This exciting volume of Techniques in Hand and Upper Extremity Surgery features a group of articles related to reconstructive procedures for problems involving the distal radioulnar joint. The reader will find some of these illustrate technical improvements on established surgical procedures and other novel concepts.
Although the relative importance of the distal radioulnar joint in the coordinated upper extremity motions and function is finally gaining greater recognition, from a teleological perspective, the development of a mobile forearm through its proximal and distal articulations represented a critical feature of bipedalism.
Even before the evolution of the distal radioulnar joint as we know it today, with its integration with the function of the ulnocarpal joint, early bipedal animals were able to rotate their forelimbs to achieve a markedly enhanced control over their environment. Among the degrees of freedom inherent in the articulations of the upper limb, forearm rotation proved to be an important evolutionary development. It allows the hand to achieve the optimal position for reaching and grasping the intended object, for bringing the acquired object to the mouth for feeding function, and for positioning the hand to reach nearly every part of the body.1
Forearm supination permits the hand to support objects with the palm up, whereas forearm pronation permits the hand to produce a downward force for both power and precision tasks. When grasping an object for tool use, a mobile distal radioulnar joint integrated with a mobile wrist allows the tool to lie in any direction to achieve the intended task.
Despite the recognized importance in upper extremity function, it has all too often taken second place to discussion regarding the distal radius or carpus. Problems such as instability, incongruity with the distal radius or ulnocarpus, or arthrosis all present major functional difficulties for patients. Given the ever increasing use of computer terminals, lack of forearm pronation is becoming even more problematic following trauma or arthrosis.
As the reader will see from the selection of articles in this edition, there continues to be exciting developments in surgical correction of distal radioulnar joint dysfunction, and it is really remarkable that for so long the treatment of these problems was simply to remove this important articulation!
Jesse B. Jupiter, MD
1. Kapandji IA. Physiologie Articulaire
, 6th ed. Paris: Maloine, 2005:106-145.