title: Chronic volar distal radioulnar joint instability: joint capsular plication to restore function.
abstract: BACKGROUND
  Volar instability of the distal radioulnar joint (DRUJ) is uncommon, and there is little written about it. The purpose of this study is to describe a new procedure to treat volar DRUJ instability and to present the outcomes of patients who received this unique surgical repair at a minimum of 1 year follow-up.
  
  
  METHODS
  We performed a retrospective case series of 6 consecutive patients treated with a volar and dorsal capsular plication procedure by an upper extremity specialist surgeon at a teaching hospital between April 1999 and October 2004. We evaluated measures, including wrist range of motion, grip strength, radiographs, Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and Patient-Rated Wrist Evaluation (PRWE), at final follow-up.
  
  
  RESULTS
  Five of 6 patients had resolution of pain and instability symptoms. The average difference in range of motion between operative and contralateral sides was -7 degrees flexion, 2 degrees extension, 4 degrees radial deviation, 2 degrees ulnar deviation, -17 degrees supination and -2 degrees pronation. Average grip strength measured 83% of the uninjured side. The average DASH score was 13.5 (range 0-46.7), and the average PRWE score was 26.7 (range 0-70). One patient had a low ulnar neuropathy, which resolved. One patient fractured the temporary DRUJ stabilization screw and had radiographic evidence of nonbridging heterotopic ossification.
  
  
  CONCLUSIONS
  Joint capsular plication for DRUJ has not yet been described in the literature. It is less elaborate in that it does not require a tendon graft with bone tunnels. The results at an average 16.5 months postoperatively are promising.
authors.affiliation: University of Calgary and the Calgary Health Region, Calgary, Alta.
authors.forename: Kelly
authors.initials: K
authors.lastname: Johnston
authors.forename: D'Arcy
authors.initials: D
authors.lastname: Durand
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Hildebrand
mesh_terms: D000293:Adolescent; D000328:Adult; D018771:Arthralgia / Q000503:physiopathology / Q000601:surgery; D001863:Bone Screws; D002648:Child; D002908:Chronic Disease; D004185:Disability Evaluation; D005260:Female; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D017746:Joint Capsule / Q000601:surgery*; D007593:Joint Instability / Q000503:physiopathology / Q000601:surgery*; D008023:Ligaments, Articular / Q000601:surgery; D008297:Male; D011403:Pronation / Q000502:physiology; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D013484:Supination / Q000502:physiology; D013536:Suture Techniques; D014955:Wrist Joint / Q000503:physiopathology / Q000601:surgery*