Salvage Operation for a Failed Total Wrist Prosthesis and Darrach Procedure by Total Wrist Revision and Distal Radioulnar Joint Arthroplasty

An unstable distal ulnar stump after Darrach resection, alongside pathology of the radiocarpal joint, is difficult to manage without fusion of at least one joint. Currently, no standard 2-in-1 arthroplasty is available. We report the case of a 72-year-old woman with loosening of the radial stem of a Universal 2 total wrist prosthesis combined with radioulnar impingement after a Darrach procedure. Because of poor radial bone stock, the standard fixation technique of a semi-constrained distal radioulnar joint prosthesis (Aptis) was not possible. We present a technique to fix the semi-constrained distal radioulnar joint prosthesis as well as a total wrist prosthesis by a custom 3-dimensional printed flange prosthesis to the ulnar border of the radius. Three years after surgery, the patient remained pain-free, with 60° flexion, 75° extension, 80° pronation, and 80° supination.