Reconstruction of the deep fibers of the distal radioulnar ligaments facilitating a tendon graft-Adams' procedure

Goal Anatomical reconstruction of the deep fibers of the distal radioulnar ligaments to stabilise the distal radioulnar joint. Indications Multidirectional instability of the distal radioulnar joint without the possibility for anatomic refixation of the distal radioulnar ligaments. Contraindications General operative contraindications, infection, insufficient soft tissue coverage, osteoarthritis of the distal radioulnar joint, excessive ulna impaction syndrome, osseous deformation. Surgical technique Dorsal approach to the distal radioulnar joint, preparation of the ulna head, transosseous transfer of tendon graft through the distal ulnar corner of the radius at the sigmoid notch, transfer through the ulnar fovea and transosseous fixation within the ulna head using an interference screw. Postoperative management Long arm cast for 4-6 weeks, then Bowers splint for further 4 weeks; optional long arm orthosis without limiting elbow flexion and extension for 4-6 weeks, then Bowers splint for further 4 weeks; starting exercises after 12 weeks. Results Reconstruction of the distal radioulnar ligaments using tendon grafts stabilises the distal radioulnar joint with restoration of joint kinematics.