24 Distal Ulna Implant Arthroplasty

• Chronic instability of the distal ulna after Darrach resection (see Chapter 21)
  
• Osteoarthritis or posttraumatic arthritis in patients with low activity demands

Pitfall

Implant stability may be difficult to achieve in cases with preoperative radioulnar divergence.

Technique

• The skin is incised along the subcutaneous border of the ulna, extending 6 to 8 cm proximally from the triquetrum (Fig. 24-1).
  
• Identify and protect the dorsal sensory branch of the ulnar nerve.
  
• The extensor retinaculum is incised between the extensor carpi ulnaris (ECU) and flexor carpi ulnaris (FCU).
  
• Elevate the ECU sheath subperiosteally from the distal ulna along with the triangular fibrocartilage complex (TFCC) and other soft tissues (Fig. 24-2).

Figure 24-1

Pearl

A dorsal approach is particularly useful when there is a preexisting dorsal incision or if joint inspection is required to decide optimal treatment.

• Use radiographs and templates to choose the proper head size.
  
• A resection guide is used to determine the osteotomy level through the ulnar neck.
  
• The distal ulna is removed, preserving all soft tissues, which will form a pocket for the prosthetic head (Fig. 24-3).

Related posts:

Intra-articular Fractures of the Distal Radius Treated with Dorsal Plate Resect Ulnar Styloid Fracture with Repair of Triangular Fibrocartilage Complex Sauve-Kapandji Procedure Darrach Procedure (Distal Ulna Resection) Scaphocapitate Fusion with Lunate Excision Capitate Shortening with Capitohamate Fusion

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