Wrist Surgery: Insights on DRUJ Dislocation and Arthritis

Director, I would like to inquire about wrist issues?

Dear Director Shih,
I suffered a wrist injury four years ago when I fell from a height of about one meter, resulting in a dislocation of the distal radioulnar joint (DRUJ) and degenerative arthritis.
Due to financial constraints and lack of care, I delayed seeking treatment for three years.
I have undergone multiple unsuccessful reconstructive surgeries, including a palmaris longus tendon reconstruction.
In my last surgery, the surgeon performed an osteotomy and removed approximately 2 cm of the distal ulnar head, effectively excising the entire ulnar head.
No bone graft was done, but I continue to experience significant pain.
The original surgeon has been unresponsive, leaving me with no options but to seek your expertise.

I would like to ask you a few questions:
1.
Why do doctors say that excising the distal ulnar head is a procedure typically performed on patients aged 70 or 80, and it is strongly discouraged for younger individuals? What are the reasons behind this?
2.
If the distal ulnar head has been removed, does that mean I cannot undergo a radial-ulnar fusion surgery? Are there still methods available to address this?
3.
Given my severe degenerative arthritis and chronic synovitis, is it possible for a physician to excise my synovium to alleviate the pain? Are there any other methods that could improve my condition?
I sincerely hope you can answer these questions.
I am a student who has suffered from this hand injury for four years and have already undergone four surgeries.
If possible, I would appreciate the opportunity to visit your clinic for assistance.
I am truly grateful for your help.

(Bowing deeply)

Shu Wei, 20~29 year old female. Ask Date: 2017/02/07

Dr. Shi Guozheng reply Orthopedics

If the wrist joint has already suffered severe wear, a synovectomy may be considered.
Ultimately, wrist fusion surgery might resolve your issue.

Reply Date: 2017/02/07

More Info

Understanding wrist surgery, particularly in the context of Distal Radioulnar Joint (DRUJ) dislocation and arthritis, is crucial for patients who have undergone multiple procedures and are experiencing persistent pain. Your situation, involving a significant injury and subsequent surgeries, raises several important questions regarding the implications of surgical decisions and potential treatment options.

1. Why is distal ulnar resection typically reserved for older patients?
The procedure you underwent, which involves resection of the distal ulna, is often considered for older patients primarily due to the implications it has on wrist biomechanics. In younger patients, the wrist joint is still developing, and removing the distal ulna can lead to instability and altered mechanics in the wrist. This can result in increased wear and tear on the remaining structures, potentially leading to further degeneration and complications. Older patients, on the other hand, may have already experienced significant degeneration, and the benefits of pain relief and improved function may outweigh the risks associated with altered wrist mechanics.

2. Can a fusion of the radius and ulna still be performed after distal ulnar resection?
While the removal of the distal ulna complicates the possibility of performing a fusion of the radius and ulna, it is not entirely ruled out. Surgeons may still consider fusion techniques depending on the remaining anatomy and the specific mechanics of your wrist. However, the absence of the distal ulna can lead to challenges in achieving a stable and functional fusion, and the decision would need to be made on a case-by-case basis. Consulting with a hand surgeon who specializes in wrist surgeries would provide more tailored insights based on your unique situation.

3. Is synovectomy a viable option for treating severe arthritis and inflammation?
Given your history of severe degenerative arthritis and chronic synovitis, a synovectomy (removal of the inflamed synovial tissue) could potentially alleviate some of your symptoms. This procedure aims to reduce pain and improve function by removing the source of inflammation. However, it is essential to understand that while synovectomy may provide symptomatic relief, it does not address the underlying degenerative changes in the joint. Therefore, it is often considered as part of a broader treatment plan that may include physical therapy, medications, or even joint replacement if the condition warrants it.

In addition to these surgical considerations, it is crucial to engage in a comprehensive rehabilitation program post-surgery. Physical therapy can play a significant role in improving wrist function, enhancing strength, and managing pain. A specialized therapist can guide you through exercises tailored to your specific needs, focusing on regaining mobility and strength while minimizing discomfort.

Furthermore, exploring non-surgical options such as corticosteroid injections or platelet-rich plasma (PRP) therapy may also provide symptomatic relief. These treatments can help reduce inflammation and promote healing in the joint.

Lastly, it is essential to maintain open communication with your healthcare providers. If you feel that your current physician is not addressing your concerns adequately, seeking a second opinion from a specialist in wrist surgery or a hand surgeon may provide you with new insights and treatment options. Your persistent pain and the impact it has on your daily life warrant thorough investigation and a proactive approach to management.

In conclusion, while your situation is complex due to the multiple surgeries and ongoing pain, there are still potential avenues for treatment. Engaging with a knowledgeable specialist who can assess your current condition and provide a tailored treatment plan is vital for improving your quality of life.

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