Background  Vaughan-Jackson syndrome (VJS) is the attritional rupture of the extensor tendons secondary to arthritis or inflammation affecting the distal radioulnar joint. The surgical outcomes following Darrach\'s procedure and tendon transfers are not well described. The primary aim of this study was to report patient-reported functional outcome measures after surgery for VJS. Secondary aims were to report health-related quality-of-life scores, patient satisfaction, and complications Methods  A single-center retrospective study was performed to identify patients who underwent surgical intervention for the management of VJS. Patient-reported outcomes were measured using the Patient-Rated Wrist and Hand Evaluation (PRWHE), Quick version of the Disability of the Arm, Shoulder, and Hand (QuickDASH), EuroQoL 5-dimensions 5-Likert (EQ-5D-5L), and calculation of the Net Promoter Score (NPS). Results  We report postoperative patient-reported functional outcome measures for 12 cases of VJS treated with distal ulna excision and extensor tendon transfer. The mean age was 69 years (range: 45-87 years; standard deviation [SD]: 14.1), and eight patients were females. Five patients had rheumatoid arthritis, and there was one case each of seronegative polyarthritis, ankylosing spondylitis, and CREST (calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia.) syndrome; the rest of the patients had osteoarthritis. At a mean of 53 months of follow-up, the mean PRWHE score was 34.5 (SD: 17.9), the mean QuickDASH score was 28.2 (SD: 18.6), and the mean EQ-5D-5L score was 0.71 (SD: 0.203). Ten patients were satisfied and the NPS was 42. Postoperatively eight patients had pain scores reported as none or mild, three as moderate, and one as severe. Two patients required further operations, both undergoing total wrist arthrodesis. Conclusion  Although a degree of functional deficit persists after Darrach\'s procedure and tendon transfer for treatment of VJS, there are also high levels of patient satisfaction, a good NPS, and a low rate of operative reintervention. Level IV  evidence.

Background  The Aptis distal radioulnar joint (DRUJ) implant has been commonly used to replace the DRUJ and restore wrist function in patients with a severely destroyed DRUJ. Objective  Promising results have been described in the literature. However, the clinical results in a multicenter setting are sparse and variable. This study evaluates the short- to midterm clinical results of 53 patients with a (mean) follow-up of 51 months. Patients and Methods  Fifty-three patients (59 implants) treated between 2011 and 2020 in three different institutions were retrospectively identified in a prospectively collected database. The main indication for Aptis DRUJ arthroplasty was a destroyed DRUJ and gross distal radioulnar instability and isolated DRUJ osteoarthritis. Functional outcome, complications, and patient satisfaction were evaluated. Patients completed the Patient-Rated Wrist Evaluation (PRWE) questionnaire and an additional questionnaire about patient satisfaction and return to hobby/work. Results  Implant survival was 92%, the surgical follow-up showed many complications (64,4%), and revision surgery was needed frequently (40.7%). In 13 cases, the follow-up was longer than 5 years. Three reimplantations had to be performed and two implants were permanently explanted. In spite of this all, wrist and forearm motion as well as pain reduction was adequate and patient satisfaction was reasonable (72.2%). Conclusion  The Aptis DRUJ arthroplasty is a viable option that can provide adequate wrist and forearm function after secure patient selection and surgical placement of the implant in the wrist with a good bone stock of the radius. The complication rate was found to be high, yet patient satisfaction was reasonable. In the case of secondary surgery, additional surgery seems to be needed. For primary surgery, the implant seems to be successful without complications. Different complications have been described, but further analysis is warranted to find the causes of complications and to objectify the performance of the Aptis DRUJ implant. Level of Evidence  IV.

