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The distal radioulnar joint is a complex structure necessary for forearm motion and force transmission across the wrist. Anatomic and biomechanical advances have revealed broad contributions to distal radioulnar joint stability and refined our understanding of the forces acting across it. Instability often co-occurs with other modes of pathology, such as arthrosis or malunion; and appropriate diagnosis and treatment require a comprehensive understanding of all contributing factors. Distal radioulnar joint instability can be broadly categorized as primary, post-traumatic or post-surgical. Treatment strategies include percutaneous, arthroscopic, soft-tissue, osteotomy and arthroplasty techniques. The purpose of this article is to review distal radioulnar joint instability and its management.

Resection arthroplasty of the distal radioulnar joint (DRUJ), such as the Darrach procedure, is a common treatment for pathology that proves refractory to more conservative measures. Although outcomes are often favorable, complications include pain, instability, ulnar translation of the carpus, and abutment of the ulnar stump on the radius [7, 13]. Darrach procedures yield inferior outcomes in patients with high functional demands [7, 26] and numerous soft-tissue stabilization procedures have been developed to control an unstable residual ulnar stump [3, 4, 12]. Unfortunately, the failed distal ulnar resection has proved quite problematic, with persistently poor outcomes despite multiple stabilization procedures [2]. DRUJ implant arthroplasty offers a possible solution. Distal ulnar hemiarthroplasties exist [5, 10], as do total ulnar head replacements [8, 14, 20, 25], but their stability requires some contribution from native soft tissues, which are often deficient, especially in salvage situations [22]. More recently, total DRUJ replacements have been developed [11, 19, 23]. One particular implant is the bipolar, self-constrained Aptis Total DRUJ Replacement Prosthesis (Aptis Medical, Louisville, KY) [21, 22]. This report describes our experience with this new implant.