Francisco del Piñal, MD, PhD, Eduardo Moraleda, MD, Jaime S. Rúas, MD, PhD, Ana Rodriguez-Vega, MD, Alexis Studer, MD

Journal of Hand Surgery American Edition Vol. 43, Issue 7, July 2018, Pages 676.e1–676.e6 © 2018 by the American Society for Surgery of the Hand – All rights reserved.

ABSTRACT (full text pdf. below)

Effectiveness of an Arthroscopic Technique to Correct Supination Losses of 90º or More

Purpose To present a new arthroscopic method for treating supination losses.

Methods Six patients (15e71 y) were eligible for this study. All had a history of trauma to the wrist more than 6 months previously. Five of them had sustained a distal radius fracture: 3 had been treated with a volar plate (1 of them for an extra-articular malunion), 1 with an external fixator and K-wires, and 1 had been treated in a cast. One of these patients underwent a further operation for correcting an intra-articular malunion. The last patient underwent an open reduction of a transscaphoid perilunate dislocation. During a standard radiocarpal arthroscopy, a curved periosteal elevator was inserted through the 6R portal into the volar-radial corner of the triangular fibrocartilage complex and advanced proximally gliding on the anterior ulnar head surface. The volar capsule was then distended with the periosteal elevator and by means of gentle sweeping motion adherences between them, the volar capsule and the ulnar head were freed. Finally, the arthroscopic release was combined with a gentle passive supination force applied by the surgeon. Full supination was maintained in an orthosis for 2 to 3 days. Afterward, regular physical therapy was instituted. Concomitant surgery, arthroscopic or open, was performed in all to treat associated conditions.

Results Full supination (90º) was achieved in all intraoperatively. At a mean follow-up of 3.3  years, mean supination was 76º in the latest follow-up (range, 50º to 90º). Mean improvement in supination was 80º (range, 50º to 100º). No distal radioulnar instability or other complications were noted.

Conclusions The method presented proved effective in severe forms of supination deficits.

Type of study/level of evidence Therapeutic V.

Key words: Supination loss, pronosupination stiffness, wrist arthroscopy, distal radius fractures.