Male, 32 years old. Motorcycles driver with pain in right wrist and limitation in pronation and supination. It has precedent of fracture of right distal radius, happened 1 year ago and treated with immobilization.
RX:
TAC: radius-ulnar joint luxation
Our quetion : what to do? Ligamentoplasty
The patient is positioned supine on the operating table with the arm abducted on a hand table and a pneumatica tourniquet applied below the axilla atfter an ultrasound guidance for axillary plexus block. A standard antiseptic preparation is followed.
The dorsal approach provides access to the entire dorsal aspect of the distal radius, distal radioulnar Joint and ulnar head.
A longitudinal incisión over the fifth dorsal compartment and DRUJ is made, followed by the immediate identification of the dorsal cutaneous branch of the ulnar nerve
Osteotomy to shorten the ulna, if necessary. Arthrotomy of the ulna and carpals and extraction of the remains of the TFCC.
Creation of the postero-anterior tunnel of the radius, orifice al 2-3mm
From the surface of the joints
The wire ring is passed through to hook the tendon the previously extracted PL tendon is looped through it.
Creation of the tunnel at the head of the ulna. Oblique direction, from the base of the styloid process to the external edge of the ulna. Wire ring to pass the tendon through. Threading of the PL tendon through the ulnar tunnel.
Mitek or similar anchorage systems.
Final detail of the passage of the PL tendon through the tunnels.
Anchoring of the ends of the tendons and blocking needle.
Careful closure of the different incisions. Immobilisation in
supination or pronation, as the case may be.
Results alter 6 months
Fuente:Asepeyo Portal Sanitario
