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Patients › Wrist

Distal Radioulnar Joint Surgery

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Updated Sep 20264 citations

Why this operation has been suggested

Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, starts with the least invasive options that suit your condition. Patients are generally referred to our clinic by their GP; if a physiotherapist has suggested you see us, you will still need a referral from your GP in order to be eligible for the Medicare rebate. At your appointment we take a history, examine your wrist, and arrange imaging such as X-rays or scans if they are needed to work out what is wrong.

The distal radioulnar joint is the joint between the two bones of your forearm, near the wrist. Surgery on it aims to steady the joint, ease pain, and let your forearm turn freely again. We usually try non-operative care first: activity change, physiotherapy or hand therapy, and splinting. Many ulnar-sided wrist problems after a broken wrist can settle with this kind of care, often over a year or more. Surgery comes next when that has not given enough improvement, or when the joint is unstable, worn, or painful from earlier injuries or conditions such as rheumatoid arthritis. When the right patient criteria are met, partial and total ulnar head replacement typically produce reliable results, and both this and joint replacement of the distal radioulnar joint bring substantial improvements in movement, grip strength, and pain. We will discuss with you whether this operation suits your wrist.

Before the operation

Before surgery you will need some simple preparation. Do not eat for seven hours before your operation. We ask for seven hours rather than six so your time can be brought forward if the theatre list runs early. Your surgeon will tell you which medicines to stop and when, and you should bring a list of everything you take. Arrange for someone to drive you home afterwards, and wear loose, comfortable clothing. X-rays and scans arranged earlier will be used to plan the operation. If you have other medical conditions, you may need blood tests or a review with the anaesthetist, the doctor who gives the anaesthetic. Most people need neither.

On the day

You come to the hospital's surgical admissions unit, where you are checked in and prepared for theatre. You meet the anaesthetist there. This operation is done under general anaesthetic. A regional nerve block is sometimes added for post-operative pain relief; the anaesthetist will discuss this with you on the day. You are then taken into the operating theatre, where the operation is performed.

When it is finished, you wake up in the recovery area. Nurses watch over you while the anaesthetic wears off. Once you are stable, you either go to the ward or go home, depending on the procedure and your recovery.

What the operation involves

There is more than one way to operate on this joint, and the right one depends on what is wrong with your wrist. If the tissues that hold the joint steady are torn but can be repaired, your surgeon mends them through a cut on the little-finger side of your wrist. If the ligaments, the strong straps that hold bone to bone, cannot be repaired, they can be rebuilt using a piece of tissue taken from your own forearm. If the joint surfaces themselves are worn out, your surgeon removes the damaged surfaces and replaces them with metal parts, either half of the joint or the whole joint.

If your forearm bone is too long and pressing on the wrist bones, a condition called ulnar impaction syndrome, your surgeon can shorten it. A small piece of bone is removed, and the bone is held in its new position with a plate and screws while it heals.

The cut is closed with stitches, and a dressing and splint are applied to protect the repair while it settles.

Your surgeon will explain which of these approaches is planned for you, and why, before you sign the consent form.

After the operation

When you wake up, you will be in the recovery area, then moved to the ward if you are staying. Nurses will check on you and give you pain relief if you need it. Your wrist will be in a dressing and a splint, as described earlier, to protect the repair while it settles. You can usually get up and move around soon after, with help at first. Someone should stay with you for the first 24 hours after you go home. Your team will tell you whether you go home the same day or stay one night in hospital.

Recovery

For the first few days your wrist will be sore and swollen. This is normal. Rest, keeping your hand raised, and the pain relief prescribed for you will ease it. The discomfort usually settles as the swelling goes down.

You will leave hospital with your wrist in a dressing and a splint to protect the repair while it settles. Hand therapy after surgery is with Ruby Doolan at Extend Rehabilitation. Ruby is a hand therapist: she will guide your exercises and make any splint you need as your wrist heals. Early on, the exercises are gentle, and they build up as movement returns. You will be able to manage most daily tasks around the home with your other hand, though some things will need help at first.

Milestones come as events rather than dates. Once the swelling settles, you will notice your forearm turning more freely. When you can grip without pain, everyday tasks like holding a cup or turning a door handle become easier. Once your surgeon clears you to drive, the usual rules apply: no driving while in a sling or splint, you must be able to hold the wheel with both hands and react in an emergency stop, and you must be off strong pain medication. See our guide on driving after upper-limb surgery for more detail.

