Nova técnica cirúrgica para Reconstrução da Articulação Radioulnar Distal em instabilidades crônicas sem Artrose

Abstract

Disorders of the distal radioulnar joint (DRUJ) of different etiologies are relatively common and can severely affect wrist and forearm function. Acute lesions, if unidentified and treated, may evolve with chronic pain and instability, or degenerative disease in more advanced stages. Due to local bone characteristics, stability is mainly given by the soft tissues, among which the triangular fibrocartilage complex (TFCC) is the main structure. Restoration of DRUJ stability is the goal of treatment and the reconstructions constitute the main group when treating chronic non-arthritic lesions. The objective of this paper is to describe a new technique of tenoplasty using a strip of flexor carpi ulnaris (FCU) tendon, for anatomical reconstruction of the DRUJ and to show dorsal and volar stability and maintenance of prono-supination after reconstruction. Ten fresh cadavers without signs of lesions or previous surgeries in the upper limbs were selected and the surgical technique was applied to both wrists, totaling 20 reproductions performed by the same hand surgeon. Photographs and finite models were made in five cadavers detailing the most important points of each steps of technique. After one pilot cadaver, other four cadavers tests were made to show improvement of dorsal and volar translations and maintenance of range of motion after the procedure. The technique of this study presents several advantages when compared to the procedures already described in the literature, because it reconstructs the TFCC and brings anatomy closer to the normal. This allows gain of stability in the sagittal and coronal plane, without compromising range of motion. Other advantages of this study include performing only two bone tunnels, with reduced risk of iatrogenic fracture; maintaining a constant tension of the graft, without loosening over time, considering that it is a dynamic tenoplasty; conservation of the primary function of the FCU, without the need of an aggressive dissection. The technique reconstructs the DRUJ complex, with technical advantages over other described procedures, being a good alternative for the treatment of chronic instabilities of DRUJ without arthritis.