur

  1. Adams BD, Berger RA (2002) An anatomic reconstruction of the distal radioulnar ligaments for posttraumatic distal radioulnar joint instability. J Hand Surg Am 27:243–251

    Article  PubMed  Google Scholar 

  2. af Ekenstam F, Hagert CG (1985) Anatomical studies on the geometry and stability of the distal radio ulnar joint. Scand J Plast Reconstr Surg 19:17–25

    Article  Google Scholar 

  3. Bickel KD (2008) Arthroscopic treatment of ulnar impaction syndrome. J Hand Surg Am 33:1420–1423

    Article  PubMed  Google Scholar 

  4. Bowers WH (1999) The distal radioulnar joint. In: Green DP, Hotchkiss RN, Peterson WC (Hrsg) Green’s operative hand surgery, 4. Aufl. Philadelphia Churchill Livingston, S. 986–1014

  5. Breen TF, Jupiter JB (1989) Extensor carpi ulnaris and flexor carpi ulnaris tenodesis of the unstable distal ulna. J Hand Surg Am 14:612–617

    Article  CAS  PubMed  Google Scholar 

  6. Eliason EL (1932). An operation for recurrent inferior radioulnar dislocation. Ann Surg 96:27–35

    Article  CAS  PubMed  Google Scholar 

  7. Fulkerson JP, Watson HK (1978) Congenital anterior subluxation of the distal ulna. A case report. Clin Orthop Relat Res 131:179–182

    PubMed  Google Scholar 

  8. Hui FC, Linscheid RL (1982) Ulnotriquetral augmentation tenodesis: a reconstructive procedure for dorsal subluxation of the distal radioulnar joint. J Hand Surg Am 7:230–236

    Article  CAS  PubMed  Google Scholar 

  9. Kihara H, Short WH, Werner FW et al (1995) The stabilizing mechanism of the distal radioulnar joint during pronation and supination. J Hand Surg Am 20:930–936

    Article  CAS  PubMed  Google Scholar 

  10. Kleinman WB, Graham TJ (1998) The distal radioulnar joint capsule: clinical anatomy and role in posttraumatic limitation of forearm rotation. J Hand Surg Am 23:588–599

    Article  CAS  PubMed  Google Scholar 

  11. Lester B, Halbrecht J, Levy IM et al (1995) „Press test“ for office diagnosis of triangular fibrocartilage complex tears of the wrist. Ann Plast Surg 35:41–45

    Article  CAS  PubMed  Google Scholar 

  12. Leung PC, Hung LK (1990) An effective method of reconstructing posttraumatic dorsal dislocated distal radioulnar joints. J Hand Surg Am 15:925–928

    Article  CAS  PubMed  Google Scholar 

  13. Manz S, Wolf MB, Leclere FM et al (2011) Capsular imbrication for posttraumatic instability of the distal radioulnar joint. J Hand Surg Am 36:1170–1175

    Article  PubMed  Google Scholar 

  14. Noble J, Arafa M (1983) Stabilisation of distal ulna after excessive Darrach’s procedure. Hand 15:70–72

    Article  CAS  PubMed  Google Scholar 

  15. Palmer AK (1990) Triangular fibrocartilage disorders: injury patterns and treatment. Arthroscopy 6:125–132

    Article  CAS  PubMed  Google Scholar 

  16. Pillukat T, Schoonhoven J van (2009) The hemiresection-interposition arthroplasty of the distal radioulnar joint. Oper Orthop Traumatol 21:484–497

    Article  PubMed  Google Scholar 

  17. Sauerbier M, Hahn ME, Berglund LJ et al (2011) Biomechanical evaluation of the dynamic radioulnar convergence after ulnar head resection, two soft tissue stabilization methods of the distal ulna and ulnar head prosthesis implantation. Arch Orthop Trauma Surg 131:15–26

    Article  PubMed  Google Scholar 

  18. Scheker LR, Belliappa PP, Acosta R et al (1994) Reconstruction of the dorsal ligament of the triangular fibrocartilage complex. J Hand Surg Br 19:310–318

    Article  CAS  PubMed  Google Scholar 

  19. Klum M, Wolf MB, Hahn P et al (2012) Predicting grip strength and key pinch using anthropometric data, DASH questionnaire and wrist range of motion. Arch Orthop Trauma Surg 132:1807–1811

    Article  PubMed  Google Scholar 

  20. Siparsky PN, Kocher MS (2009) Current concepts in pediatric and adolescent arthroscopy. Arthroscopy 25:1453–1469

    Article  PubMed  Google Scholar 

  21. Cardenas-Montemayor E, Hartl JF, Wolf MB et al (2013) Subjective and objective results of arthroscopic debridement of ulnar-sided TFCC (Palmer type 1B) lesions with stable distal radio-ulnar joint. Arch Orthop Trauma Surg 133:287–293

    Article  PubMed  Google Scholar 

  22. Tsai TM, Stilwell JH (1984) Repair of chronic subluxation of the distal radioulnar joint (ulnar dorsal) using flexor carpi ulnaris tendon. J Hand Surg Br 9:289–294

    Article  CAS  PubMed  Google Scholar 

  23. Ward LD, Ambrose CG, Masson MV et al F (2000) The role of the distal radioulnar ligaments, interosseous membrane, and joint capsule in distal radioulnar joint stability. J Hand Surg Am 25:341–351

    Article  CAS  PubMed  Google Scholar 

  24. Wong KH, Yip TH, Wu WC (2004) Distal radioulnar joint dorsal instability treated with dorsal capsular reconstruction. Hand Surg 9:55–61

    Article  PubMed  Google Scholar 

  25. Schoonhoven J van, Herbert T (2004) The dorsal approach to the distal radioulnar joint. Tech Hand Up Extrem Surg 8:11–15

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Die korrespondierenden Autoren geben für sich und ihre Koautoren an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

Authors

Corresponding authors

Correspondence to F. Unglaub or M.B. Wolf.

Additional information

Die Autoren möchten darauf hinweisen, dass ein Teil der Ergebnisse bereits in folgender Originalarbeit publiziert wurde: Manz S, Wolf MB, Leclère FM et al (2011) Capsular imbrication for posttraumatic instability of the distal radioulnar joint. J Hand Surg Am 36:1170–117

Rights and permissions

Reprints and permissions

About this article

Cite this article

Unglaub, F., Manz, S., Bruckner, T. et al. Die dorsale Kapseldoppelung zur Therapie der dorsalen Instabilität des distalen Radioulnargelenks. Oper Orthop Traumatol 25, 609–614 (2013). https://doi.org/10.1007/s00064-012-0223-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00064-012-0223-2

Schlüsselwörter

Keywords

Navigation