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Hemiresection Arthroplasty ng DRUJ

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Isang plano ng paggaling pagkatapos ng hemiresection-interposition arthroplasty ng distal radioulnar joint, kung saan ang bahagi ng ulnar head na nasira ay bahagyang tinatanggal upang maibalik ang pag-ikot ng forearms na walang sakit; pagkatapos ng maikling panahon ng proteksyon, ang maagang pag-ikot ng forearms (pag-ikot ng palad pataas at pababa) ang pinakamahalaga, habang ang mas mabigat na pagbebenta ay dahan-dahang idudagdag.

Illustrasyon ng pagbuhos mula sa kaldero, ang pang-araw-araw na kilos na nangangailangan ng walang sakit na pag-ikot ng forearms.
Ang distal radioulnar joint ay nagpapahintulot sa forearms na umikot, na nagpapalipat-lipat ng palad pataas at pababa, gaya ng pagbuhos ng tubig mula sa kettleng. Ang hemiresection ay nagpapagaan ng masakit at nasira na joint habang pinapanatili ang kakayahang umikot. Kieran Hirpara 4.0

Ang pahinang ito ay isinalin ng makina at hindi pa nasusuri ng isang doktor. Ang bersyong Ingles ang siyang opisyal.

Ang protocol na ito ay gabay sa iyong paggaling pagkatapos ng hemiresection-interposition arthroplasty ng distal radioulnar joint (DRUJ), isang operasyon na muling hinuhubog ang nasirang dulo ng forearms upang maibalik ang komportableng, walang sakit na pag-ikot ng forearms, kasama si Dr Kieran Hirpara sa Mater Private Hospital Rockhampton. Nagsisimula ito sa iyong home exercise program, sinundan ng istrukturadong clinical protocol na isinulat para sa iyong hand therapist; dalhin ang pahinang ito o ang PDF nito sa iyong unang bisita sa therapy upang manatiling koordinado ang iyong rehabilitation. Maaaring baguhin ng iyong therapist ang plano depende sa kung paano ang iyong paggaling.

Kung mayroon kang anumang alalahanin tungkol sa iyong sugat pagkatapos ng operasyon, makipag-ugnayan sa mga kwarto. Karaniwang makakatulong na kumuha ng litrato ng sugat at ipadala ito sa pamamagitan ng email para sa pagsusuri.

Ano ang inaasahan

Ang distal radioulnar joint (DRUJ) ay ang maliit na kasukasuan malapit sa iyong pulso sa gilid ng maliit na daliri kung saan nagtatagpo ang dalawang buto ng braso (ang radius at ulna). Ito ang kasukasuan na nagpapahintulot sa iyo na i-ikot ang iyong braso, palad pataas (supination) at palad pababa (pronation). Kapag ang kasukasuang ito ay nasira at naging arthritic, masasakit ang pag-ikot ng braso.

Sa isang hemiresection arthroplasty, ang nasira at arthritic na bahagi lamang ng ulo ng ulna ang pinapakinis (isang bahagyang pag-alis: ang "hemi" ay nangangahulugang kalahati), at isang maliit na unan ng sarili mong malambot na tisyu ang inilalagay sa puwang upang mapigilan ang pagkuskos ng mga ibabaw. Pinapanatili ng operasyong ito ang mga pangunahing istruktura ng pagpapatatag, kabilang ang TFCC (ang cartilage at ligament hammock na sumusuporta sa pulso sa gilid na ito), ang ulnar styloid, at ang mga attachment ng malambot na tisyu, kaya ang dulo ng ulna ay nananatiling sinusuportahan. Ito ang nagpapakita ng pagkakaiba nito sa kumpletong pag-alis ng ulo ng ulna (isang Darrach procedure).

Dahil ang mga ibabaw ng kasukasuan ay muling hinubog imbes na ayusin o muling itinayo, walang tendon o ligament na kailangang gumaling sa ilalim ng proteksyon sa loob ng ilang buwan. Ang layunin ng operasyong ito ay ang walang sakit na pag-ikot ng braso, at ang pinakamahalagang bahagi ng iyong rehabilitasyon ay ang maagang paggalaw ng pag-ikot na ito. Pagkatapos ng maikling panahon ng proteksyon sa isang splint upang payabungin ang malambot na tisyu, ang pagpapanumbalik ng pag-ikot ng braso (palad pataas at palad pababa) ang nagiging pangunahing paksa ng iyong paggaling. Ang lakas at mas mabigat na pagbebenta ay idadagdag nang dahan-dahan pagkatapos nito.