Everyone heals at their own pace, and your timeline may differ. Your surgeon and your hand therapist will guide you along the way.

What can go wrong

Most patients do well, but problems can occasionally happen. Your surgeon and the team monitor you closely to spot any issue early.

Sometimes the joint does not stay as steady as we hoped. You might notice a clicking, clunking or grinding feeling when you turn your forearm, or a sense that the joint is slipping out of place. Some people feel pain on the little-finger side of the wrist, especially when lifting or twisting. If this happens, bring it up at your next review. If the joint feels like it is truly locking or giving way, call the clinic sooner.

The joint surfaces can also wear over time. This feels like a deep, aching pain that is worse with turning movements, such as turning a key or opening a jar. The wrist may feel stiff or grating. Mention this at your review so it can be checked.

If the bone was shortened to ease pressure on the wrist, the bone needs time to knit in its new position. If you feel sharp pain at the site, or notice new swelling or warmth there, contact the clinic. The plate and screws can also cause irritation under the skin once swelling settles. A tender lump or rubbing over the metal is worth reporting at your review.

The tissues on the back of the wrist can be irritated by surgery too. You might notice weakness when straightening your fingers or wrist, or pain when you bend the wrist back. Tell your surgeon or hand therapist if this does not settle.

Any of these problems can usually be sorted out, but early reporting makes that easier. If you feel suddenly unwell, have spreading redness, or pain that does not ease with simple painkillers, seek urgent care rather than waiting for your appointment.

The complications table on this page lists typical rates if you want the specifics.

When to call us

Call us straight away if you have a fever, or if the wound becomes more red, swollen, or starts to leak fluid. Go to emergency if you have sudden severe pain, new swelling in your calf, or shortness of breath. These can be signs of a blood clot. Also go to emergency if you lose feeling in your hand or fingers, or if you cannot move your wrist or fingers at all. If anything else worries you, call the clinic. We would rather hear about it early.

Advanced reading: the deeper science (optional)

This section goes further than you need for your own treatment decisions. The distal radioulnar joint is worth the extra reading because it is the joint in the wrist we are worst at measuring, the one most often blamed prematurely, and the one where waiting is most often the right answer.

We cannot reliably measure the problem

Instability of this joint is diagnosed largely by feel, the examiner shifts the ulna against the radius and forms an impression. A 2025 review of assessment strategies concluded plainly that reliable, quantifiable methods for analysing distal radioulnar joint instability remain an unmet need, and that developing them is essential to improving management [1].

That has a direct consequence for you. When the diagnosis rests on a subjective test, the threshold for calling a joint unstable varies between examiners, and so does the threshold for operating on it. A second opinion here is not distrust; it is a reasonable response to a test with known limits.

Most ulnar-sided pain after a wrist fracture settles

This is the single most useful finding for anyone with a painful wrist after a distal radius fracture. A comprehensive review concluded that most ulnar-sided wrist problems following distal radial fractures can be treated non-operatively initially, typically for over a year, in anticipation of substantial improvement with time [2].

A year is longer than most people expect to be told to wait, and the temptation to intervene earlier is strong on both sides of the consultation. The exception named in the same review is important and specific: early marked subluxation of the joint that physically blocks forearm rotation does need addressing rather than observing [2].

So the default is patience, with a defined reason to abandon it.

When salvage is needed, the choice is finer than it looks

If the joint is destroyed and non-operative management has genuinely failed, the classic options are the Darrach procedure, removing the end of the ulna, and the Sauvé-Kapandji, which fuses the joint and creates a gap more proximally to allow rotation.

A systematic review comparing them found comparable satisfaction regardless of the underlying pathology, with similar improvement in range of motion, strength and overall function. The difference was in the reoperation rate, which was higher with the Sauvé-Kapandji [3].

That is a clean discriminator. Where two operations produce the same result, the one requiring fewer further operations has the advantage, though the Sauvé-Kapandji retains a role where preserving the ulnar support of the carpus matters, which is precisely why it was devised.

Ulnar impaction is a different problem with its own answer

Ulnar-sided pain from the ulna being relatively too long, ulnar impaction syndrome, is treated by shortening the load path, either by cutting and shortening the ulnar shaft or by arthroscopically removing the dome of the ulnar head. A meta-analysis of 311 patients found both effective, with the arthroscopic wafer procedure showing fewer complications and a lower reoperation rate [4].

