WIDE EXCISION OF THE DISTAL ULNA - A MULTICENTER CASE-STUDY

Excision of the distal ulna to treat degenerative disease or instabili ty has fallen into disfavor following reports of radioulnar impingemen t, carpal instability, and distal ulnar instability. Alternative proce dures for reconstruction of the painful distal ulna have been develope d to address these problems; the results have been generally favorable . When faced with distal ulnar reconstruction that has failed after mu ltiple surgical procedures, or a distal ulnar neoplasm, the surgeon is left with few treatment options. Creation of a one-bone forearm, free fibular transfer, and allograft replacement have been attempted, with mixed outcomes. We report the results of 5 men and 7 women who underw ent wide excision of the distal ulna, defined as surgical excision of 25% to 50% of the ulnar length. The diagnosis was failed distal radiou lnar reconstruction or excision in 8 patients, osteomyelitis in 1, con genital pseudoarthrosis of the radius in 1, and neoplasm in 2. No soft tissue reconstruction was performed. Patients were examined at an ave rage of 22 months after surgery for radiocarpal and radioulnar instabi lity, functional outcome, pain relief, grip strength, and range of mot ion. Nine of the 12 procedures resulted in good or excellent results; 1 patient had a fair result after resection for osteosarcoma, and the procedure in 2 patients failed, requiring conversion to a one-bone for earm. Grip strength was restored to 75% of the normal side and range o f motion was restored to 86% of the normal side. Wide excision of the distal ulna without soft tissue reconstruction is a simple and durable treatment of neoplasms of the distal ulna or salvage of the failed re construction of the distal radioulnar joint. We do not recommend its u se in patients with incompetency or disruption of the interosseous mem brane. Copyright (C) 1998 by the American Society for Surgery of the H and.