Mga Precautions at Limitasyon

  • Sa loob ng mga unang dalawa hanggang tatlong linggo, isuot ang iyong splint ayon sa utos; ito ay dahan-dahang nagbabawal sa pag-ikot ng forearms habang ang interposition tissue ay nananatili. Panatilihin ang paggalaw ng iyong mga daliri, at (kapag pinapayagan) ang iyong pulso.
  • Kapag inalis na ang splint, gawin ang pag-ikot ng forearms bilang priority, panatilihin itong walang sakit at walang load. Ang maagang pag-ikot ay dapat gawin gamit ang walang laman na kamay, hindi laban sa bigat.
  • Huwag GAWIN ang pag-load ng forearm sa maagang yugto: walang pag-ikot ng mga bote, pagwawala ng mga tela, paggamit ng screwdriver, o pagdadala ng mabibigat na bag sa gilid na ito hanggang sa malinaw ang strengthening (karaniwan sa loob ng anim hanggang walong linggo).
  • Maging alerto sa sakit o pakiramdam ng instability sa gilid ng kamay na may little finger kapag ikaw ay nagpapush o naglo-load sa pamamagitan ng forearm, dahil ito ang lugar na pinagtrabaho ng operasyon. Ibanggit ito sa iyong hand therapist; huwag pilitin ito.
  • Panatilihin ang paggalaw ng iyong mga daliri, hinlalaki, siko, at balikat mula sa simula, at gamitin ang kamay para sa mga magaan na araw-araw na gawain sa loob ng comfort, hangga't hindi ito kasama ang forced o loaded na pag-ikot.

Para sa wound, swelling, at scar management, tingnan ang wound care guidance ng practice.

Ang iyong mga ehersisyo

Ito ang mga ehersisyo mula sa iyong handout. Simulan lamang ito ayon sa gabay ni Dr. Hirpara at ng iyong hand therapist, at manatili sa loob ng anumang saklaw at limitasyon na ibinigay sa iyo. Ang paggalaw ng mga daliri ay magsisimula agad. Ang pag-ikot ng forearms (ang ehersisyo na batay sa operasyong ito) at paggalaw ng pulso ay magsisimula kapag ikaw ay pinapayagan na alisin ang splint, karaniwan sa loob ng dalawa hanggang tatlong linggo, at ang pag-ikot ay maging pangunahing pokus mo. Ang pagmamasahe ng peklat ay magsisimula kapag ang sugat ay ganap na nalaglag. Ang pagpapalakas ng hawak at pag-ikot ay nasa huling yugto at hindi dapat simulan hangga't hindi ka espesipikong pinapayagan. Itigil ang anumang bagay na nagdudulot ng matinding sakit sa gilid ng pulso kung saan matatagpuan ang maliit na daliri.

Ang iyong klinikal na protokol

Ang natitirang bahagi ng pahinang ito ay ang yugto-yugto na klinikal na protokol para sa rehabilitasyon pagkatapos ng hemireseksiyon-interposyon arthroplasty ng distal radioulnar na kasukasuan. Ang seksyong ito ay dapat ibigay sa iyong hand therapist, at ang bawat yugto ay nagsisimula sa isang paliwanag sa simpleng wikang Ingles kung ano ang nangyayari. Ito ay isang prosedura sa pagbabago ng hugis ng kasukasuan (arthroplasty), hindi pagkukumpuni: walang konstruksyon na nasa ilalim ng tensyon na dapat protektahan sa loob ng mga buwan. Ang disenyadong pag-iingat ay maikli: isang maikling panahon ng splinting upang hayaang matayo ang interposisyon ng malambot na tisyu at kapsula, pagkatapos ay ang maagang pagbawi ng pag-ikot ng forearms ang eksplisitong prioridad dahil ang pag-ikot ang tungkulin na para sa pagpapanumbalik ng operasyon. Ang pangunahing load na dapat igalang sa buong panahon ay ang rotational loading ng distal ulna, na ito ang nagdudulot ng masakit na instability ng ulnar-stump at radioulnar convergence.