The shaft osteotomy involves a plate, a healing bone and the possibility of the osteotomy failing to unite; the arthroscopic procedure avoids all three. Where the anatomy suits it, that is a meaningful difference.

Reviewed by Dr Kieran Hirpara · 13 August 2026.

Want the clinical detail? Read the clinician version.

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.

References for the advanced reading
  1. Christy M, Wright DJ, Goldfarb CA. Assessment strategies for distal radioulnar joint instability: current state and a need for improved tools. J Hand Surg Am. 2025;50(12):1505-14.
  2. Giddins G. The distal radioulnar joint after distal radial fractures: when and how do we need to treat pain, stiffness or instability? J Hand Surg Eur Vol. 2023;48(3):230-45.
  3. Lamont S, Debkowska M, Johnsen P, Froehle A, Cotterell IH, Isaacs J. Outcomes of Darrach and Sauvé-Kapandji procedures: a systematic review. Hand (N Y). 2022;19(1):68-73.
  4. Shi H, Huang Y, Shen Y, Wu K, Zhang Z, Li Q. Arthroscopic wafer procedure versus ulnar shortening osteotomy for ulnar impaction syndrome: a systematic review and meta-analysis. J Orthop Surg Res. 2024;19(1).
Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

  • Salvage of failed distal radioulnar joint reconstruction requires a thorough understanding of normal anatomy, biomechanics, and the modes of failure of the primary procedure to develop effective strategies [1].
  • Most ulnar-sided wrist problems associated with distal radial fractures can be treated non-operatively initially, typically for over a year, in anticipation of substantial improvement with time [2].
  • Distal radioulnar joint instability is often an underestimated lesion requiring systematic clinical examination and imaging for detection [4].
  • Surgeons recommended distal radioulnar joint treatment in 67% (404 of 607) of the scenarios in a survey of treatment variation after plate fixation of distal radial fractures [5].
  • The most common recommended treatment for distal radioulnar joint issues after plate fixation of distal radial fractures was cast immobilization, cited in 41% (247 of 607) of scenarios [5].
  • Distal radioulnar joint instability management covers anatomic and biomechanical advances, categorization of instability, and treatment strategies including percutaneous, arthroscopic, soft-tissue, osteotomy and arthroplasty techniques [6].
  • Ulnar shortening osteotomy is a good option to treat patients with ulnar impaction syndrome regardless of the distal radioulnar joint angle [7].
  • Distal radioulnar joint ligament reconstruction is indicated when native ligaments are not reparable, provided there is no radius or ulna bony deformity or arthritis of the distal radioulnar joint [8].
  • Severely damaged and painful distal radioulnar joints can be reconstructed by resection arthroplasty or by hemi- or total arthroplasty [9].
  • There is presently no evidence that ulnar head and total radio-ulnar joint prostheses produce long-lasting results [10].
  • When appropriate patient selection criteria are met, partial and total ulnar head replacement typically produce reliable results [20].

Anatomy & Pathophysiology

  • Stability of the distal radioulnar joint is maintained by two factors: compression between the articulating surfaces and tension in the ligament in the direction of its fibers [33].
  • The flexor carpi ulnaris and extensor carpi ulnaris muscles serve as dynamic stabilizers of the distal radioulnar joint [15].
  • Anatomical variations in the sigmoid notch and ulnar head significantly influence joint mechanics and treatment outcomes [34].
  • The interaction between ligaments, muscles, and bones is essential for distal radioulnar joint stability [16].
  • Closed treatment is frequently successful for isolated acute distal radioulnar joint dislocations due to the healing potential of the peripheral triangular fibrocartilage complex [18].
  • Radial lengthening did not demonstrate a benefit in improving distal radioulnar joint stability in a triangular fibrocartilage complex injury model [36].
  • Pressures within the distal radioulnar joint change with forearm rotations, with the highest intra-articular pressure recorded in supination under no disruption-no load, no disruption-loaded, and disrupted triangular fibrocartilage complex conditions [37].
  • The Aptis distal radioulnar joint arthroplasty considerably alters forearm kinematics, which can have clinical implications [29].
  • Distal radioulnar joint kinematics during handstanding vary with school age in female gymnasts, with high school students showing a significantly larger increase in distal radioulnar joint separation compared to elementary school students [30].

