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J Wrist Surg 2023; 12(03): 261-264
DOI: 10.1055/s-0041-1740488
Case Report

Reconstruction of the Distal Oblique Bundle for DRUJ Instability

Niels O.B. Thomsen 
1   Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
2   Department of Translational Medicine - Hand Surgery, Lund University, Malmö, Sweden
,
Anders Björkman 
1   Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
2   Department of Translational Medicine - Hand Surgery, Lund University, Malmö, Sweden
3   Department of Hand Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Abstract

Background Treatment algorithm for disruption of the triangular fibrocartilage complex (TFCC) from the ulnar fovea includes direct TFCC repair, tendon reconstruction of the radioulnar ligaments, or a salvage procedure in cases with painful distal radioulnar joint (DRUJ) degeneration.

Case Description We describe our surgical technique for reconstruction of the distal oblique bundle (DOB), to attain DRUJ stability in a young man, after failed attempts of direct TFCC reinsertion and radioulnar ligament reconstruction with the Adams procedure.

Literature Review Reconstruction of the central band of the interosseous membrane is well recognized for Essex-Lopresti injuries that demonstrate longitudinal forearm instability. The role for reconstruction/reinforcement of the DOB to restore DRUJ stability after TFCC injury has not gained the same recognition and needs further clarification.

Clinical Relevance DOB reconstruction technique described is extra-articular and technically straightforward. We believe that the procedure could be considered for patients with an irreparable TFCC injury as a part of the treatment algorithm for younger patients, who otherwise would face a more extensive salvage procedure.

Keywords

distal oblique bundle - distal radioulnar joint - instability - triangular fibrocartilage complex


Publication History

Received: 18 February 2021

Accepted: 09 November 2021

Article published online:
31 December 2021

© 2021. Thieme. All rights reserved.

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  • References

  • 1 Haugstvedt JR, Langer MF, Berger RA. Distal radioulnar joint: functional anatomy, including pathomechanics. J Hand Surg Eur Vol 2017; 42 (04) 338-345
    CrossrefPubMedGoogle Scholar
  • 2 Palmer AK. Triangular fibrocartilage complex lesions: a classification. J Hand Surg Am 1989; 14 (04) 594-606
    CrossrefPubMedGoogle Scholar
  • 3 Atzei A, Luchetti R, Garagnani L. Classification of ulnar triangular fibrocartilage complex tears. A treatment algorithm for Palmer type IB tears. J Hand Surg Eur Vol 2017; 42 (04) 405-414
    CrossrefPubMedGoogle Scholar
  • 4 Adams BD, Berger RA. An anatomic reconstruction of the distal radioulnar ligaments for posttraumatic distal radioulnar joint instability. J Hand Surg Am 2002; 27 (02) 243-251
    CrossrefPubMedGoogle Scholar
  • 5 Nakamura T, Abe K, Nishiwaki M, Iwamoto T, Sato K. Medium- to long-term outcomes of anatomical reconstruction of the radioulnar ligament to the ulnar fovea. J Hand Surg Eur Vol 2017; 42 (04) 352-356
    CrossrefPubMedGoogle Scholar
  • 6 Garcia-Elias M, Smith DE, Llusá M. Surgical approach to the triangular fibrocartilage complex. Tech Hand Up Extrem Surg 2003; 7 (04) 134-140
    CrossrefPubMedGoogle Scholar
  • 7 Adams JE. Forearm instability: anatomy, biomechanics, and treatment options. J Hand Surg Am 2017; 42 (01) 47-52
    CrossrefPubMedGoogle Scholar
  • 8 Kitamura T, Moritomo H, Arimitsu S. et al. The biomechanical effect of the distal interosseous membrane on distal radioulnar joint stability: a preliminary anatomic study. J Hand Surg Am 2011; 36 (10) 1626-1630
    CrossrefPubMedGoogle Scholar
  • 9 Low SL, Clippinger BB, Landfair GL, Criner-Woozley K. A biomechanical evaluation of the DRUJ after distal oblique bundle reconstruction. J Hand Surg Am 2020; 45 (05) 452.e1-452.e8 , e458
    CrossrefPubMedGoogle Scholar
  • 10 Riggenbach MD, Conrad BP, Wright TW, Dell PC. Distal oblique bundle reconstruction and distal radioulnar joint instability. J Wrist Surg 2013; 2 (04) 330-336
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Riggenbach MD, Wright TW, Dell PC. Reconstruction of the distal oblique bundle of the interosseous membrane: a technique to restore distal radioulnar joint stability. J Hand Surg Am 2015; 40 (11) 2279-2282
    CrossrefPubMedGoogle Scholar
  • 12 Brink PR, Hannemann PF. Distal oblique bundle reinforcement for treatment of DRUJ instability. J Wrist Surg 2015; 4 (03) 221-228
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Meyer DC, Snedeker JG, Weinert-Aplin RA, Farshad M. Viscoelastic adaptation of tendon graft material to compression: biomechanical quantification of graft preconditioning. Arch Orthop Trauma Surg 2012; 132 (09) 1315-1320
    CrossrefPubMedGoogle Scholar
  • 14 Stein AJ, Adabi K, Schofield JL, Marsh M, Paulo J. Anatomic dorsal and volar radioulnar ligament reconstruction with Mersilene augmentation for distal radioulnar joint instability. Tech Hand Up Extrem Surg 2015; 19 (01) 27-31
    CrossrefPubMedGoogle Scholar
  • 15 Aita MA, Mallozi RC, Ozaki W, Ikeuti DH, Consoni DAP, Ruggiero GM. Ligamentous reconstruction of the interosseous membrane of the forearm in the treatment of instability of the distal radioulnar joint. Rev Bras Ortop 2018; 53 (02) 184-191
    PubMedGoogle Scholar