20 Hemiresection Arthroplasty of the Distal Ulna

• Approach the DRUJ through the fifth extensor compartment, leaving the distal portion intact (Fig. 20-1).
  
• Raise an ulnarly based rectangular capsular flap but do not open the sixth compartment for the extensor carpi ulnaris (Fig. 20-2).

Figure 20-1

Pitfall

Avoid cutting the dorsal radioulnar ligament.

• Obliquely resect a portion of the ulnar head, leaving the styloid attached to the triangular fibrocartilage complex (TFCC) (Fig. 20-3).
  
• Contour the distal ulna to a hemispherical shape (Fig. 20-4).
  
• Wrap the dorsal capsular flap over the distal ulna and suture to volar DRUJ capsule (Fig. 20-5A).
  
• Extensor retinaculum repaired to dorsal edge of sigmoid notch leaving EDQ superficial to repair (Fig. 20-5A,B).

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