DRUJ Schecker Implant

Distal Radio-Ulnar Joint ArthritisDistal Radio-Ulnar Joint Arthritis

Findings:

The wrist will be painful, particularly with twisting motions and with carrying loads.

The little finger side of the wrist is often swollen. Power grip and pinch can be painful and weak, from soreness in that area of the wrist joint.

Cause:

The condition can be from osteo-arthritis, and may follow quite late after an injury to the wrist years before, as some ligament injuries initially heal but leave instabilities that cause late joint deterioration. It will frequently occur in rheumatoid arthritis, and may be one of the first joints to become involved. Other forms of arthritis can involve this joint, including psoriatic and less common causes.

In early ligament injuries, surgical repair may be indicated, but commonly soreness will resolve with splinting support and retraining wrist use, over a period of 6 months.

The triangular fibro-cartilage complex is one of the most important stabilising ligaments of this part of the wrist.

DRUJ wrist xrayEstablished arthritis:

A number of surgical techniques have been developed over the past 40 years to treat disabling arthritis in the DRUJ. Most of the techniques will combine elements of :

  • partial or total removal of the head of the ulna,
  • reconstruction of stabilising ulna ligaments
  • interposition of muscle or ligament material between the radius and ulna.
  • These operations include:
  • the Darrach procedure (complete removal of the ulna head)
  • Matched hemi-resection of the ulna head
  • the Sauve-Kapandji procedure.

A common complication of these procedures is the development of pain and clicking in the wrist with load carrying and power grip: similar to that prior to the surgery. These operations tend to fail with gradual loosening of the ligament support for the distal ulna, and instability develops particularly with the joint under load.

Total DRUJ replacement arthroplasty xrayTotal DRUJ replacement arthroplasty:

The Aptis DRUJ prosthesis has been developed over the past 10 years by Dr Luis Scheker, Hand Surgeon of Louisville Hand Surgery Associates, Kentucky. It has been used in more than 1,000 people with consistent success.

In my experience, within 2 weeks of the joint replacement, an increased range of pronation and supination- twisting motion of the wrist, with very little or no pain, has been the consistent outcome.

Your recovery will be aided by hand therapists who will establish your rehabilitation programme, directed to rapid settling of swelling and joint stiffness, then strength building.

In the large groups of patients with these joint replacements a low complication rate has been found. Although sporting activities involving power wrist use is discouraged, an active life-style can often be resumed. The prosthesis can be injured in high energy trauma situations, but revision is possible.

Recipients of all joint prostheses must be very cautious of infection: protective antibiotics must be used with all significant dental work, all sore throats or urinary tract infections: and considered with all fevers to avoid infection involving the prosthesis.

- Philip A. Griffin, FRACS