Twenty Year Follow-Up after Microsurgical Reconstruction of the Dru-Joint with a Free Vascularized Joint Transfer

Introduction: A destroyed painful distal radio-ulnar joint is mainly reconstructed using artificial ulna-head prostheses. A biologic technique to reconstruct a distal radio-ulnar joint with a free microvascular second MTP-II joint was studied. In comparison the joint size and articular joint surfaces were quite similar, but there were differences especially in the ligamentous structure. A clinical autogenous reconstruction for a destroyed ulnar head and DRU-joint was done as a salvage procedure in 1994 for a failure case after Darrach procedure.

Methodology and Material: Operative technique was practiced using fresh cadaver wrists and MTP II-joints. The proximal phalanx was inserted inside the radius through the sigmoid notch and the metatarsal head was fixed sideways against distally resected ulna. Ulno-Radial distance was corrected. The findings were considered sufficient to allow a pilot clinical trial with the consent of an unhappy patient. A clinical case was performed in 1994. The patient was a 50-year old male with a previous wrist arthrodesis because of a SLAC wrist problem. The ulna head had been used as a bone graft for the wrist arthrodesis resulting into very instable, snapping and painful pro-supination.

Results: According to the cadaver experiments, the DRUJ reconstruction seemed technically possible and a 140 degree arch of motion at the MTP-II joints was able to serve in a pro-supination movement. In clinical case the transplanted MTP-II-joint showed good healing with radius and ulna. The joint has maintained its alignment. It has worked as a new DRU-joint allowing nearly normal pro-supination. The range is from 75 pronation to 65 degree supination. The patient has been satisfied with the stability and movement. The grip strength has been normal.

Conclusions: The data from the cadaver experiments and from this successful clinical case with twenty years follow-up demonstrates an autogenous possibility for selected failed Darrach cases as a reconstructive procedure. The need for this rather complicated salvage procedure is rare but it can be considered in younger age groups after failed Darrach operation instead of prosthetic replacement of the ulnar head.