The major complications of distal ulna resection, the Darrach procedure, are radioulnar impingement and instability. High failure rates have been reported despite published modifications of the Darrach procedure. Several surgical techniques have been developed to treat this difficult problem and to mitigate the symptoms associated with painful convergence and impingement. No technique has demonstrated clinical superiority. Recently, implant arthroplasty of the distal ulna has been endorsed as an option for the management of the symptomatic patient with a failed distal ulna resection. However, there are concerns for implant longevity, especially in young, active adults. Resection interposition arthroplasty relies on interposition of an Achilles tendon allograft between the distal radius and the resected distal ulna. Although this technique does not restore normal mechanics of the distal radioulnar joint, it can prevent painful convergence of the radius on the ulna. Achilles allograft interposition arthroplasty is a safe and highly effective alternative for failed distal ulna resections, especially for young, active patients, in whom an implant or alternative procedure may not be appropriate.
5 Kleinman WB, Graham TJ. Distal ulnar injury and dysfunction. In: Peimer CA, , ed. Surgery of the Hand and Upper Extremity. New York, NY: McGraw-Hill; 1996: 667-709
12 Sotereanos DG, Leit ME. A modified Darrach procedure for treatment of the painful distal radioulnar joint. Clin Orthop Relat Res 1996; 325 (325) 140-147
14 Chu PJ, Lee HM, Hung ST, Shih JT. Stabilization of the proximal ulnar stump after the Darrach or Sauvé-Kapandji procedure by using the extensor carpi ulnaris tendon. Hand (NY) 2008; 3 (4) 346-351
15 Minami A, Iwasaki N, Ishikawa J, Suenaga N, Kato H. Stabilization of the proximal ulnar stump in the Sauvé-Kapandji procedure by using the extensor carpi ulnaris tendon: long-term follow-up studies. J Hand Surg Am 2006; 31 (3) 440-444
19 Greenberg JA, Yanagida H, Werner FW, Short WH. Wide excision of the distal ulna: biomechanical testing of a salvage procedure. J Hand Surg Am 2003; 28 (1) 105-110
20 Watson HK, Brown RE. Ulnar impingement syndrome after Darrach procedure: treatment by advancement lengthening osteotomy of the ulna. J Hand Surg Am 1989; 14 (2 Pt 1) 302-306
21 van Schoonhoven J, Fernandez DL, Bowers WH, Herbert TJ. Salvage of failed resection arthroplasties of the distal radioulnar joint using a new ulnar head prosthesis. J Hand Surg Am 2000; 25 (3) 438-446
22 Berger RA, Cooney III WP. Use of an ulnar head endoprosthesis for treatment of an unstable distal ulnar resection: review of mechanics, indications, and surgical technique. Hand Clin 2005; 21 (4) 603-620 , vii
23 Fernandez DL, Joneschild ES, Abella DM. Treatment of failed Sauvé-Kapandji procedures with a spherical ulnar head prosthesis. Clin Orthop Relat Res 2006; 445: 100-107
24 Willis AA, Berger RA, Cooney III WP. Arthroplasty of the distal radioulnar joint using a new ulnar head endoprosthesis: preliminary report. J Hand Surg Am 2007; 32 (2) 177-189
28 van Schoonhoven J, Mühldorfer-Fodor M, Fernandez DL, Herbert TJ. Salvage of failed resection arthroplasties of the distal radioulnar joint using an ulnar head prosthesis: long-term results. J Hand Surg Am 2012; 37 (7) 1372-1380
29 Sotereanos DG, Göbel F, Vardakas DG, Sarris I. An allograft salvage technique for failure of the Darrach procedure: a report of four cases. J Hand Surg [Br] 2002; 27 (4) 317-321
30 Greenberg JA, Sotereanos D. Achilles allograft interposition for failed Darrach distal ulna resections. Tech Hand Up Extrem Surg 2008; 12 (2) 121-125
32 Minami A, Iwasaki N, Ishikawa J, Suenaga N, Yasuda K, Kato H. Treatments of osteoarthritis of the distal radioulnar joint: long-term results of three procedures. Hand Surg 2005; 10 (2-3) 243-248
34 Daecke W, Martini AK, Schneider S, Streich NA. Amount of ulnar resection is a predictive factor for ulnar instability problems after the Sauvé-Kapandji procedure: a retrospective study of 44 patients followed for 1–13 years. Acta Orthop 2006; 77 (2) 290-297
35 Sauerbier M, Hahn ME, Berglund LJ, An KN, Berger RA. Biomechanical evaluation of the dynamic radioulnar convergence after ulnar head resection, two soft tissue stabilization methods of the distal ulna and ulnar head prosthesis implantation. Arch Orthop Trauma Surg 2011; 131 (1) 15-26
36 Sauerbier M, Hahn ME, Fujita M, Neale PG, Berglund LJ, Berger RA. Analysis of dynamic distal radioulnar convergence after ulnar head resection and endoprosthesis implantation. J Hand Surg Am 2002; 27 (3) 425-434
