Outcomes of DRUJ Capsular Release for Posttraumatic Forearm Rotational Contracture

Abstract

Posttraumatic limitation of forearm rotation can occur anywhere along the forearm. It is often the result of scar formation at the distal radioulnar joint (DRUJ) following injury to the distal forearm. In previous literature, very little emphasis has been placed on the DRUJ capsule and its role in limiting pronation and supination. Our purpose was to determine the safety and effectiveness of open volar, dorsal, and combined DRUJ capsular release on restoring forearm rotation in patients with posttraumatic rotational stiffness, including when used in combination with a proximal forearm release.

We retrospectively identified 13 patients who had undergone an open volar, dorsal, or combined DRUJ capsular release for posttraumatic rotational contracture. Patients who had proximal forearm or elbow contracture releases in combination with a DRUJ release were included. Patients were excluded if they had arthroscopic surgery, contractures secondary to congenital deformities, or had undergone revision surgery. Our primary outcome of interest was final supination and pronation in degrees.

Between 2011 and 2023, 13 patients were identified meeting inclusion criteria with an average age of 43 ± 16 years. The mean time from procedure to follow-up was 6.5 ± 4.3 years.

At final follow-up, supination and pronation were significantly improved compared with preoperative. Average preoperative supination was 32 ± 30 degrees, and postoperative was 68 ± 15 degrees. Average preoperative pronation was 42 ± 36 degrees, and postoperative was 69 ± 25 degrees. At final follow-up, the mean Patient-Rated Wrist and Hand Evaluation (PRWHE) score was 21 ± 18.

There was one postoperative complication, DRUJ instability that resolved after an ulnar shortening osteotomy (n = 1). Four patients had mild degenerative changes in the DRUJ noted on X-ray at final follow-up.

DRUJ capsular release is a viable option for rotational contractures of the forearm with a good restoration of both pronation and supination, good functional outcomes, and a low incidence of complications. It may be used in isolation or in combination with a proximal forearm contracture release.

Prognosis; Level IIC.