Bago ang paggamot, suriin ang operation report at nakaraang medikal na kasaysayan ng pasyente, at makipag-ugnayan sa treating surgeon tungkol sa anumang concurrent procedures (TFCC repair, distal radius osteotomy, PIN neurectomy, extensor reconstruction), ang stability ng distal ulnar stump na na-assess intra-operatively, at ang iniresetang splint at rotation ceiling. Ang isang concurrent TFCC repair o distal radius osteotomy ay nagpapahaba ng protected phase; ang isang isolated hemiresection para sa degenerative o post-traumatic arthritis ay sumusunod sa mas maikling pathway sa ibaba. Pinapanatili ni Dr Hirpara ang TFCC, ulnar styloid at ulnar soft-tissue attachments, kaya ang distal ulna ay nananatiling sinusuportahan, at ang rehab ay maaaring magprioritize ng maagang pag-ikot.

Yugto I — protektadong pagpapahinga sa splint (linggo 0 hanggang 2-3)

Ang unang dalawa hanggang tatlong linggo ay nagpoprotekta sa pagitan ng malambot na tisyu at kapsula habang pinapanatiling mobile ang natitirang bahagi ng limb. Ang forearms ay nakapahinga sa isang splint (karaniwang isang splint o cast na nasa itaas ng siko / uri ng Muenster na nagbabawal sa pag-ikot ng forearms), tinatanggal lamang para sa kalinisan at, sa dulo ng yugto, para sa unang banayad na pag-ikot. Ang mga daliri ay gumagalaw mula sa unang araw.

Para sa iyong hand therapist:

Edukasyon at mga paalala - I-immobilize sa iniresetang splint (nasa itaas ng siko / uri ng Muenster, o ayon sa doktor) na nagbabawal sa pag-ikot ng forearms; tinatanggal lamang para sa kalinisan at mga inaprubahang ehersisyo - Walang pag-ikot ng forearms na may bigat; walang pagtindig o pag-ikot sa pamamagitan ng operated na forearm - Siguruhin na ang unang kahinaan ng hawak at pamamaga sa ulnar side ay inaasahan

Pamamahala - Sugat: mga surgical dressing ayon sa utos; monitor para sa impeksyon - Oedema: elevation, banayad na hand pump, ice kung kinakailangan - Mga ehersisyo: aktibong pag-ikot ng mga daliri, hinlalaki, at (kung hindi hadlang ng splint) shoulder ROM mula sa unang araw; banayad na pag-ikot ng siko ayon sa kakayahan ng splint; ipakilala ang banayad na pain-free active forearm rotation sa huling ilang araw ng yugtong ito kung pinapayagan ng doktor ang maagang pagtatanggal

Mga pamantayan para sa pag-progres - Pagpapahinga ng sugat; natapos ang panahon ng splint (≈2-3 linggo para sa isolated hemiresection); inaprubahan ng doktor para sa aktibong pag-ikot

Yugto II — maagang pag-ikot ng forearms (ang prioridad) (linggo 2-3 hanggang 6)

Ito ang nagtatakda na yugto. Labas sa splint, ang aktibong pronasyon at supinasyon ay naging pangunahing paksa ng rehabilitasyon: banayad, madalas, walang sakit, at walang bigat. Idinadagdag ang galaw ng pulso. Ang pag-ikot ang function na ibinalik ng operasyon, kaya ito ay pinagmumulan nang aktibo dito habang ang pag-load ay patuloy na iniwasan.

Para sa iyong hand therapist:

Pagsusuri - Aktibo at pasibong pronasyon/supinasyon ng forearm (layunin na maibalik ang ~80° sa bawat direksyon na ulat sa mga serye ng resulta); ROM ng pulso at daliri; sakit sa ulnar na pulso; pamamaga; pagsusuri ng sugat/ganda

Edukasyon at mga paalala - Ang pag-ikot ng forearm ang prioridad: madalas, walang sakit, walang bigat na aktibong pronasyon/supinasyon, itak ang siko sa gilid upang i-isolate ang forearm - Walang resisted o loaded na pag-ikot, walang mabigat na pagkapit, walang mga gawain na may pag-ikot hanggang ~6-8 linggo - Ang ilang splint ay karagdagang nagbabawas sa end-range na pag-ikot para sa ilang linggo pagkatapos ng pag-alis ng cast; igalang ang anumang itinakdang hangganan

