Long-term functional outcome and patient satisfaction after ulnar head resection.
OBJECTIVE
Resection of the ulnar head (Darrach procedure) is still frequently performed in patients suffering from posttraumatic osteoarthritis of the distal radioulnar joint (DRUJ). Ulnar impingement syndrome is sometimes observed with subsequent poor functional outcome. Here, we present a long-term follow-up study after Darrach procedure to evaluate functional results, pain relief, and patient satisfaction.


METHODS
Thirty-seven patients after ulnar head resection who were treated in our clinic between 2006 and 2012 were invited for follow-up investigation. Follow-up included radiologic outcomes, objective measures (active range of motion (AROM) and grip strength), the patients' individual perception of disability (pain, visual analog scale (VAS), the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, and patient-rated wrist evaluation score (PRWE)).


RESULTS
A total of 25 patients with 27 operated wrists were available for clinical evaluation and radiologic follow-up. The AROM of the treated wrists averaged 145.7° (89.7% of the contralateral side) for pronation and supination. The average VAS decreased from 6.5 to 2.3 postoperatively. Mean grip strength was 12.4 kg (57.1%). Patients showed satisfying results with an average PRWE of 42 and an average DASH of 25.5. Radiographic radioulnar convergence did not correlate with clinical symptoms. Overall, patient satisfaction was high and 22 patients (88%) would choose to undergo the operation again.


CONCLUSIONS
In patients with posttraumatic and chronic DRUJ osteoarthritis, the Darrach procedure leads to satisfactory long-term results especially concerning mobility and sustainable pain relief. Symptomatic ulnar impingement and persistent pain of the ulnar stump are rare sequelae of this procedure.
Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University Heidelberg, Germany.
Hernekamp
H
Jochen-Frederick
Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University Heidelberg, Germany.
Yary
Y
Pouyan
Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University Heidelberg, Germany.
Bigdeli Amir
BA
Khosrow
Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University Heidelberg, Germany.
Hirche
H
Christoph
Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University Heidelberg, Germany.
Bickert
B
Berthold
Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University Heidelberg, Germany.
Kneser
K
Ulrich
Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University Heidelberg, Germany. Electronic address: thomas.kremer@bgu-ludwigshafen.de.
Kremer
K
Thomas
D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D018737:Hand Strength; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods; D017060:Patient Satisfaction; D011859:Radiography / Q000379:methods; D016059:Range of Motion, Articular; D016896:Treatment Outcome; D014457:Ulna / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D014954:Wrist Injuries / Q000150:complications*
Chronic DRUJ-osteoarthritis; Darrach procedure; Distal radioulnar joint; Ulnar head resection