Patients with distal radioulnar joint OA may be managed with adipofascial flap technique
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BOSTON — Researchers from Madrid found a posterior interosseous artery adipofascial flap technique was safe for treatment of patients with distal radioulnar joint osteoarthritis, based on results presented here.
In a presentation at the American Society for Surgery of the Hand Annual Meeting, Aleksandar Lovic Jazbec, MD, said patients treated with the technically demanding technique had significantly improved pronosupination, flexion and extension postoperatively.
Lovic and colleagues analyzed results of the treatment among 16 patients (mean age of 48 years) with a mean of 28 months follow-up.
“The technique is designed for young high-demand patients with posttraumatic distal radioulnar joint (DRUJ) arthritis,” Lovic, of the division of hand surgery, microsurgery and peripheral nerves in the department for plastic surgery and burns at University Hospital La Paz, in Madrid, told Healio.
At the meeting, Lovic said, in his hands, a total DRUJ prosthesis is an option in some young high-demand patients, however its use may be challenging. In addition, for some mid-sized health systems with limited financial capacity, “it's kind of a burden that cannot be supported. So, we needed an efficient alternative for DRUJ replacement.”
According to the description of the technique in the abstract, the DRUJ is exposed intraoperatively via a dorsal longitudinal approach so that the cartilage of the ulnar head and subchondral bone can be debrided in such a way that it preserves ulnocarpal and radioulnar stabilizers.
“We came up with this technique, which is based on a Bowers procedure, and the differences are we are not ‘punishing’ the ulnar head like the Bowers procedure. We are reshaping the ulnar head in a cylindrical way, just peeling off the cartilage, the rest of cartilage, and coming to cancellous bone and then putting the vascularized tissue coating on a ‘new’ head and that, with this, we achieve a stable interpositional material which adheres to the ulnar head,” Lovic said at the meeting.
A thin adipofascial pedicled flap is harvested from the pedicled posterior interosseous artery and then interposed around the ulnar head and sigmoid cavity.
The two most important steps of the procedure are “design of the adipofascial interosseous pedicled flap and perimetral cylindric osteotomy of the ulnar head,” Lovic told Healio.
To prevent slippage of the flap, it is fixed to the posterior and anterior capsule and this construct is enhanced with a hemi-extensor digiti minimi tendon plasty.
Follow-up for the patients studied showed preoperative mean QuickDASH scores of 63 improved to 19 postoperatively, and mean postoperative measurements of pronosupination, flexion and extension were 74°/69°, 53° and 45°, respectively.
According to the abstract, this range of motion improvement from preoperative measurements was a significant improvement, as were the pain scores with 11 patients who reported being fully pain-free.
“All the patients recovered their sports activities and also returned to work. So this is reproducible and a safe technique, there is no foreign material implanted, [it] provides almost normal range of motion and strength, and patients returned to normal,” Lovic said.
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Lovic Jazbec A, et al. Paper 60. Presented at: American Society for Surgery of the Hand Annual Meeting; Sept. 29-Oct. 1, 2022; Boston.
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