Pamamahala - Mga ehersisyo: aktibo at active-assisted pronasyon/supinasyon bilang pangunahing pokus; aktibong flexion/extension ng pulso at radial/ulnar deviation; patuloy na ROM ng daliri at grip (walang resisted grip pa); simulan ang pamamahala ng ganda kapag ang sugat ay ganap na nakabagabag na - Mga modality para sa oedema at ganda kung kinakailangan

Mga kriteryo para mag-proceed - Komportable, kontrolado, halos buong walang sakit na aktibong pag-ikot ng forearm; nakabagabag na sugat; sakit ≤3/10; walang provocative na sakit sa ulnar na bahagi sa banayad na pag-ikot

Yugto III — pagpapalakas at pagbabalik (linggo 6-8 at higit pa)

Kapag naibalik na ang rotasyon at walang sakit, magsisimula ang pagpapalakas at dahan-dahang ito ay dadagdagan: hawak (grip) muna, pagkatapos ay loaded forearm rotation, na may espesyal na pagmamasid para sa masakit na kawalan ng katatagan sa ulnar-stump o radioulnar convergence sa ilalim ng load. Ang pagbabalik sa mas mabibigat na trabaho at sports ay batay sa mga kriteryo.

Para sa iyong hand therapist:

Mga Pagsusuri - Lakas ng hawak kumpara sa kabilang bahagi (ang ulat ng outcome series ay nagpapakita ng paggaling patungo sa ~85-90% ng contralateral na bahagi); lakas ng rotasyon ng forearms at anumang sakit o kawalan ng katatagan sa loaded na rotasyon; functional at work-/sport-specific na pagsusuri kung angkop

Edukasyon at mga paalala - Ipakilala ang resisted grip muna, pagkatapos ay graded loaded forearm rotation (hal. pag-ikot ng martilyo gamit ang magaan na timbang) mula sa anim hanggang walong linggo; dahan-dahang dagdagan ang load - Mag-ingat sa masakit na kawalan ng katatagan sa ulnar-stump / radioulnar convergence sa ilalim ng axial o rotational load: kung ito ay mapapalala, bawasan ang load at makipag-ugnayan sa surgeon

Pamamahala - Mga ehersisyo: progressive grip/putty work; graded resisted pronation/supination (magaan → katamtaman); task-specific loading; patuloy na anumang natitirang ROM work - Isaalang-alang ang discharge kapag ang rotasyon at hawak ay functional at halos symmetrical at naabot ang angkop na pagbabalik ng function - Isaalang-alang ang referral pabalik sa treating doctor kung ang paggaling ay huminto, o kung may persistent na sakit sa ilalim ng load sa gilid ng ulnar na nagpapahiwatig ng instability sa stump o convergence

Mga Kriteryo para sa pagbabalik sa load/sports - Halos symmetrical na lakas ng hawak at rotasyon; walang sakit sa loaded na rotasyon; walang kawalan ng katatagan sa functional testing

Pagbabalik sa trabaho at gawain

Ang magaan na pang-araw-araw na paggamit ng kamay (pagkain, pagsulat, magaan na pag-aalaga sa sarili) ay inirerekomenda mula sa simula, hangga't komportable ito, basta't hindi ito kasama ang pilit o may bigat na pag-ikot ng forearms. Dahil ang iyong forearm ay may splint nang maaga at kailangan mong makapagkontrol ng gulong nang ligtas (kasama ang pag-ikot nito), magplano ng tulong sa transportasyon sa unang ilang linggo; maaari kang magmaneho muli kapag wala ka nang splint at komportable at ligtas kang makapag-ikot ng forearm para magmaneho, na kumpirmado sa iyong review.

Ang mga gawain na may bigat na pag-ikot (pagbubukas ng mahigpit na bote, pagwawring, paggamit ng screwdriver, pagdadala ng mabibigat na bag sa gilid na iyon) ay hinihintay hanggang sa malinaw ang pagpapalakas (karaniwan ay sa loob ng anim hanggang walong linggo) at dahan-dahang binubuo. Ang pagbabalik sa mas mabigat na manual na trabaho at sports ay sumusunod sa parehong criterion-based progression at nakadepende sa pagbawi ng walang sakit, halos symmetrical na pag-ikot ng forearm at grip, na pinapasiya ni Dr. Hirpara at ng iyong hand therapist kaysa sa kalendaryo lamang.

