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      Ulnar Head Reconstruction with Microvascular Second Metatarsal

      research-article
      , MD, PhD, , MD, PhD
      Plastic and Reconstructive Surgery Global Open
      Wolters Kluwer Health

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          Abstract

          Background:

          The distal radioulnar joint along with the interosseous ligament of the forearm and the proximal radioulnar joint, form a functionally integrated system responsible for the pronation–supination of the hand. The distal ulna, the so-called ulnar head, is an integral part of this system. Apart from its well-known role in forearm rotation, the ulnar head is essential in transverse load transmission through the distal radioulnar joint upon resisted elbow flexion. Autologous reconstruction of ulnar head would theoretically be beneficial with respect to prostheses.

          Methods:

          Three cases of ulnar head reconstruction with microvascular second metatarsal are reported herein including trauma, oncological, and congenital ethiologies.

          Results:

          The clinical result was good without complaints of instability.

          Conclusions:

          The cases included in this series, although heterogeneous, indicate that this treatment may be feasible also in postoncological resections and in congenital cases.

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          Most cited references10

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          Failed distal ulna resections.

          Twenty patients with complaints of pain and limitation of activities for more than 1 year after ulnar head resection (Darrach) were studied. Their ages ranged from 18 to 60 years (mean, 38 years). The initial indications for operation were posttraumatic derangement in 18 patients, radial growth anomaly in 1, and a lesion of the ulna in 1. Follow-up ranged from 29 to 135 months (mean, 61 months). The patients had an average of 2.2 additional operations, with up to seven procedures per patient. Radiographs were compared with those from an equal number of successful Darrach resections chosen randomly, and no significant differences were noted. All 20 patients continue to have difficulties despite several years of treatment. The Darrach resection can result in serious disability, especially in the younger patient and the patient with lax ligaments. Reoperation on these patients is rarely successful.
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            Implant arthroplasty for the distal radioulnar joint.

            The distal radioulnar joint (DRUJ) is a weight-bearing joint; the ulnar head is frequently excised either totally or partially and in some cases is fused because of degenerative, rheumatoid, or posttraumatic arthritis and treated with a "salvage procedure." The result of these procedures is the inability of those patients to lift even minor weight. Articles about these procedures report the ability to pronate and supinate, but they rarely discuss grip strength or lifting capacity. We present an alternative to the salvage procedures that allows full range of motions as well as the ability to grip and lift weights encountered in daily living, such as a gallon of milk. The Aptis total DRUJ replacement prosthesis (Aptis Medical, Louisville, KY), a bipolar self-stabilizing DRUJ endoprosthesis, restores the forearm function. The technique of implantation is presented here.
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              Implant arthroplasty for treatment of ulnar head resection-related instability.

              Resection of the ulnar head in cases of debilitating pain owing to arthrosis of the distal radioulnar joint can provide satisfying relief. However, there is mounting evidence that pain with heavier use, instability, and torque-generating weakness in more active individuals may result in less satisfying outcomes. Implant arthroplasty can provide a means to stabilize the radius to the ulna after ulnar head resection, but it requires significant attention to requisite soft tissue stabilization and alignment of the distal radius to the implant to be successful.
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                Author and article information

                Journal
                Plast Reconstr Surg Glob Open
                Plast Reconstr Surg Glob Open
                GOX
                Plastic and Reconstructive Surgery Global Open
                Wolters Kluwer Health
                2169-7574
                13 April 2017
                April 2017
                : 5
                : 4
                : e1284
                Affiliations
                From the Reconstructive Surgery, Clinica Cavadas, Hospital de Manises, Valencia, Spain.
                Author notes
                Alessandro Thione, MD, PhD, Reconstructive Surgery Unit, Clinica Cavadas, Hospital de Manises, Paseo Facultades 1, 46021 Valencia, Spain, E-mail: althione@ 123456gmail.com
                Article
                00006
                10.1097/GOX.0000000000001284
                5426872
                652dfcfe-6654-479c-8998-afa83cbe6578
                Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

                History
                : 5 December 2016
                : 6 February 2017
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