Distal Radioulnar Arthrodesis

Abstract

Distal radioulnar arthrodesis with ostectomy of the distal ulna is an excellent method of stabilizing the distal radioulnar joint and the ulnar side of the carpus. It is also useful in distal ulnar bone loss with the ulnar head intact ((Fig. 43-1 A) (Fig. 43-1 B) (Fig. 43-1 C) (Fig. 43-1 D) Fig. 43-1 E-J) or distal radioulnar instability (Figs. 43-2 A-H). Rotation then occurs through the distal ulnar defect. The interosseous membrane must remain intact to prevent dorsal dislocation of the distal portion of the proximal ulnar fragment, which could cause skin pressure, irritation, and even rupture of the extensor carpi ulnaris. When performing this procedure, the proximal and distal bone ends at the site of the distal ulnar ostectomy are waxed, and periosteum is secured over the bone ends. A portion of the pronator quadratus is brought into the defect. These maneuvers help stabilize the distal end of the proximal ulna and also prevent reestablishment of osseous continuity at the distal ulnar ostectomy site.