Surgical Treatment of Distal Radio-Ulnar Joint (DRUJ) Arthritis

The anatomy of the DRUJ predisposes it to the aggressive synovial destruction characteristic of RA. The DRUJ relies mainly on soft tissue structures for stability, therefore, the triangular fibrocartilage complex (including the TFC proper, volar and dorsal radioulnar ligaments, ulnocarpal ligaments, and subsheath of the extensor carpus ulnaris) plays a substantial role in stabilizing the DRUJ. Early diagnosis and medical treatment of rheumatoid arthritis of the DRUJ is essential to minimize the bony and soft tissue destruction that occurs as the disease severity worsens. Deformity and instability at both the radioulnar and ulnocarpal joints should be addressed if surgical management is required. Distal ulnar resection (Darrach's procedure) and DRUJ arthrodesis (Sauve-Kapandji procedure) have historically been performed to treat DRUJ arthritis, but newer interposition arthroplasty and endoprothesis techniques are currently being evaluated.