Two-Year Clinical and Radiographic Evaluation of Scheker Prosthesis (Aptis) Distal Radioulnar Joint Arthroplasty.

PURPOSE: To evaluate the clinical and radiographic outcomes of patients who underwent semiconstrained distal radioulnar joint arthroplasty. METHODS: A retrospective analysis was performed on a series of patients who underwent distal radioulnar joint arthroplasty with more than a 23-month follow up. The quantitative outcome variables included the visual analog scale for pain; Disability of the Arm, Shoulder, and Hand (DASH) score; Patient-Rated Wrist Evaluation (PRWE); and Mayo wrist score. The range of motion, grip strength, torque, and lifting capacity were measured at final follow up and compared with that of the nonsurgical extremity. Complications related to the prosthesis were assessed. RESULTS: Twenty-one patients (mean age 57 years) were assessed at an average 41-month follow up (23-73 months). Fifteen underwent prior hand, wrist, or elbow procedures. Four patients required 5 reoperations. The postoperative median visual analog scale pain score was 0.6 at rest and 2.1 with activity. The median postoperative DASH score was 26.7, PRWE 41, and Mayo wrist score was 65. Upon comparing the supination torque of the operative and intact sides, the operative side was found to average 87% of the intact side on a work simulator and 77% on the simulator's D-ring. Eight of 20 patients had lysis around the collar of the ulnar component (40%), as detected using radiography. Three of 21 (14%) radial plates were malpositioned, with 2 resulting in a fracture. The overall complication rate was 29%. CONCLUSIONS: Distal radioulnar joint arthroplasty using the Scheker prosthesis demonstrated good patient pain scores and the restoration of supination strength. The collar lysis resulted in weaker supination and grip strength. Still, the patients experienced mild levels of pain and moderate disability. A moderate complication rate persisted, as reported by other authors. Accurate radial component placement is important. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Endoscopically assisted ulnar neurolysis for cubital tunnel syndrome.

Controversy remains regarding the surgical treatment of cubital tunnel syndrome. Similar outcomes with ulnar nerve transposition, both subcutaneous and submuscular, and simple decompression have recently been reported. We describe an endoscopically assisted cubital tunnel release through a 2-cm incision using readily available standard equipment. Seventeen of 21 procedures successfully alleviated symptoms of cubital tunnel syndrome in these patients. Four patients who developed ulnar nerve subluxation intraoperatively who were treated with medial epicondylectomy failed to experience relief of symptoms and were successfully treated with anterior submuscular transposition. Patients with more profound motor weakness and/or electrodiagnostic studies had less complete relief of symptoms.