Addressing Habitual DRUJ Dislocations: Surgical Options and Solutions

I would like to ask the director a question regarding dislocations (I am very grateful)?

I would like to ask the director a question regarding dislocations (I am very grateful).
I have habitual dislocations of the distal radioulnar joint (DRUJ), which has caused the ulnar head to be prominent.
Even after ligament reconstruction, which was not ideal, there is still a possibility of dislocation, even if additional tendons are harvested from my body.
If I undergo ulnar shortening surgery and use a plate for fixation, will that resolve the issue? I have heard that after shortening, fixation may not be necessary and that ulnar-radial fusion surgery might not be required.
Would this approach be more suitable for me? Thank you very much, director; this is my last question (a bow).

Shu Wei, 20~29 year old female. Ask Date: 2016/08/25

Dr. Shi Guozheng reply Orthopedics

It may be possible to address the issue, but detailed questions should still be discussed with your attending physician.

Reply Date: 2016/08/25

More Info

Addressing habitual dislocations of the distal radioulnar joint (DRUJ) can be quite complex, especially when previous surgical interventions, such as ligament reconstruction, have not yielded satisfactory results. Your concern about the persistent dislocation and the associated symptoms, such as the prominence of the ulnar head, is valid and warrants a thorough discussion regarding potential surgical options.

In cases of habitual DRUJ dislocations, the primary goal of surgical intervention is to restore stability to the joint while preserving function. If ligament reconstruction has proven ineffective, alternative surgical strategies may be considered. One such option is ulnar shortening osteotomy, which involves shortening the ulna to reduce the load on the DRUJ and improve joint congruency. This procedure can help alleviate the mechanical instability that contributes to dislocation.

The use of a plate for fixation after ulnar shortening is a common practice, as it provides the necessary stability during the healing process. It is crucial to ensure that the ulna is appropriately shortened to achieve the desired alignment and stability. In some cases, this procedure can significantly reduce the frequency of dislocations and improve overall function.

Regarding your question about whether ulnar shortening can be performed without fixation, it is generally not advisable to forgo stabilization, especially in the context of habitual dislocations. Proper fixation is essential to allow for adequate healing and to prevent complications such as nonunion or malunion. The goal is to create a stable environment for the bone to heal correctly, which is typically achieved through the use of plates or screws.

As for the need for a distal radioulnar fusion (DRU fusion), this is usually considered a last resort when other surgical options have failed or if there is significant joint degeneration. Fusion can provide stability but at the cost of motion at the DRUJ. It is essential to weigh the benefits and drawbacks of fusion against other options, such as ulnar shortening, based on your specific situation and functional goals.

In summary, ulnar shortening osteotomy with plate fixation could potentially address your habitual DRUJ dislocations effectively. However, it is crucial to have a detailed discussion with your orthopedic surgeon about your specific case, including the extent of your dislocation issues, previous surgeries, and your functional expectations. They will be able to provide tailored advice and help you make an informed decision about the best surgical approach for your condition. Always remember that each case is unique, and the best treatment plan will be one that considers your individual circumstances and goals.

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