Classification

  • Salvage of failed distal radioulnar joint reconstruction requires understanding normal anatomy, biomechanics, and modes of failure of the primary procedure [1].
  • Thorough knowledge of the anatomy and kinematics of the distal radioulnar joint is necessary to manage pathologic conditions [3].
  • Surgeons recommended distal radioulnar joint treatment in 67% (404 of 607) of scenarios, most commonly cast immobilization in 41% (247 of 607) [5].
  • The functional anatomy and pathomechanics of the distal radioulnar joint emphasize the interaction between ligaments, muscles, and bones for stability [16].
  • Advances in minimally invasive surgical techniques have transformed the management of distal radioulnar joint instability [24].
  • Coronal shift should be added to classic measures of distal radius fracture reduction because of its fundamental role in distal radioulnar joint stability [27].

Clinical Presentation

  • Salvage of failed distal radioulnar joint reconstruction requires a thorough understanding of normal anatomy, biomechanics, and the modes of failure of the primary procedure [1].
  • A thorough knowledge of the anatomy and kinematics of the distal radioulnar joint is necessary to manage pathologic conditions [3].
  • Surgeons recommended distal radioulnar joint treatment in 67% (404 of 607) of scenarios involving plate fixation of distal radial fractures, most commonly cast immobilization in 41% (247 of 607) [5].
  • Distal radioulnar joint instability and its management involve anatomic and biomechanical advances, categorization of instability, and treatment strategies including percutaneous, arthroscopic, soft-tissue, osteotomy and arthroplasty techniques [6].
  • DRUJ ligament reconstruction is indicated when native ligaments are not reparable, provided there is no radius or ulna bony deformity or arthritis of the DRUJ [8].
  • Chronic distal radioulnar joint instability results from various traumatic injuries and can lead to chronic functional impairment, pain, and arthritis if left untreated [11].
  • Stabilization of the ulnar stump seems to alleviate pain and improve forearm rotation and functional outcomes, although no direct correlation exists between radioulnar convergence and patient outcomes [12].
  • Standard and alternative exposures of the wrist joint and DRUJ are discussed, with case examples illustrating their use [13].
  • The occurrence of osteoarthritis of the scaphotrapeziotrapezoid and distal radioulnar joints was affected by the presence of osteoarthritis of the adjacent joint [14].
  • There is substantial surgeon-to-surgeon variation in interpreting MRI signal changes and arthroscopic findings in the distal radioulnar ligaments and central disc, raising concerns about overdiagnosis and overtreatment versus underdiagnosis [17].
  • Treatment goals in the acute setting for distal radius fracture should be to prevent future instability or incongruency of the distal radioulnar joint, while goals in the chronic setting should be to restore stability and congruency to allow for painless, full motion [19].
  • Surgical outcomes for the management of the distal radioulnar joint in rheumatoid arthritis are best when performed before the patient displays severe joint destruction, fixed contractures, subluxation, or dislocation [21].
  • The etiology, clinical presentation, and treatment strategies for unique problems affecting the pediatric and adolescent distal radioulnar joint include Madelung deformity, physeal arrest, and osteochondromatosis [35].

Investigations

  • Coronal shift should be added to the classic measures of distal radius fracture reduction because of its fundamental role in distal radioulnar joint stability [27].
  • Conventional radiography should be the first imaging modality to exclude or diagnose wrist pathology [32].
  • When conventional radiography is inconclusive, high resolution 3 Tesla MRI is advised [32].
  • A nuanced understanding of 3D relationships can enhance preoperative planning when correcting ulnar-side pathology [39].
  • Imaging the DRUJ requires knowledge of the complex bony, muscular, and ligamentous anatomy [40].
  • Standard well-positioned radiography is the appropriate first step for imaging the DRUJ [40].
  • High-resolution MRI helps delineate ligamentous structures in the DRUJ [40].
  • Dynamic CT is indicated for clinical instability of the DRUJ [40].

Treatment

  • Treatment strategies for distal radioulnar joint instability include percutaneous, arthroscopic, soft-tissue, osteotomy, and arthroplasty techniques [6].
  • Treatment goals in the acute setting should be to prevent future instability or incongruency of the distal radioulnar joint [19].
  • Treatment goals in the chronic setting should be to restore stability and congruency to allow for painless, full motion [19].
  • Indirect ulnar shortening by distraction through the distal radius fracture site provides a simple and novel strategy for the management of persistent distal radioulnar joint instability during volar plating, obviating the need for prolonged immobilization or to alter standard postoperative protocols [23].
  • The Aptis total distal radioulnar joint prosthesis is a good rescue option for patients with previous failed surgical procedures, providing significant improvements in range of motion, grip strength, and pain scores with a mean follow-up of 9.7 years [25].
  • Combined extensor retinaculum capsulorrhaphy and suture repair effectively restores stability to both the distal radioulnar joint and ulnocarpal joint in patients with triangular fibrocartilage complex-related ulnocarpal instability, considerably reducing pain and preserving range of motion [38].

