Posterior Interosseous Artery Adipofascial Flap for the Management of Distal Radioulnar Joint Osteoarthritis

Abstract

The management of distal radioulnar joint (DRUJ) osteoarthritis in young and active patients remains challenging. The purpose of this study was to describe our experience with a vascularized tissue interposition arthroplasty, based on a posterior interosseous artery adipofascial flap. This procedure is a biological alternative to previous DRUJ arthroplasties for patients who demand a strong and stable wrist and forearm. In this group of patients, it is indicated in the setting of osteoarthritis with pain and pronosupination block, but without advanced degeneration of the bone stock and the soft tissue stabilizers. This procedure was performed in 20 patients (mean age: 46), with a mean follow-up of 31 months. Mean postoperative pronation, supination, wrist flexion, and extension improved from the preoperative range to 73.2 degrees, 69 degrees, 52.4 degrees, and 45 degrees, respectively. A marked improvement in pain was recorded (from 7 to 1.5 Visual Analog Scale), with 13 patients completely pain-free. The mean preoperative Quick Disabilities of the Arm, Shoulder, and Hand score was 65.1, and the mean postoperative Quick Disabilities of the Arm, Shoulder, and Hand score was 20.1. Most patients had returned to work and resumed their hobbies. The technique proved effective as an alternative for the management of DRUJ osteoarthritis in young patients with high functional demands. Level of Evidence: Level IV—therapeutic.