Distal Radioulnar Joint Arthroplasty with a Scheker

We report the case of a 28 year old man who sustained a rotary injury to his wrist. Eight months later at an outside institution, he underwent an ulnar shortening osteotomy. One year later, due to continuing symptoms, a second sur-gery was performed, with hardware removal and distal right ulna resection. He presented to our institution 16 months later with constant, worsening pain in his right up-per extremity which increased with activity, despite treat-ment. Physical examination showed limited range-of-motion of flexion and extension in the right wrist, de-creased range of supination at the elbow, decreased right grip strength, and instability of the distal ulnar stump. Initial radiographs demonstrated distal ulnar resection (Figure 1). The patient next underwent placement of a Scheker prosthesis (Aptis Medical) at the DRUJ. A post-operative image is shown in Figure 2. Discussion The DRUJ allows supination and pronation of the fore-arm and is important to one’s grip strength and lifting abil-ity. Arthropathy of the DRUJ can occur as the result of a variety of mechanisms, including inflammatory arthritis (particularly rheumatoid arthritis), post-traumatic causes and congenital or developmental abnormalities of the joint surfaces (1). A common post-traumatic cause is a ma-lunited Colles fracture of the distal radius. DRUJ arthropa-thy presents with pain near the DRUJ, particularly with gripping and resisted rotation of the forearm. The diagno-sis can be made on the basis of standard AP and lateral radiographs. After degenerative findings have developed in the DRUJ articular surfaces, surgical options are largely limited to salvage procedures (1). Therefore, conservative manage-ment with splints, anti-inflammatory medications, activity modification and steroid injections is preferred. Once con-servative methods fail, resection of the distal ulna can be considered to relieve pain at the DRUJ. Distal ulnar resec-tion, however, disrupts the stability of the entire forearm, leading to a reduction in stability and torque strength, a