Total Distal Radioulnar Joint Arthroplasty for Paget's Disease of Bone.

Journal of Wrist Surgery
Patrick H MullettThomas J Christensen

Abstract

Background  Distal radioulnar joint (DRUJ) and ulnocarpal pathology, such as ulnocarpal impaction, are relatively common causes of ulnar-sided wrist pain. We herein report a rare case of ulnocarpal impaction and DRUJ arthropathy due to Paget's disease of bone (PDB) in the ulna. Case Description  A 65-year-old, right-hand-dominant male was diagnosed with right-sided ulnocarpal impaction secondary to PDB. While diagnosing the cause of this patient's ulnar wrist pain was relatively straightforward, the management of his pain and symptoms was less so. After a thorough discussion with the patient regarding medical versus surgical management, and after presenting all available surgical options, he opted for a total distal radioulnar joint arthroplasty (TDRUJA). At 3-year follow-up, his wrist is pain-free, has excellent functionality, near-normal motion, and he is highly satisfied. Literature Review  Currently, there are no specific recommendations for surgical management of PDB in the ulna, causing ulnocarpal impaction. While resection of the pathologically enlarged ulnar head (Darrach procedure) and the Suavé-Kapandji (SK) procedure are standard surgical treatment options, a major known disadvantage of these procedures is painful ul...Continue Reading

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