gms | German Medical Science

Objectives/Interrogation: Ulnar head implants are indicated in post-traumatic arthritis of DRUJ, failure of previous operations (Bowers, Sauvé-Kapandji, Darrach), tumor resection. This technique is also indicated in inflammatory arthritis with pain at DRUJ or limitation of pronosupination in alternative to other operations but it is still condroversial. Controversy is related to the possibility of other surgical options as Sauvé-Kapandji, Darrach o Bowers procedures that are wdely used in RA patients. Moreover diffuse concomitant or subsequent involvement of radiocarpal or intercapal joints of the same hand may necessitate a multiple operation plan. The aim of this study is to analyse the results and define the actual indications of this technique in RA patients

Methods: Out of 53 wrist treated with ulnar head implant in our Unit, 10 patients had inflammatory arthritis (9 RA and 1 Psoriatic arthritis) were treated as affected by akyosis or osteoarthritis type of RA according to Simmen Classification. Of those, one had a previous failed Bowers operation. All were females. Mean age 56yo (42- 74) All patients had a limitation of prono-supination and elective pain at DRUJ. Five patients were reviewed with a mean follow up of 6 years (2 - 10 years). Mayo score, Dash and PRWE score were used to evaluate the results

Results and Conclusions: The results were good in 2 patients, fair in 3. Restoration of pronosupintion was obtained in all patients except one who had a supination limited to 50°. Mean ulnar deviation was 27° (0- 45°), mean radial deviation was 5° (0- 15°), extension 20° (0-40°), flexion 21° (5- 30°). Mean DASH was 42 (22,5- 47,5) and PRWE was 31 (11- 48,5). Pain was absent in 2 cases, occasional in 2 cases, moderate in 1 case. No complications recorded.

From our data the results were satisfactories in all patients even if arthritis can progress in other joints of the same hand and limb. There is a bias in the results of the wrist scores used as other joints of the upper limb are involved in RA and this creates worse clinical scores compared to post-traumatic patients. Among salvage procedures ulnar head implant gives a very good restoration of function and aesthetic appearance of the wrist. This technique is indicated in selected cases of isolated DRUJ arthritis without excessive laxity, with limitation of pronosupination and elective pain at distal radio-ulnar joint.