Yu Ning Hsiao, Chi Sheng Chien, Tsung Mu Wu

Department of Orthopedics, Chi Mei Medical Center, Tainan, Taiwan

Keywords: Distal oblique bundle, distal radioulnar joint, instability, minimally invasive surgery, suture-button suspension, wrist pain.


The stability of distal radioulnar joints is afforded by bony radioulnar articulation and peripheral soft-tissue stabilizers. The primary soft-tissue stabilizers are structures that surround the distal radioulnar joint and are collectively referred to as the triangular fibrocartilaginous complex. Among the stabilizers, the volar and dorsal radioulnar ligaments contribute the most to the stability of distal radioulnar joints. For acute traumatic distal radioulnar joint instability accompanied by purely ligamentous injury, traditional surgical treatments involve the repair or reconstruction of the distal radioulnar ligament; however, these intra-articular procedures are highly invasive and difficult. The extra-articular reconstruction of the secondary stabilizer such as the distal oblique bundle of the interosseous membrane has attracted significant attention in recent years; however, most studies have only conducted cadaveric or laboratory modelbased investigations. In this article, we present three patients who suffered from acute dorsal wrist pain after a trauma event. Radiographic and physical examinations revealed distal radioulnar joint instability. All patients were treated with minimally invasive suture-button suspension augmentation in the direction of distal oblique bundle of the interosseous membrane. The instability was resolved after the surgical procedure, but two patients developed ulnar wrist pain and one patient underwent implant removal. All patients have been continually followed at our outpatient department and exhibited stable wrists, despite mild limitation in the range of motion after the procedure. In conclusion, acute traumatic distal radioulnar joint instability may be sufficiently treated with suture-button suspension for augmentation of the distal oblique bundle; however, some obstacles impede the in vivo adoption of this treatment.

Citation: Hsiao YN, Chien CS, Wu TM. Treatment of acute distal radioulnar joint instability with distal oblique bundle augmentation of the interosseous membrane by suture-button suspension: A case series. Jt Dis Relat Surg 2022;33(3):658-665.

Author Contributions

Conception of the work and drafted the manuscript: Y.N.H.; Gathered the needed information for the manuscript; Provided the first author with academic experiences: C.S.C.; Supervised the direction of manuscript; Revision of the manuscript; Final approval of the version to be published: T.M.W.; All authors have read and approved the final manuscript.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.