Anatomic integrity of the distal radioulnar joint (DRUJ) is essential for the normal function of the wrist and forearm. Arfhrotic, rheumatoid or tumor joint destruction as well as instability and radioulnar convergence following ulnar head resection or Sauve-Kapandji procedures lead to painful limitation of forearm rotation and diminished grip strength.Prosthetic ulnar head replacement obviates the disadvantages of distal ulnar resection, aims to restore pain free forearm rotation, maintains ulnar support of the carpus, corrects radioulnar length discrepancy and controls radioulnar impingement. Based on the medium and long term satisfactory results obtained with ulnar head prosthetic replacements, distal ulnar partial or total resections have become rare indications in the younger manually active patient. For these reasons maintenance of the ulnar head with a hemi-prosthesis is our current preference whenever the joint needs to be salvaged, the goals being restoration of joint load transfer and stability while preserving normal kinematics of forearm rotation (Fig. 1).
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