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Adams Procedure – a Method of Repair for Post-Traumatic DRUJ Instability

Konstantin Ganchev, Blagovest Belchev, Desislava Simeonova, Dennis Veliev, Preslav Penev

Abstract

Introduction: The triangular fibrocartilage complex (TFCC) is a ligamentous and cartilaginous structure that suspends the distal radius and the ulnar carpus from the distal ulna. It consists of a triangular fibrocartilage disc, radioulnar ligaments (RUL) and ulnocarpal ligaments (UCL) and is considered the main stabilizer of the distal radioulnar joint. The etiology of TFCC injuries consists of falls onto pronated hyperextended wrist, forced rotational movements or they are in association with distal forearm fractures. Patients report trauma followed by ulnar-side wrist pain, swelling, sound of clicking during supination or pronation and later on - loss of grip strength. Two specific classifications are used. The Palmer classification gives accurate anatomical location of the lesion while the five-graded Atzei-EWAS classification is used to determine the severity of the rupture. Stabilization of the distal radioulnar joint with reconstruction of distal radioulnar ligaments as outlined by Adams is indicated if a refixation of the triangular fibrocartilage complex is no longer possible and there are no present arthrotic changes.

Materials and Methods: Ten patients with distal radioulnar joint instability caused by 4th grade TFCC tears were diagnosed and admitted to the Clinic of Orthopedics and Traumatology in St. Anna University Hospital, Varna for the interval 2013-2017. The procedure of Adams was the surgical method of choice for all of them.

Results: MAYO wrist score was used for evaluation of the patients’ pre- and postoperative conditions. The results showed restored stability, relieved symptoms and attained near-physiological levels of pronation and supination after the surgical procedure.

Conclusion: TFCC injuries are not to be treated lightly as they trouble the mechanics of the DRUJ. Surgical treatment is considered superior to the conservative, and the Adams procedure is an effective method of approach towards the 4th grade tears.


Keywords

TFCC, DRUJ, Adams procedure


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