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Chirurgia di salvataggio in caso di sublussazione dorsale dell'ulna

Chirurgia di salvataggio in caso di sublussazione dorsale dell’ulna

11 giugno, 2021

Cirugía de rescate en subluxación cubital_01_20210603

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The patient starts from an ulna plus picture (that is, the ulna is longer than the radius at its distal ends) with ulnar pain, due to impaction of the ulnar head against the lunate bone of the right wrist. Before going to Dr Piñal, she had undergone an incorrectly executed arthroscopic Wafer procedure, in which the head of the ulna was not lowered evenly, but was cut in a wrong area, causing a bone hole, which impeded the patient’s supination movement (turning of the the distal radioulnar joint to put the palm of the hand up).

Dorsal subluxation of the ulna
On the left –in the two sections of the radiograph of the distal radioulnar joint- the bone hole caused by the previous Wafer procedure (indicated by the arrows) can be seen. On the right, its consequences: dorsal subluxation of the ulna and loss of complete pronosupination movement.

The problem

In addition to the initial symptoms of ulnar pain, which persisted, as a result of the Wafer procedure described, the patient suffered more pain and a dorsal subluxation of the ulna, which, in this case, caused the ulna itself to hook with the radius. This joint problem made the supination movement impossible for the patient.

The goals

The clinical objectives of Dr Piñal and his team are to eliminate ulnar pain and regain full pronosupination movement.

The plan

Dr Piñal addresses the case through a complex arthroscopy that restores bone damage from the first operation, reshaping the head of the ulna.

Images of the arthroscopic procedure of Dr Piñal in which the remodeling of the head of the ulna is observed.

The results

Thanks to salvage surgery, ulnar pain disappears and the effects of the previous unsuccessful procedure are reversed, with which the patient recovers the function of the distal radioulnar joint and, therefore, the capacity for supination movement.

Complete pronosupination movement
The upper pictures allow us to see the before (left) and after of the salvage surgery, with the patient executing a complete pronosupination movement.

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