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.
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