Pagkatapos ng iyong protokol

Ang protokol na ito ay nagtatrabaho kasama ng pangkalahatang payo para sa paggaling ng klinika; tingnan ang pamamahala ng sakit pagkatapos ng operasyon, pag-aalaga sa sugat, at pamamahala ng peklat. Kung ang iyong problema sa DRUJ ay sumunod sa isang fracture ng pulso, ang protokol para sa pagtitiyak ng distal radius fracture ay isang kapaki-pakinabang na kasama. Ang nakalaang plano ay sumasalamin sa publikadong gabay sa rehabilitasyon pagkatapos ng hemiresection arthroplasty ng distal radioulnar joint, at ang iyong patuloy na paggaling ay pinamumunuan nang indibidwal ni Dr. Hirpara at ng iyong hand therapist ayon sa pag-unlad ng iyong forearms.

Reviewed by Dr Kieran Hirpara · 21 June 2026.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

DRUJ Hemiresection-Interposition Arthroplasty (Bowers) — Procedure Outcomes & Post-operative Rehabilitation

Topic scope: post-operative rehabilitation after hemiresection-interposition arthroplasty (HIT) of the distal radioulnar joint (DRUJ) — the Bowers procedure — for painful DRUJ arthritis (degenerative, post-traumatic, or inflammatory). The arthritic portion of the ulnar head is partially resected and a soft-tissue spacer is interposed, preserving the TFCC, ulnar styloid and ulnar soft-tissue attachments so the distal ulna remains supported. This is a joint-reshaping arthroplasty, not a repair or reconstruction: the rehab is therefore an early-rotation pathway built around a short protected settling phase, then prioritised restoration of forearm pronation/supination, then graded loading — not months of construct protection.

Defining principle of the rehab here: the operation exists to restore pain-free forearm rotation, and nothing is sutured under tension that must heal protected for months. The deliberate restraint is a brief splinted phase (commonly an above-elbow / Muenster-type splint limiting forearm rotation for ~2-3 weeks in the isolated case) to let the soft-tissue interposition and capsule settle. After that, early active pronation/supination is the explicit priority — rotation is the function the operation restores. The single load to respect throughout is rotational/axial loading of the distal ulna, which provokes the characteristic failure mode: painful ulnar-stump instability and radioulnar convergence. The main branch point that lengthens the protected phase is a concurrent procedure (TFCC repair, distal radius osteotomy, extensor reconstruction).

A. PROCEDURE OUTCOMES (hemiresection-interposition arthroplasty)

The Bowers HIT is a long-established, generally reliable salvage for the arthritic DRUJ. The evidence base is level IV (retrospective cohorts and case series, no randomised trials), but it is consistent across decades: most patients gain durable pain relief and improved, stable forearm rotation, with the principal residual concern being ulnar-stump instability / radioulnar convergence under load.

  • The original Bowers series established the procedure and its rationale. Bowers' 1985 description (38 patients, mean ~2.5 yr) reported stable, painless rotation in the great majority — in rheumatoid patients ~85% achieved stable painless rotation (pronation ~84°, supination ~77°), and degenerative/post-traumatic patients achieved painless rotation averaging ~80° in each direction. The technique was explicitly designed to preserve the functional ulnocarpal ligament complex [Bowers, J Hand Surg Am 1985]. Level IV (foundational case series).
  • Long-term outcomes are durable but with a defined complication rate. A long-term cohort (66 patients, mean follow-up 8.6 years) reported low residual pain (median NRS 1/10), an overall complication rate of ~14% and reoperation ~8%; reported complications included stylocarpal impingement, ulnar subluxation, exostoses and tendon rupture. Inflammatory-arthritis patients had lower pain than post-traumatic patients (median 0 vs 5). The same series found PIN neurectomy associated with improved pain scores [HIT long-term outcome study, Hand (N Y) 2019]. Level IV (cohort).
  • Forearm rotation, grip and pain all improve measurably. A capsuloretinacular HIT series (21 wrists, mean ~2 yr 10 mo) reported significant gains: pronation 56.8°→83.0°, supination 60.0°→82.0°, grip 66.0%→87.4% of the contralateral side, VAS pain 62→23 mm, DASH 37.7→25.0, PRWE 48.1→24.4, with no post-operative DRUJ instability reported in that series [HIT capsuloretinacular series, J Wrist Surg 2023]. Level IV (cohort).
  • HIT sits within a family of DRUJ salvage options (Darrach distal ulna resection, Sauvé-Kapandji arthrodesis-pseudarthrosis, matched/hemiresection variants, and ulnar-head implant arthroplasty), each with its own instability/convergence profile; HIT's selling point is preservation of the ulnar support structures to reduce stump instability versus a formal Darrach [Bowers 1985; Glowacki, Hand Clin 2005; Chidgey, JAAOS 1995; Rekant, Hand Clin 2012; Murray, Hand Clin 2011]. Mechanistic / narrative-review.

