title: The "Four-Leaf Clover" Treatment Algorithm: A Practical Approach to Manage Disorders of the Distal Radioulnar Joint.
abstract: Most symptomatic distal radioulnar joint (DRUJ) conditions result from derangements to several structures that may include the length, shape, and/or orientation of the articulating surfaces; the cartilage of the DRUJ and/or ulnocarpal joint; the DRUJ and/or ulnocarpal joint ligaments; and the extensor carpi ulnaris and/or pronator quadratus muscle. Once a complete diagnosis is made, often only one of these components is addressed, which results in suboptimal clinical outcomes. In this article, we present a treatment algorithm (the Four-Leaf Clover algorithm) to guide treatment of DRUJ pathology. The Four-Leaf Clover principle is a guiding algorithm, not a document forcing the surgeon to adopt one particular treatment. Its purpose is to provide treating physicians with a checklist that helps ensure that they do not miss any of the different components that need to be addressed for a complete treatment. Using the treatment algorithm, we should achieve satisfactory resolution of patients' symptoms after addressing the particular components in a stepwise approach.
authors.affiliation: Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN. Electronic address: Kakar.sanjeev@mayo.edu.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Kakar
authors.affiliation: Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN; Kaplan Institute, Barcelona, Spain.
authors.forename: Marc
authors.initials: M
authors.lastname: Garcia-Elias
mesh_terms: D000465:Algorithms; D003661:Decision Support Techniques; D006801:Humans; D007592:Joint Diseases / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D014955:Wrist Joint
keywords: Distal radioulnar joint; distal radioulnar joint pathology; treatment