Complications

  • Most ulnar-sided wrist problems associated with distal radial fractures can be treated non-operatively initially for over a year in anticipation of substantial improvement with time [2].
  • Anatomic distal radioulnar joint reconstruction represents an important evolutionary step in the history of surgical treatment for distal radioulnar joint instability [22].
  • Indirect ulnar shortening by distraction through the distal radius fracture site provides a simple and novel strategy for managing persistent distal radioulnar joint instability during volar plating, obviating the need for prolonged immobilization or altering standard postoperative protocols [23].
  • Both APTIS distal radioulnar joint arthroplasty and ulnar head replacement yield substantial functional improvements and good long-term survivorship [26].
  • Adding a distally based longitudinal extensor carpi ulnaris strip to ulnar shortening osteotomy seems to be an effective treatment in patients with irreparable degenerative triangular fibrocartilage complex injuries due to ulnar impaction syndrome [28].

Recovery

  • The original anatomic distal radioulnar joint reconstruction technique described by Sanders and its procedure modifications represent an important evolutionary step in the history of surgical treatment for distal radioulnar joint instability [22].
  • Adding a distally based longitudinal extensor carpi ulnaris strip to ulnar shortening osteotomy for restoring distal radioulnar joint stability seems to be an effective treatment in patients with irreparable degenerative triangular fibrocartilage complex injuries due to ulnar impaction syndrome [28].