B. REHABILITATION / THERAPY EVIDENCE

There is no trial-level evidence for any specific rehabilitation regimen after DRUJ HIT. Protocols are surgeon- and technique-derived expert consensus, reported as the post-operative methods of the outcome series and operative-technique articles above. The consensus is consistent on its key features.

  • A brief protected settling phase, not prolonged immobilisation. In the isolated hemiresection (no distal radius osteotomy, no TFCC repair), a long-arm plaster splint for ~10 days followed by a removable Muenster splint for a further 2-3 weeks is typical; cohort series report an upper-arm cast ~3 weeks then a forearm cast 1-2 weeks. Where a distal radius osteotomy or TFCC repair is added, immobilisation is longer (e.g. a long-arm cast in ~45° supination for ~4 weeks) [Pillukat & van Schoonhoven, Oper Orthop Traumatol 2009; HIT capsuloretinacular series, J Wrist Surg 2023]. Weak / expert consensus.
  • Early forearm rotation is the explicit priority once protection ends. The whole point of the operation is rotation, so active pronation/supination is pursued early and frequently. Some protocols further limit end-range rotation by splint for ~4 more weeks after the cast comes off before unrestricted motion and load [Pillukat & van Schoonhoven 2009]. Weak / expert consensus.
  • Loading is added last, watching for the characteristic failure mode. Range and load are returned to normal after the rotation-limited window; the specific thing to watch is painful ulnar-stump instability and radioulnar convergence under axial/rotational load, which is the biomechanically demonstrated weak point of distal-ulna procedures [Sauerbier et al., J Hand Surg Br 2002; Douglas et al., J Hand Surg Am 2014; Barret et al., Orthop Traumatol Surg Res 2020]. Mechanistic (biomechanical) + consensus.
  • Finger, thumb, elbow and shoulder motion from day one is standard to prevent stiffness, as in any forearm/wrist immobilisation pathway. Consensus.

Recovery trajectory (expected, evidence-anchored)

Phase Window Restraint Hand use / therapy focus Strength / load Notes
I — Protected settling Week 0 to 2-3 Splint limiting forearm rotation (Muenster / above-elbow type) Active finger/thumb/shoulder ROM from day 1; elbow ROM as splint allows; first gentle pain-free rotation toward end of phase None through forearm Longer if concurrent TFCC repair or distal radius osteotomy (cast in supination ~4 wk)
II — Early forearm rotation (priority) Week 2-3 to 6 Unloaded; some protocols cap end-range rotation a few more weeks Active pronation/supination as the main focus, elbow tucked; add wrist ROM; finger/grip ROM; scar massage once healed No resisted/loaded rotation, no heavy grip Target restoration toward ~80° each direction; pain-free is the rule
III — Strengthening & return Week 6-8+ Restrictions lifted progressively Resisted grip first, then graded loaded rotation (hammer turns); task-specific loading Build load slowly; grip recovers toward ~85-90% contralateral Watch for ulnar-stump instability / radioulnar convergence under load

(Phase windows mirror the precautions and phase tables in the patient protocol; they are typical expert-consensus guides, not trial-derived deadlines, and lengthen with concurrent procedures.)

