17.1 THE ROLE OF THE HERBERT ULNAR HEADPROSTHESIS IN THE MANAGMENT OF DRUJINSTABILITYS. Talwalkar, N. Roy, I. Trail, M. Hayton, L. Gwilliamand J. MartinWrightington Hospital, Wigan, UKBackground: Excessive resection of the distal end of theulna can result in instability of the distal stump andradioulnar impingement. We have used the HerbertUlnar Head Prosthesis in the management of patientswith DRUJ instability, particularly failed resectionarthroplasties of the DRUJ since 1996.Patients and methods: Between 1996 and December2002, we operated on 57 cases of which 37 were availablefor clinical follow-up. Patients were assessed with postalquestionnaire, clinical exam and X-ray. The average ageof patients was 54.4 years with a mean follow-up of 4.4years. Patients had an average of three index operationsranging from 0 to 6. Nineteen patients had previouswrist fusion and two cases had wrist replacementsurgery.Results: The mean VAS for pain (0–10) improved from7.9 to 3.9. Seventy per cent of the patients felt that theyhad a good to excellent result while 63% felt that theywould have the same procedure for a similar problem.Sixty-seven per cent of the f l exion–extension range and80% of the pro-supination range was preserved whencompared with the opposite side. A limited resorption ofthe distal cortex of the ulna was frequent (average2.3mm) without any clinical consequence except in 5cases 410mm bone loss was noted. Six cases had radialscalloping 45mm, three of which are progressive. Fiveprostheses had been removed and two implants wereradiologically loose. One implant fractured which wassubsequently removed. At review none of the implantswere unstable though three cases had undergoneoperation for instability. Nine patients complained ofpain over the ECU tendon, which appears to be arecurrent problem and main reason for postoperativepain. Six patients had surgical exploration of ECU forpain.Conclusion: The Herbert distal ulnar head prosthesisgives satisfactory results as a salvage procedure for acomplex problem. A long-term study needs to be doneto conf i rm our f i ndings and provide data for survivor-ship analysis.10.1016/j.jhsb.2006.03.05017.2 PRELIMINARY RESULTS AFTER RECON-STRUCTION OF THE DESTROYED DRUJ WITHAN ULNAR HEAD PROSTHESISM. Mueller, T. Gohla, G. Germann and M. SauerbierBG Trauma Center Ludwigshafen, Plastic and HandSurgery of, the University of Heidelberg, GermanyBackground: Resection of the distal ulna, partialresection of the joint surfaces with or without interposi-tion of connective soft tissue, or fusion of the distalradius and ulna with creation of a proximal pseudoar-throsis such as the Kapandji–Sauve´ procedure arecommon methods to treat the arthritic destroyed DistalRadio Ulnar Joint (DRUJ). One of the drawbacks ofthese salvage procedures is the potential risk of painfulradioulnar instability. Recent biomechanical studiesshowed that implantation of an ulnar head prosthesisis a promising procedure to restore the anatomy of theDRUJ.Objectives: The purpose of this study was to evaluate thepreliminary results after reconstruction of the destroyedDRUJ with an ulnar head prosthesis.Patients and methods: Fourteen patients were includedin this study and examined clinically. Bilateral measure-ment of grip strength (JAMAR), active range of motionand subjective outcome data (DASH questionnaire)were analysed. Primary ulnar head prosthesis implanta-tion was done in nine cases, implantation followingfailed salvage operations in f i ve cases.Results: The average patient age was 49 years, 11patients were male, three female, and the average follow-up time was 14 months. The average grip strength was75% of the contra lateral hand, pro-/supination was1411 ( ¼ 78% of the contra lateral hand), the averageDASH score was 15 points. Twelve of the 14 patientswere satisf i ed with the f i nal result, in two patients theulnar head prosthesis had to be removed. In one case,due to infection and in the second case, due to apersistent painful incongruence of the DRUJ.Discussion: Our results demonstrate that with implanta-tion of an ulnar head prosthesis satisfying results and ananatomic reconstruction of the DRUJ can be achieved.The data show that the prosthesis prevents radioulnarinstability. It is also possible to use the device as aprimary option instead of resection procedures of thedistal ulna.10.1016/j.jhsb.2006.03.051ARTICLE IN PRESSWRIST 2 81