Key Evidence

  • [L5] Salvage of failed distal radioulnar joint reconstruction requires a thorough understanding of normal anatomy, biomechanics, and the modes of failure of the primary procedure to develop effective strategies. [1] (10.1016/j.hcl.2010.05.004)
  • [L5] Most ulnar-sided wrist problems associated with distal radial fractures can be treated non-operatively initially, typically for over a year, in anticipation of substantial improvement with time. [2] (10.1177/17531934221140238)
  • [L5] A thorough knowledge of the anatomy and kinematics of the distal radioulnar joint is necessary to manage pathologic conditions. [3] (10.1016/j.hcl.2005.08.002)
  • [L5] Distal radioulnar joint instability is often an underestimated lesion requiring systematic clinical examination and imaging for detection. [4] (10.1007/s00402-020-03371-0)
  • [L4] Surgeons recommended distal radioulnar joint treatment in 67% (404 of 607) of the scenarios, most commonly cast immobilization in 41% (247 of 607). [5] (10.1177/17531934261449057)
  • [L5] The purpose of this article is to review distal radioulnar joint instability and its management, covering anatomic and biomechanical advances, categorization of instability, and treatment strategies including percutaneous, arthroscopic, soft-tissue, osteotomy and arthroplasty techniques. [6] (10.1177/1753193414527052)
  • [L4] Ulnar shortening osteotomy is a good option to treat patients with ulnar impaction syndrome regardless of the distal radioulnar joint angle. [7] (10.1177/17531934241262931)
  • [L5] DRUJ ligament reconstruction is indicated when native ligaments are not reparable, provided there is no radius or ulna bony deformity or arthritis of the DRUJ. [8] (10.1016/j.hcl.2020.07.004)
  • [L5] Severely damaged and painful distal radioulnar joints can be reconstructed by resection arthroplasty or by hemi- or total arthroplasty. [9] (10.1016/j.hcl.2020.07.008)
  • [L5] The introduction of ulnar head and total radio-ulnar joint prostheses has provided a new method, but there is presently no evidence that these implants produce long-lasting results. [10] (10.1054/jhsb.2002.0815)
  • [L5] Chronic distal radioulnar joint instability results from various traumatic injuries and can lead to chronic functional impairment, pain, and arthritis if left untreated. [11] (10.1016/j.hcl.2010.05.010)
  • [L5] Stabilization of the ulnar stump seems to alleviate pain and improve forearm rotation and functional outcomes, although no direct correlation exists between radioulnar convergence and patient outcomes. [12] (10.1016/j.hcl.2014.12.003)
  • [L5] Standard and alternative exposures of the wrist joint and DRUJ are discussed, with case examples illustrating their use. [13] (10.1016/j.hcl.2014.07.003)
  • [L4] The occurrence of osteoarthritis of the scaphotrapeziotrapezoid and distal radioulnar joints was affected by the presence of osteoarthritis of the adjacent joint. [14] (10.1016/j.jhsa.2023.05.009)
  • [L4] The flexor carpi ulnaris and extensor carpi ulnaris muscles serve as dynamic stabilizers of the distal radioulnar joint. [15] (10.1177/17531934231168299)
  • [L5] The purpose of this review article is to present and illustrate the current understanding of the functional anatomy and pathomechanics of the distal radioulnar joint, emphasizing the interaction between ligaments, muscles, and bones for stability. [16] (10.1177/1753193417693170)
  • [L5] There is substantial surgeon-to-surgeon variation in interpreting MRI signal changes and arthroscopic findings in the distal radioulnar ligaments and central disc, raising concerns about overdiagnosis and overtreatment versus underdiagnosis. [17] (10.1177/17531934241254705)
  • [L5] This article reviews the anatomy, biomechanics, and treatment of acute dislocations of the distal radioulnar joint and distal ulna fractures, emphasizing that closed treatment is frequently successful for isolated dislocations due to the healing potential of the peripheral TFCC. [18] (10.1016/j.hcl.2010.05.009)
  • [L5] Treatment goals in the acute setting should be to prevent future instability or incongruency of the distal radioulnar joint, while goals in the chronic setting should be to restore stability and congruency to allow for painless, full motion. [19] (10.1016/j.hcl.2021.02.011)
  • [L4] When appropriate patient selection criteria are met, partial and total ulnar head replacement typically produce reliable results. [20] (10.1177/1753193417693177)
  • [L5] Surgical outcomes are best when performed before the patient displays severe joint destruction, fixed contractures, subluxation, or dislocation. [21] (10.1016/j.hcl.2005.08.009)
  • [L4] This report documents the original anatomic DRUJ reconstruction technique described by Sanders and our procedure modifications, representing an important evolutionary step in the history of surgical treatment for DRUJ instability. [22] (10.1016/j.jhsa.2020.08.001)
  • [L4] Indirect ulnar shortening by distraction through the distal radius fracture site provides a simple and novel strategy for the management of persistent DRUJ instability during volar plating, obviating the need for prolonged immobilization or to alter standard postoperative protocols. [23] (10.1016/j.jhsa.2018.02.030)
  • [L5] Advances in minimally invasive surgical techniques have transformed the management of DRUJ instability. [24] (10.1177/17531934261417561)
  • [L4] The Aptis total distal radioulnar joint prosthesis is a good rescue option for patients with previous failed surgical procedures, providing significant improvements in range of motion, grip strength, and pain scores with a mean follow-up of 9.7 years. [25] (10.1177/17531934231192375)
  • [L2] Both APTIS DRUJ arthroplasty and ulnar head replacement yield substantial functional improvements and good long-term survivorship. [26] (10.1177/17531934261415827)
  • [L5] Coronal shift should be added to the classic measures of distal radius fracture reduction because of its fundamental role in distal radioulnar joint stability. [27] (10.1016/j.jhsa.2014.08.022)
  • [L4] Adding a distally based longitudinal extensor carpi ulnaris strip to ulnar shortening osteotomy for restoring distal radioulnar joint stability seems to be an effective treatment in patients with irreparable degenerative triangular fibrocartilage complex injuries due to ulnar impaction syndrome. [28] (10.1177/17531934231197942)
  • [L4] The Aptis distal radioulnar joint arthroplasty considerably alters forearm kinematics, which can have clinical implications. [29] (10.1177/17531934241274142)
  • [L4] The DRUJ kinematics during handstanding vary with school age in female gymnasts, with high school students showing a significantly larger increase in DRUJ separation compared to elementary school students. [30] (10.1177/23259671251368997)
  • [L2] Conventional radiography should be the first imaging modality to exclude or diagnose wrist pathology; when inconclusive, high resolution 3 Tesla MRI is advised. [32] (10.1177/1753193416683876)
  • [L5] Stability of the distal radioulnar joint is maintained by two factors: compression between the articulating surfaces and tension in the ligament in the direction of its fibers. [33] (10.1016/j.hcl.2010.05.002)
  • [L5] Anatomical variations in the sigmoid notch and ulnar head significantly influence joint mechanics and treatment outcomes. [34] (10.1016/j.hcl.2012.03.002)
  • [L5] The purpose of this article is to review the etiology, clinical presentation, and treatment strategies for the management of unique problems affecting the pediatric and adolescent distal radioulnar joint, including Madelung deformity, physeal arrest, and osteochondromatosis. [35] (10.1016/j.hcl.2010.06.001)
  • [L5] Radial lengthening did not demonstrate a benefit in improving DRUJ stability in a triangular fibrocartilage complex injury model. [36] (10.1016/j.jhsa.2025.06.013)
  • [L5] Pressures within the DRUJ changed with forearm rotations, with the highest intra-articular pressure recorded in supination under no disruption-no load, no disruption-loaded, and disrupted TFCC conditions. [37] (10.1016/j.jhsa.2023.11.015)
  • [L4] The combined HS and suture repair effectively restores stability to both the DRUJ and UCJ in patients with TFCC-related ulnocarpal instability, considerably reducing pain and preserving range of motion. [38] (10.1016/j.jhsg.2025.100806)
  • [L4] A nuanced understanding of these 3D relationships can enhance preoperative planning when correcting ulnar-side pathology. [39] (10.1016/j.jhsg.2023.12.006)
  • [L5] Imaging the DRUJ requires knowledge of the complex bony, muscular, and ligamentous anatomy; standard well-positioned radiography is the appropriate first step, while high-resolution MRI helps delineate ligamentous structures and dynamic CT is indicated for clinical instability. [40] (10.1016/j.hcl.2010.07.001)

