ARTICLESThe Distal Radioulnar Joint in Rheumatoid ArthritisKopylov, Philippe M.D., Ph.D. Author Information From the Hand and Upper Extremity Unit, Department of Orthopedics, Lund University Hospital, Lund, Sweden. Address correspondence and reprint requests to Philippe Kopylov, MD, PhD, Hand and Upper Extremity Unit, Department of Orthopedics, Lund University Hospital, Lund, Sweden. E-mail: [email protected] Techniques in Orthopaedics: September 2003 - Volume 18 - Issue 3 - p 246-252 Buy Abstract Summary The distal radioulnar (DRU) joint is the keystone weight-bearing joint of the distal forearm. The classic excision of the ulnar head described in many procedures has to be evaluated carefully. In rheumatoid arthritis, the ulnar column of the carpus tends to slide anteriorly with supination of the carpus. The DRU joint can dislocate with accentuation of the prominence of the ulnar head as a result of the anterior dislocation of the carpus and the radius. This creates caput ulnae syndrome. The main goal of surgery of the rheumatoid wrist is a pain-free wrist with restoration of painless pronation/supination. This can be achieved by synovectomy and ulnar head resection. However, the complications with ulnar stump instability are not negligible, and the stabilization of the ulna remains the major concern of this surgery. DRU joint fusion, according to Sauvé-Kapandji, does not reduce the ulna stump problems, but gives a better residual anatomy of the wrist and is recommended in younger patients. DRU joint prostheses are under development and today are only indicated as a salvage procedure. However, in the near future, the DRU joint will be treated with synovectomy and stabilization by resurfacing implant. © 2003 Lippincott Williams & Wilkins, Inc.