A simple button-to-button fixation for chronic distal radio-ulnar junction disruption: a case report and literature review

Introduction and importance: The stability of the wrist joint is essential. A simple button-to-button (BtB) fixation technique may provide long-term stability after a chronic distal radio-ulnar joint (DRUJ) disruption and result in a good functional outcome. Case presentation: A 32-year-old female was admitted to the clinic right after having difficulties with wrist rotation movement for 6 months before admission. There was a history of traffic accidents before this complaint. She fell to the ground with her arm holding her body in a wrist rotation position. A tenderness was found during physical examination, specifically on her left wrist joint. Further, a piano key sign was positive. Magnetic Resonance Imaging revealed DRUJ disruption. The patient was diagnosed with chronic DRUJ disruption. Clinical discussion: We implement a simple, minimally invasive surgical approach with a novel kit of BtB fixation to stabilize wrist function. The length of surgery was measured and showed a short duration of 10 minutes. The Visual Analog Scale (VAS), Euroqol 5-Dimension (EQ5D) score, and Disability of Arm, Shoulder, and Hand (DASH) were determined and showed a good patient-reported outcome. The cost of treatment was estimated, resulting in an Average Cost-Effectiveness Ratio of $2692/QALY. Conclusion: The minimally invasive approach with the BtB procedure is a simple and cost-effective approach for treating a chronic DRUJ disruption in selected patients. VAS, EQ5D, and DASH scores pointed out a good functional outcome.