Instability and Arthritis of the Distal Radioulnar Joint

➢ Arthritis and instability represent 2 of the most common pathological processes affecting the distal radioulnar joint (DRUJ). These conditions can present in isolation or as components of a multifactorial process.➢ Nonoperative treatment is indicated for most acute injuries to the DRUJ. The joint should be immobilized in a position of stability to allow for ligament healing. Likewise, early arthritis responds favorably to rest, immobilization, corticosteroids, and nonsteroidal anti-inflammatory drugs (NSAIDs).➢ When DRUJ instability is refractory to nonoperative measures, native ligament repair is the preferable method of treatment. When this method is not possible, anatomical reconstruction of the distal radioulnar ligaments should be performed.➢ For advanced DRUJ arthritis Darrach resection should be reserved for the elderly, low-demand patient. The Sauvé-Kapandji procedure allows for arthrodesis of the DRUJ while maintaining forearm rotation and a stable base for the ulnar carpus.➢ DRUJ hemiarthroplasty procedures have been associated with favorable preliminary results. These implants attempt to reproduce native biomechanics and may be used in lieu of or as a salvage procedure after resection arthroplasty. DRUJ arthroplasty should be used as a salvage procedure.