References

[1] Salvage of Failed Distal Radioulnar Joint Reconstruction. Hand Clinics. 2010. DOI: 10.1016/j.hcl.2010.05.004

[2] The distal radioulnar joint after distal radial fractures: when and how do we need to treat pain, stiffness or instability?. Journal of Hand Surgery (European Volume). 2023. DOI: 10.1177/17531934221140238

[3] Hemiresection Arthroplasty of the Distal Radioulnar Joint. Hand Clinics. 2005. DOI: 10.1016/j.hcl.2005.08.002

[4] Distal radioulnar joint instability: current concepts of treatment. Archives of Orthopaedic and Trauma Surgery. 2020. DOI: 10.1007/s00402-020-03371-0

[5] Factors associated with variation in treatment of the distal radioulnar joint after plate fixation of distal radial fractures. Journal of Hand Surgery (European Volume). 2026. DOI: 10.1177/17531934261449057

[6] Instability of the distal radioulnar joint. Journal of Hand Surgery (European Volume). 2014. DOI: 10.1177/1753193414527052

[7] Does the distal radioulnar joint orientation influence the outcome of ulnar shortening osteotomy: a retrospective study. Journal of Hand Surgery (European Volume). 2024. DOI: 10.1177/17531934241262931

[8] Chronic Distal Radioulnar Joint Instability. Hand Clinics. 2020. DOI: 10.1016/j.hcl.2020.07.004

[9] Solutions for the Unstable and Arthritic Distal Radioulnar Joint. Hand Clinics. 2020. DOI: 10.1016/j.hcl.2020.07.008

[10] Failed Ulnar Head Resection: Prevention and Treatment. Journal of Hand Surgery. 2002. DOI: 10.1054/jhsb.2002.0815

[11] The Management of Chronic Distal Radioulnar Instability. Hand Clinics. 2010. DOI: 10.1016/j.hcl.2010.05.010

[12] Management of Complications of Distal Radioulnar Joint. Hand Clinics. 2015. DOI: 10.1016/j.hcl.2014.12.003

[13] Exposures of the Wrist and Distal Radioulnar Joint. Hand Clinics. 2014. DOI: 10.1016/j.hcl.2014.07.003

[14] Prevalence and Associated Factors for Primary Osteoarthritis of the Scaphotrapeziotrapezoid, Radiocarpal, and Distal Radioulnar Joints in the Japanese General Elderly Population. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2023.05.009

[15] Stability of the distal radioulnar joint with and without activation of forearm muscles. Journal of Hand Surgery (European Volume). 2023. DOI: 10.1177/17531934231168299

[16] Distal radioulnar joint: functional anatomy, including pathomechanics. Journal of Hand Surgery (European Volume). 2017. DOI: 10.1177/1753193417693170