BACKGROUND: Ulnar impingement syndrome is a prevalent source of ulnar carpal pain; however, there is ongoing debate regarding the specific location of shortening, the method of osteotomy, the extent of shortening, and the resulting biomechanical alterations.
METHODS: To investigate the biomechanical changes in the distal radioulnar joint (DRUJ) resulting from different osteotomy methods, a cadaveric specimen was dissected, and the presence of a stable DRUJ structure was confirmed. Subsequently, three-dimensional data of the specimen were obtained using a CT scan, and finite element analysis was conducted after additional processing.
RESULTS: The DRUJ stress did not change significantly at the metaphyseal osteotomy of 2-3 mm but increased significantly when the osteotomy length reached 5 mm. When the osteotomy was performed at the diaphysis, the DRUJ stress increased with the osteotomy length, and the increase was greater than that of metaphyseal osteotomy. Stress on the DRUJ significantly increases when the position is changed to pronation dorsi-extension. Similarly, the increase in stress in diaphyseal osteotomy was greater than that in metaphyseal osteotomy. When the model was subjected to a longitudinal load of 100 N, neither osteotomy showed a significant change in DRUJ stress at the neutral position. However, the 100 N load significantly increased stress on the DRUJ when the position was changed to pronation dorsi-extension, and the diaphyseal osteotomy significantly increased stress on the DRUJ.
CONCLUSIONS: For patients with distal oblique bundle, metaphyseal osteotomy result in a lower increase in intra-articular pressure in the DRUJ compared to diaphyseal osteotomy. However, it is crucial to note that regardless of the specific type of osteotomy employed, it is advisable to avoid a shortening length exceeding 5 mm.

Unclear wrist tumors are a common clinical presentation in patients with pain and movement restrictions of the wrist. We report a rare case of a benign tumor of the wrist in a 63-year-old female patient who presented with a ganglion-like swelling of the right hand. After examination and preoperative radiological diagnostics, the indication for an open surgery was indicated for resection of either a typical ganglion cyst or a peripheral nerve sheath tumor was made. Interestingly, the suspected diagnosis was not correct. The intraoperative finding and histological analysis revealed typical findings of synovial chondromatosis of the distal radioulnar joint. Although synovial chondromatosis is a relatively rare, and even rarer in the wrist, it is important to consider it as a differential diagnosis when a patient presents with a \'simple\' wrist ganglion.

UNASSIGNED: Distal radioulnar joint (DRUJ) injuries can be devastating and challenging to manage. The multiplanar curvature exhibited by the ulna impacts the morphology of the DRUJ, making it difficult to assess through two-dimensional radiographs alone. We used full-length, three-dimensional (3D) computed tomography angiography scans to assess the relationship between ulnar bowing, DRUJ ulnar variance (UV), and sigmoid notch angle. The goal of this study was to establish normal anatomic ranges for these landmarks to improve treatment for forearm traumas and DRUJ pathologies.
UNASSIGNED: Eighty-two intact upper extremity computed tomography angiography scans were examined and reconstructed into 3D models. We characterized ulnar bowing and DRUJ metrics using computer-aided design software. Measures of central tendency and Pearson correlation coefficients were calculated for comparative analysis.
UNASSIGNED: The study yielded an average ulnar length of 272.3 mm. We identified the proximal ulnar bow at 36.7% of the bone\'s total length, possessing a depth of 10.3 mm, a proximal angle of 6.6°, and a distal angle of 3.9°. The distal ulnar bow appeared at 75.3% of the bone\'s length, characterized by a depth of 4.2 mm, a proximal angle of 2°, and a distal angle of 4.3°. In the coronal plane, the proximal angle of the proximal ulnar bow correlated positively with UV (r = 0.39, P < .001), whereas the distal angle of the distal ulnar bow correlated negatively (r = -0.48, P < .001). We also found significant correlations between the depths of both proximal and distal bows with UV (r = 0.38, P < .001; r = -0.34, P < .001, respectively). Moreover, UV within the DRUJ strongly correlated with the sigmoid notch angle (r = -0.77, P = .01). In contrast, the sagittal plane metrics did not show meaningful correlations with UV.
UNASSIGNED: Sagittal alignment and translation at the DRUJ articulation are directly related to ulna bowing at the distal ulna. A nuanced understanding of these 3D relationships can enhance preoperative planning when correcting ulnar-side pathology.
UNASSIGNED: Therapeutic IV.