C. KEY CONTROVERSIES / EVIDENCE QUALITY

  1. HIT vs Darrach. The Darrach (complete distal ulna resection) is simpler but sacrifices the ulnar support structures and is more prone to painful proximal ulnar-stump instability and radioulnar convergence, especially in younger, higher-demand or post-traumatic patients. HIT preserves the TFCC/styloid/attachments to mitigate this — but biomechanical work shows HIT also converges under load, just to a different degree, so convergence is a spectrum, not a HIT-vs-Darrach binary [Sauerbier et al., J Hand Surg Br 2002; Douglas et al., J Hand Surg Am 2014]. Darrach remains reasonable in low-demand/elderly patients. *Moderate (biomechanical
  2. cohort).*
  3. HIT vs Sauvé-Kapandji. Sauvé-Kapandji fuses the DRUJ and creates a controlled proximal pseudarthrosis, preserving the ulnar head/buttress for the carpus; it is often favoured where ulnar translation of the carpus is a concern (e.g. rheumatoid), but it too can develop painful proximal-stump instability. Long-term Sauvé-Kapandji and modified-Sauvé-Kapandji series report durable function with that caveat [Reissner et al., J Hand Surg Eur 2021; Zimmermann et al., Arch Orthop Trauma Surg 2003]. Choice is patient- and pathology-specific, not evidence-mandated. Moderate.
  4. HIT vs ulnar-head (implant) replacement. Implant ulnar-head arthroplasty is an alternative — particularly for failed resection/instability salvage — restoring a load-bearing buttress, but it adds implant-specific complications. Long-term implant series report good outcomes; it is increasingly used to rescue a painful, unstable stump after resection-type procedures [Kakar et al., J Hand Surg Am 2010; Adams, Hand Clin 2010; Watts et al., Hand Clin 2010; Rekant, Hand Clin 2012]. Moderate.
  5. The rehab regimen itself is consensus, not trial-derived. No RCT compares immobilisation length, rotation timing or loading progression after HIT. The "brief protection → early rotation → graded load" structure is inferred from technique articles and the methods of level-IV outcome series. Exact phase timings are typical, not deadlines, and shift with concurrent procedures. Weak / expert consensus.
  6. Patient selection drives results. Inflammatory-arthritis patients report lower residual pain than post-traumatic patients in long-term follow-up; adjunct PIN neurectomy is associated with better pain scores. Both point to outcome being substantially a selection/technique matter, not a rehab one [HIT long-term cohort, Hand 2019]. Moderate (within level-IV data).

D. EVIDENCE STRENGTH FLAGS (summary)

  • STRONG (RCT / SR): none. There are no randomised trials of DRUJ HIT or of its rehabilitation.
  • MODERATE: the biomechanical basis of radioulnar convergence / ulnar-stump instability under load across distal-ulna procedures (cadaveric studies); the comparative trade-offs among HIT / Darrach / Sauvé-Kapandji / ulnar-head replacement (consistent cohort + mechanistic data).
  • LEVEL IV (cohort / case series — the outcome evidence): pain relief, grip recovery (~85-90% contralateral), pronation/supination gains (toward ~80° each), ~14% complication and ~8% reoperation rates, durability to ~8-9 years. Consistent but uncontrolled and surgeon-reported.
  • WEAK / EXPERT CONSENSUS (the rehab regimen): the specific brief-protection → early-rotation → graded-load programme, the Muenster/above-elbow splint choice, the ~2-3 week protected window, and all exact phase timings — derived from technique articles and the methods sections of level-IV series, lengthened by concurrent procedures. No comparative rehab evidence exists.

CITATIONS

RAG corpus (180,000+ Orthopaedic articles)

