Treatment of chronic dislocation or subluxation of the distal radioulnar joint.

Twenty-eight patients with chronic instability of the distal radioulnar (DRU) joint were treated with 4 procedures: Sauvé-Kapandji procedure (11 cases), Milch ulnar shortening osteotomy (9 cases), Bowers hemiresection interposition arthroplasty (4 cases), or ligamentous reconstruction (4 cases). The indication for operation in all cases was pain in the DRU joint and weakness of grip strength. Sixteen of 28 patients also complained of limitation of forearm rotation. At an average follow-up of 18 months, there were 72% satisfactory results in patients treated with the Sauvé-Kapandji procedure, 88.9% with the Milch procedure, 75% with the Bowers procedure, and no satisfactory results with ligamentous reconstruction. We believe that the Milch procedure is indicated for the wrist with mild instability with adequate articular surface of the DRU joint. The Bowers procedure and the Sauvé-Kapandji procedure are useful in treating patients with gross instability with or without articular damage to the DRU joint.