Artikel
Darrach’s procedure in total wrist arthroplasty
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Autoren
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Trygve Holm-Glad
- Oslo University Hospital, University of Oslo, Oslo, Norway
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Magne Røkkum
- Oslo University Hospital, University of Oslo, Oslo, Norway
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Ole Reigstad
- Oslo University Hospital, University of Oslo, Oslo, Norway
| Veröffentlicht: | 6. Februar 2020 |
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Gliederung
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Objectives/Interrogation: Concomitant painful arthrosis in the radiocarpal and DRUJ joint may be treated by combining total wrist arthroplasty (TWA) with resection of the distal ulna (Darrach's procedure). Results following Darrach's procedure combined with TWA and Darrach's procedure performed on wrists with previously implanted TWA are presented.
Methods: From 2001 to 2017 Darrach's procedure was performed on 30 (25 Motec®, 5 ReMotion®) of 164 prosthetic wrists, either in combination with (17/30 wrists) or median 14 (2 to 55) months following TWA implantation (13/30 wrists). The patients completed the QDASH and PRWHE scores and graded radial and ulnar sided wrist pain preoperatively and at follow-up. AROM (flexion, extension, radial and ulnar deviation), forearm rotation, and grip strength were measured.
Results and Conclusions: In one patient a dorsally prominating ulna end caused rupture of the extensor tendons to the 3.-5. fingers two months after the procedure. He was reoperated with tendon transfer and further shortening of the ulna. Additional ulna shortening (re-Darrach) was done in two patients after 15 and 31 months due to continuing pain and radiological impingement between the radius and the shortened ulna. In 6/30 patients the arthroplasty was revised to a new arthroplasty (5) or arthrodesis (1) due to muscular imbalance (1) or loosening of the distal (3), proximal (1) or both components (1) after median 3.2 (0.5-9) years.
Two years after combined TWA and Darrach's procedure (n=17) there was a significant improvement in PRWHE (65 vs 27), Q-DASH (50 vs 26), radial sided wrist pain at rest (31 vs 16) and activity (64 vs 31), ulnar sided wrist pain at rest (38 vs 10) and activity (65 vs 21), supination (59 vs 73°), AROM (74 vs 110°) and grip strength (JAMAR 13 vs 19 kg) (p<0.05). Pronation (80 vs 77°) was unchanged.
Darrach's procedure performed on wrists with TWA in situ (n=13) resulted in significant improvement of ulnar sided wrist pain at rest (39 vs 15) and activity (72 vs 36) two years later (p<0.05), without affecting pain on the radial side of the wrist at rest (18 vs 17) or activity (34 vs 35). Pronation improved significantly (76° vs 82°, p<0.05). Supination (72 vs 79°), AROM (104 vs 103°) and grip strength (JAMAR 19 vs 20 kg) remained unchanged.
Darrach's procedure results in ulnar sided pain relief and improves function in patients with TWA and painful DRUJ arthrosis.
