[Non-traumatic osteoarthritis of the distal radio-ulnar joint: a consecutive series of 11 wrists with 42 months follow-up].
OBJECTIVE
Non-traumatic osteoarthritis of the distal radio-ulnar joint is generally observed in a context of chondrocalcinosis and can lead to rupture of the extensor tendons. We reviewed patients operated on in our unit between 1986 and 1988 for this condition in order to examine modalities of surgical care.


METHODS
Eleven patients who underwent surgery for non-traumatic osteoarthritis of the distal radio-ulnar joint were included in the study. Demographic data, clinical signs, joint amplitudes, radiologically identified lesions, peroperative macroscopic features, and results of the microscopic examinations of the synovectomy specimen were recorded. Injury to the extensor tendons and surgical procedures used for repair were noted. Outcome was assessed clinically (pain, stability of the ulnar stump, active extension of the fingers, pronation-supination, flexion-extension) and radiologically.


RESULTS
The series included 11 wrists in 8 women, mean age 73.2 years. The underlying cause was chondrocalcinosis in 9 cases and primary osteoarthritis in 2. All patients had painful pronation-supination and 9 of them had ruptured extensor tendons. There was a dorsal displacement of the ulnar head in all cases. Synovectomy-realignment-stabilization was performed using the Sauvé-Kapandji procedure in 10 wrists and resection of the ulnar head using the Darrach procedure in one. Extensor tendons were repaired by side-to-side anastomosis with neighboring tendons in 6 wrists and with grafts in 3. At a mean 42 months follow-up, 7 wrists were pain free and 4 continued to have climatic pain. The ulnar stump was stable in all cases. All the patients achieved active extension of the fingers and preserved wrist mobility.


CONCLUSIONS
According to the literature, non-traumatic osteoarthritis of the distal radio-ulnar joint is uncommon and occurs principally in the elderly patient. The most common complication being rupture of the extensor tendons. Different treatments can be discussed, but we prefer synovectomy-realignment-stabilization using the Sauvé-Kapandji method which, in light of the results obtained in this series, can regularly provide good pain relief and good functional results when associated with tendon repair as needed and as early as possible.
Couturier
C A
CA
Centre de Chirurgie Orthopédique et Traumatologique, Hôpital Bichat, 46, rue Henri-Huchard, 75877 Paris Cedex 18, France. c.couturier@noos.fr
Alnot
J Y
JY
D000368:Aged; D000369:Aged, 80 and over; D002805:Chondrocalcinosis / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D010027:Osteotomy / Q000379:methods*; D010146:Pain / Q000209:etiology; D011403:Pronation; D016059:Range of Motion, Articular; D012422:Rupture, Spontaneous; D013484:Supination; D000074402:Synovectomy; D013710:Tendons / Q000601:surgery*; D016896:Treatment Outcome; D014457:Ulna / Q000601:surgery*; D014955:Wrist Joint