The Darrach Procedure: Are Additional Stabilization Procedures Necessary?

ABSTRACT

Criticism of the distal ulna resection (“Darrach Procedure”) due to reported postoperative instability of the distal ulna has led to a variety of different procedures and modifications from the originally described method for the purpose of enhancing stability of the distal ulna. Its necessity was questioned.

Thirty procedures in 29 patients were performed (by 1 surgeon) without any supplemental stabilization procedures. Preoperative diagnoses included rheumatoid disease (n=18), post-traumatic arthritis (n=11), and degenerative arthritis (n=1). Average follow-up was 38 months (range: 6-79 months). Eight patients were lost to follow-up and 1 patient died; 21 patients were available for follow-up. Seventeen patients were seen in final follow-up and 4 had telephone interviews.

For the patients seen, visual analog pain scale (1 [no pain] to 10 [unbearable pain]) and patient satisfaction (1 [unsatisfied] to 4 [very satisfied]) were assessed. Clinical instability of the distal ulna, range of motion, and grip strength were recorded in patients seen. Patient satisfaction averaged 3.9/4, no instability was noted, pain averaged 0.2/10, and grip strength averaged 76% of the contralateral side (10 of 17 patients whose preoperative grip averaged 55% of opposite, postoperative averaged 92%). Pronation averaged 81º (80º on uninvolved side) and supination averaged 84º (87º on uninvolved side). Pronation ranged from 45º-90º whereas supination ranged from 55º-90º. One patient who had 45º of pronation and 55º of supination had a concomitant elbow injury.

The Darrach procedure, performed with careful attention to the amount of distal ulna resected, provides excellent results without supplemental stabilization procedures.