Scientific Online Resource System

Scripta Scientifica Medica

An anatomic reconstruction of the distal radioulnar joint for posttraumatic instability by Adams-Berger procedure

Georgi Ganchev


INTRODUCTION: The distal radio ulnar joint has an important and complex role in the motion of the wrist joint and the entire upper limb. The anatomical relations between the distal radius, ulna and the ulnar carpus are very fine and precise and even minor disturbances in their congruence may lead to significant changes in motions and pronounced pain syndrome. The post-traumatic instability of the distal radio ul­nar joint (DRUJ) affects all age groups. However, the contingent of professional athletes may be determined as the risk one. DRUJ instability resulting from a trauma can lead to significant discomfort expressed in ul­nar pain syndrome involving the ulnocarpal joint, weakness and limitation of the motion of the radiocar­pal joint.

AIM: The aim of this paper is to present the Adams-Berger surgical procedure and the results after the ana­tomical reconstruction in cases of DRUJ instability.

MATERIALS AND METHODS: During the period 2009 - 2015, at the Clinic of Orthopedics and Traumatol­ogy at St. Anna University Hospital for Active Treatment, Varna, 17 patients with DRUJ instability were op­erated on by the Adams procedure.

RESULTS: DRUJ stability was observed three years after the surgery on average and 1st degree instability was seen in one of the patients. The average Modified Mayo Wrist Score was 70.01 points prior to the surgery and 93.6 points at the 36th month after the surgery. The subjective opinion of 14 of the patients was that the result was excellent, two of them determined it as very good and one of them - as good. In all of the patients an improvement in a number of parameters was observed, such as flexion, extension, radial and ulnar devi­ation, pronosupination and muscle strength reaching values comparable to those in the health hand.

DISCUSSION: There are many surgical techniques aimed at restoring DRUJ stability. An alternative option is ligamentoplasty with half of the tendon of flexor capri ulnaris, which, however, does not give absolute sta­bility and has limited indications. In the presence of malposition after distal radius fracture, the stability can be improved after corrective osteotomy.


distal radio ulnar joint (DRUJ); triangular fibrocartilage complex (TFCC); instability; Adams-Berger procedure

Full Text


Breen TF, Jupiter JB. Extensor carpi ulnaris and flexor carpi ulnaris tenodesis of the unstable distal ulna. J Hand Surg Am. 1989;14(4):612–7.

Adams BD, Berger RA. An anatomic reconstruction of the distal radioulnar ligaments for post-traumatic distal radioulnar joint instability. J Hand Surg Am. 2002;27(2):243–51.

Mathoulin Ch, Atzei A. Réparation du ligament triangulaire (TFCC) : rapport d,une série de 72 cas suivant une nouvelle classification; e-mémoires de l’Académie Nationale de Chirurgie, 2010, 9 (1): 21-7.

Kihara H, Short WH, Werner FW, Fortino MD, Palmer AK. The stabilizing mechanism of the distal radioulnar joint during pronation and supination. J Hand Surg Am. 1995;20(6):930–6. doi: 10.1016/S0363-5023(05)80139-X

Oda T, Wada T, Isogai S, Iba K, Aoki M, Yamashita T. Corrective osteotomy for volar instability of the distal radioulnar Joint associated with radial shaft malunion. J Hand Surg Eur Vol. 2007;32(5):573–7. doi: 10.1016/J.JHSE.2007.04.018

About The Author

Georgi Ganchev
Medical university of Varna

Department of Orthopedics and Traumatology, Faculty of Medicine

Font Size