title: Functional results of the Darrach procedure: a long-term outcome study.
abstract: OBJECTIVE
  To assess long-term functional outcome after ulnar head excision for distal radioulnar joint dysfunction with prior or concomitant wrist trauma. We hypothesized that long-term outcomes would reflect good functional results with satisfactory pain relief.
  
  
  METHODS
  A retrospective chart review identified patients who had undergone the Darrach procedure for traumatic or posttraumatic distal radioulnar joint (DRUJ) pathology. We assessed subjective outcomes using a visual analog scale questionnaire to assess pain, wrist stability, and overall satisfaction. We evaluated objective functional outcomes using the Quick Disabilities of the Shoulder, Arm, and Hand and Patient-Rated Wrist Evaluation measures. Final radiographs were compared with preoperative x-rays to investigate the effect of possible ulnar impingement syndrome (convergent instability).
  
  
  RESULTS
  A total of 98 patients with 99 wrists met our predetermined inclusion criteria. Of these, 27 patients with a total of 27 wrists were available for final follow-up, 15 of whom were available for final in-office follow-up with radiographs (6-20 y). Patients displayed an average Quick Disabilities of the Shoulder, Arm, and Hand score of 17 and a Patient-Rated Wrist Evaluation score of 14. Final average visual analog scale scores for pain (0-4), pain with activity (0-4), overall satisfaction (0-4), and wrist stability (0-10) were 0.1, 0.6, 3.7, and 1.5, respectively. Final average wrist range of motion was 85°/78° and 41°/45° for pronation-supination and flexion-extension, respectively. A total of 7 patients displayed radioulnar impingement based on dynamic radiography. This ulnar impingement was not associated with clinical reports of pain and did not affect outcome measures in a statistically significant manner.
  
  
  CONCLUSIONS
  The Darrach procedure provides reliably good long-term subjective and objective results for the treatment of a symptomatic DRUJ after a distal radius fracture. Patients can expect to have excellent forearm range of motion at long-term follow-up. Nearly one-half of patients had dynamic convergence of the DRUJ when stressed radiographically; however, the presence of radiographic dynamic convergence did not influence clinical outcomes.
authors.affiliation: Department of Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH 45267-0212, USA. grawebn@ucmail.uc.edu
authors.forename: Brian
authors.initials: B
authors.lastname: Grawe
authors.forename: Carrie
authors.initials: C
authors.lastname: Heincelman
authors.forename: Peter
authors.initials: P
authors.lastname: Stern
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005542:Forearm / Q000503:physiopathology; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D010147:Pain Measurement; D011885:Radius Fractures / Q000150:complications*; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014457:Ulna / Q000601:surgery*; D014955:Wrist Joint / Q000503:physiopathology*; D055815:Young Adult