Management of chronic distal radio-ulnar joint (DRUJ) instability using Adams-Berger technique – A report of two cases in different scenarios

Abstract

Background: Chronic distal radioulnar joint instabilities are difficult conditions to manage and can result in poor outcomes if not addressed adequately. Aims: We report on two cases of chronic distal radioulnar joint instability in different clinical scenarios successfully managed by the anatomic reconstruction procedure. Methods: First was a case of isolated distal radioulnar joint injury with intrinsic flat sigmoid notch and chronic instability whereas the second was an old case of malunited distal radius fracture and persistent distal radioulnar joint instability with fresh peri-implant fracture of radius shaft. The DRU joint instaility in both cases were managed by Adams-Berger technique of reconstruction using ipsilateral palmaris longus tendon. Results: Excellent outcomes were achieved in both the cases in terms of stability, pain control, range of movements and functional outcome. Conclusion: In the absence of radial shortening malunion and advanced distal radioulnar joint arthritis, this technique of reconstruction can be expected to provide good to excellent outcomes in this patient sub-group. Successful distal radioulnar ligament reconstruction was achieved without the added procedures of sigmoid notch-plasty or distal radius osteotomy for the isolated coronal malunion. This report is testimony to the versatility of the procedure.

Keywords

• Humans
• Adult
• Wrist
• Joint instability
• Triangular fibrocartilage
• Ligaments