  • Glowacki KA. Hemiresection arthroplasty of the distal radioulnar joint. Hand Clin. 2005. DOI: 10.1016/j.hcl.2005.08.002
  • Sauerbier M, Fujita M, Hahn ME, et al. The dynamic radioulnar convergence of the Darrach procedure and the ulnar head hemiresection interposition arthroplasty: a biomechanical study. J Hand Surg Br. 2002. DOI: 10.1054/jhsb.2002.0763
  • Douglas KC, Parks BG, Tsai MA, et al. The biomechanical stability of salvage procedures for distal radioulnar joint arthritis. J Hand Surg Am. 2014. DOI: 10.1016/j.jhsa.2014.03.028
  • Barret H, Lazerges C, Chammas P, et al. Modification of matched distal ulnar resection for distal radio-ulnar joint arthropathy: analysis of distal instability and radio-ulnar convergence. Orthop Traumatol Surg Res. 2020. DOI: 10.1016/j.otsr.2020.07.008
  • Chidgey LK. The distal radioulnar joint: problems and solutions. J Am Acad Orthop Surg. 1995. DOI: 10.5435/00124635-199503000-00005
  • Murray PM. Current concepts in the treatment of rheumatoid arthritis of the distal radioulnar joint. Hand Clin. 2011. DOI: 10.1016/j.hcl.2010.10.002
  • Lee SK, Hausman MR. Management of the distal radioulnar joint in rheumatoid arthritis. Hand Clin. 2005. DOI: 10.1016/j.hcl.2005.08.009
  • Ozer K. Management of complications of distal radioulnar joint. Hand Clin. 2015. DOI: 10.1016/j.hcl.2014.12.003
  • Zimmerman RM, Jupiter JB. Instability of the distal radioulnar joint. J Hand Surg Eur Vol. 2014. DOI: 10.1177/1753193414527052
  • Rekant M. Distal ulna arthroplasties. Hand Clin. 2012. DOI: 10.1016/j.hcl.2012.08.016
  • Watts AC, Hayton MJ, Stanley JK. Salvage of failed distal radioulnar joint reconstruction. Hand Clin. 2010. DOI: 10.1016/j.hcl.2010.05.004
  • Kakar S, Swann R, Perry K, et al. Distal radioulnar joint implant arthroplasty: a long-term outcome analysis. J Hand Surg Am. 2010. DOI: 10.1016/j.jhsa.2010.05.010
  • Adams BD. Complications of wrist arthroplasty. Hand Clin. 2010. DOI: 10.1016/j.hcl.2010.01.006
  • Reissner L, Schweizer A, Unterfrauner I, et al. Long-term results of the Sauvé-Kapandji procedure. J Hand Surg Eur Vol. 2021. DOI: 10.1177/17531934211004459
  • Zimmermann R, Gschwentner M, Arora R, et al. Treatment of distal radioulnar joint disorders with a modified Sauvé-Kapandji procedure: long-term outcome with special attention to the DASH questionnaire. Arch Orthop Trauma Surg. 2003. DOI: 10.1007/s00402-003-0529-5
  • Nypaver C, Bozentka DJ. Distal radius fracture and the distal radioulnar joint. Hand Clin. 2021. DOI: 10.1016/j.hcl.2021.02.011
  • Pillukat T, van Schoonhoven J. Die Hemiresektions-Interpositionsarthroplastik des distalen Radioulnargelenks nach Bowers [The hemiresection-interposition arthroplasty of the distal radioulnar joint]. Oper Orthop Traumatol. 2009. DOI: 10.1007/s00064-009-1913-2

DRUJ hemiresection literature (URLs)

  • Bowers WH. Distal radioulnar joint arthroplasty: the hemiresection-interposition technique. J Hand Surg Am. 1985;10(2):169-178. https://www.jhandsurg.org/article/S0363-5023(85)80100-3/abstract (PMID: 3980927)
  • Hemiresection interposition arthroplasty of the distal radioulnar joint: a long-term outcome study. Hand (N Y). 2019. DOI: 10.1177/1558944719873430. https://pmc.ncbi.nlm.nih.gov/articles/PMC8461192/
  • Hemiresection capsuloretinacular interposition arthroplasty for distal radioulnar joint osteoarthritis. J Wrist Surg. 2023. DOI: 10.1055/s-0043-1771341. https://pmc.ncbi.nlm.nih.gov/articles/PMC11606672/
  • Mid- to long-term functional results after Bowers' hemiresection interposition arthroplasty of the distal radio-ulnar joint. PubMed. https://pubmed.ncbi.nlm.nih.gov/35238965/
  • Pillukat T, van Schoonhoven J. The hemiresection-interposition arthroplasty of the distal radioulnar joint (operative technique). Oper Orthop Traumatol. 2009. https://link.springer.com/article/10.1007/s00064-009-1913-2 (PMID: 20058126)
  • Ulnar head hemiresection with interposition and extensor reconstruction — surgical technique. OrthOracle. https://www.orthoracle.com/library/ulnar-head-hemiresection-with-interposition-and-extensor-reconstruction/

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