• Thomas Pillukat and Jörg van Schoonhoven.
• Klinik für Handchirurgie, Rhön-Klinikum, Bad Neustadt an der Saale, Germany. t.pillukat@handchirurgie.de
• Oper Orthop Traumatol. 2009 Nov 1; 21 (4-5): 484-97.

ObjectiveRestoration of forearm rotation and pain relief at the distal radioulnar joint by resection of the joint surfaces of the ulnar head, interposition of a capsular-retinacular flap, and preservation or reconstruction of the ulnocarpal complex.IndicationsPainful osteoarthritis of the distal radioulnar joint.ContraindicationsLongitudinal instability in the forearm, e.g., Essex-Lopresti lesions or after radial head resection. Posttraumatic ulnar subluxation of the carpus.Surgical TechniqueExposition of the distal radioulnar joint via the floor of the fifth extensor compartment and preparation of an ulnarbased capsular-retinacular flap. Preservation of the fourth and sixth extensor compartment. Resection of the jointbearing areas of the ulnar head preserving the ulnar styloid and the triangular fibrocartilage complex (TFCC). If necessary, refixation or reconstruction of the TFCC. Interposition of the capsular-retinacular flap between the distal radius and ulna. Stabilization of the distal ulna by suture fixation of the dorsal part of the flap to the dorsal rim of the sigmoid notch.Postoperative ManagementImmobilization in a long arm cast with 45 degrees forearm supination for 4 weeks. Afterwards, forearm pronation and supination are further limited for 4 weeks by a splint. Following that period, the range of motion and the load are raised to normal levels.ResultsThe hemiresection-interposition arthroplasty of the distal radioulnar joint improves the range of forearm rotation. Pain is significantly reduced and grip strength increased. Instability of the distal ulna may persist or result; however, this gives rise to moderate complaints only in some patients. Patients' satisfaction is high and the functional results are good.

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