Background  The volar dislocation of the distal ulna is an uncommon injury and often missed due to its rarity. If diagnosed early, it can be managed with a simple closed reduction followed by immobilization. Open reduction is recommended in case of any interposition preventing reduction. Case Description  In this case report, we present a rare case of neglected volar distal ulna dislocation associated with a distal radius fracture presenting with a fixed supination deformity that was managed successfully with a Sauvé- Kapandji procedure using a modified approach to restore forearm rotation. At 10 months, the patient had a good union at the distal radio ulnar joint (DRUJ) with improved forearm rotations. Literature Review To our knowledge  no previous cases of neglected volar distal ulna dislocation with distal radius fracture has been reported in the literature. Clinical Relevance  If DRUJ stability cannot be restored after closed reduction of distal radius fracture, open reduction and internal fixation of the fracture should always be performed to avoid subsequent DRUJ subluxation/dislocations.

Volar dislocation of the distal radioulnar joint is a rare injury that is often missed at initial presentation. We report a 21-year-old male patient who presented 2 months after sustaining this injury. He was successfully managed by open reduction and reconstruction of the dorsal radioulnar ligament using a partial distally based extensor carpi ulnaris tendon strip. A literature review showed only a few reported cases with varied methods for management. The technique utilised is analysed in comparison to the others. Level of Evidence: Level V (Therapeutic).

OBJECTIVE: The distal radioulnar joint (DRUJ) is supported by an array of dynamic and static stabilizers, of which the triangular fibrocartilage complex (TFCC) is the most important, and the distal interosseous ligament is next in importance. The distal oblique band (DOB) is an identifiable component of the distal interosseous ligament, found in a subset of the population. Our objective was to determine the contribution of the DOB to DRUJ stability in the presence of a disrupted TFCC.
METHODS: Twenty-three above-elbow specimens were prepared by removing the TFCC and the DRUJ joint capsule, preserving the distal interosseous ligament and the pronator quadratus. Cadavers were stratified into two groups-those with, and those without a DOB. A bone plate and screws were attached to the ulna; then, a transverse load was applied to failure, creating a diastasis between the radius and ulna.
RESULTS: The group with a DOB had a mean load at failure of 160.7 ± 46.5 N. The group without a DOB had a mean load at failure of 148.0 ± 26.3 N. Stiffness prior to failure was 16.9 N/mm in the group with a DOB and 12.4 N/mm in the group without a DOB.
CONCLUSIONS: The current results indicate that the DOB may not substantially contribute to DRUJ stability in the presence of a disrupted TFCC.
CONCLUSIONS: Stability of the DRUJ after TFCC injury may not be substantially improved by the presence of a DOB. Thus, the clinical importance of DOB reconstruction remains unclear.

UNASSIGNED: IV.

The aims of this study were to retrospectively assess the occurrence of complications or need for secondary wrist procedures after the Sauvé-Kapandji procedure, and to prospectively assess patient-reported outcomes at long-term follow-up. All patients treated with the Sauvé-Kapandji procedure in our tertiary referral hospital between January 2008 and September 2021 were identified and contacted to complete the Quick Disabilities of the Arm, Shoulder, and Hand and the Patient-Rated Wrist/Hand Evaluation outcome measures. In total, 30 patients, with a median follow-up of 82 months, were included in this study. Complications occurred in 6 of 30 patients, which resulted in six secondary wrist procedures. Mean Quick Disabilities of the Arm, Shoulder, and Hand and Patient-Rated Wrist/Hand Evaluation scores were 30.1 and 33.6, respectively. We conclude that in respect of long-term outcomes, the Sauvé-Kapandji procedure can still be deemed to be a useful procedure, especially in patients with few other reconstructive options.Level of evidence: IV.