[17] Pain and instability ascribed to the distal radioulnar ligaments and central disc as part of the triangular fibrocartilage complex: a round table discussion. Journal of Hand Surgery (European Volume). 2024. DOI: 10.1177/17531934241254705

[18] Acute Dislocations of the Distal Radioulnar Joint and Distal Ulna Fractures. Hand Clinics. 2010. DOI: 10.1016/j.hcl.2010.05.009

[19] Distal Radius Fracture and the Distal Radioulnar Joint. Hand Clinics. 2021. DOI: 10.1016/j.hcl.2021.02.011

[20] Non-constrained implant arthroplasty for the distal radioulnar joint. Journal of Hand Surgery (European Volume). 2017. DOI: 10.1177/1753193417693177

[21] Management of the Distal Radioulnar Joint in Rheumatoid Arthritis. Hand Clinics. 2005. DOI: 10.1016/j.hcl.2005.08.009

[22] The Original Anatomic Reconstruction of Palmar and Dorsal Radioulnar Ligaments for Distal Radioulnar Joint Instability. The Journal of Hand Surgery. 2020. DOI: 10.1016/j.jhsa.2020.08.001

[23] Radial Distraction to Stabilize Distal Radioulnar Joint in Distal Radius Fixation. The Journal of Hand Surgery. 2018. DOI: 10.1016/j.jhsa.2018.02.030

[24] Restoring balance in the distal radioulnar joint: advancements in minimally invasive surgical approaches. Journal of Hand Surgery (European Volume). 2026. DOI: 10.1177/17531934261417561

[25] Long-term results of the AptisTM total distal radioulnar joint prosthesis after previous failed surgical procedures. Journal of Hand Surgery (European Volume). 2023. DOI: 10.1177/17531934231192375

[26] Efficacy and safety of prosthetic arthroplasty of the distal radioulnar joint: a systematic review. Journal of Hand Surgery (European Volume). 2026. DOI: 10.1177/17531934261415827

[27] Coronal Shift of Distal Radius Fractures: Influence of the Distal Interosseous Membrane on Distal Radioulnar Joint Instability. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2014.08.022

[28] An alternative treatment for degenerative triangular fibrocartilage complex injuries with distal radioulnar joint instability: first experience with 48 patients. Journal of Hand Surgery (European Volume). 2023. DOI: 10.1177/17531934231197942

[29] Performance of the Aptis distal radioulnar joint implant: kinematic and geometric analysis. Journal of Hand Surgery (European Volume). 2024. DOI: 10.1177/17531934241274142

[30] Distal Radioulnar Joint Kinematics Evaluated Using Ultrasonography During Handstanding in Female Gymnasts. Orthopaedic Journal of Sports Medicine. 2025. DOI: 10.1177/23259671251368997

[32] Diagnostic modalities for distal radioulnar joint. Journal of Hand Surgery (European Volume). 2016. DOI: 10.1177/1753193416683876

[33] Understanding Stability of the Distal Radioulnar Joint Through an Understanding of Its Anatomy. Hand Clinics. 2010. DOI: 10.1016/j.hcl.2010.05.002

[34] Anatomy and Biomechanics of the Distal Radioulnar Joint. Hand Clinics. 2012. DOI: 10.1016/j.hcl.2012.03.002

[35] The Management of Congenital and Acquired Problems of the Distal Radioulnar Joint in Children. Hand Clinics. 2010. DOI: 10.1016/j.hcl.2010.06.001

[36] Effect of Radial Lengthening on the Stability of the Distal Radioulnar Joint: A Biomechanical Cadaveric Study. The Journal of Hand Surgery. 2026. DOI: 10.1016/j.jhsa.2025.06.013

[37] Intra-Articular Pressure in the Distal Radioulnar Joint: A Biomechanical Study. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2023.11.015

[38] Extensor Retinaculum Capsulorrhaphy and Suture Repair for Ulnocarpal and Distal Radioulnar Joint Instability: One-Year Results. Journal of Hand Surgery Global Online. 2025. DOI: 10.1016/j.jhsg.2025.100806

[39] Ulnar Bowing and Distal Radioulnar Joint Anatomy: A Three-Dimensional, In Situ Clinical Assessment. Journal of Hand Surgery Global Online. 2024. DOI: 10.1016/j.jhsg.2023.12.006

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