Can you please explain to me what is a Darrach procedure for the wrist? I have a friend who is going on and on about this being the best thing that happened to her since sliced bread. Really? What kind of surgery is this anyway? I didn't want to hear any more about it from her but I admit, now I'm curious enough to ask.
As you might suspect, the name Darrach really refers to the physician who first described and used this operation on someone's wrist. Dr. Darrach actually published an article on his approach back in 1913. He used it on a patient who had a chronically dislocating wrist.
It is basically the surgical removal (called excision) of the distal end of the ulna. The ulna is one of the two bones in the forearm. The distal end refers to the end of the ulna at the wrist. Since the two forearm bones meet at the elbow and at the wrist, distal is the term used to designate the wrist end of the bone.
The place where the two forearm bones meet at the wrist is referred to as the distal radioulnar joint or DRUJ. Disruption of this joint for any reason (e.g., trauma, congenital deformity, degenerative arthritis) can cause disabling pain and dislocation. The joint is meant to help the wrist bones slide, glide, and rotate. These motions make it possible to brush your teeth, hold a cup of coffee, push up from a chair, pick up a cat or dog, and many activities of daily living.
But changes in the joint for any reason can produce pain, tenderness, loss of motion, and eventually, loss of function. By removing a small portion of the damaged end of the bone, the joint can still work but without the rubbing that's causing the painful symptoms.
Your friend's enthusiasm for the positive results of this procedure is understandable. The pain of an unstable or degenerating distal radioulnar joint (DRUJ) can be very debilitating. Being able to move the wrist, hand, and forearm again freely and without pain from this simple procedure is better than sliced bread!
Ryan M. Zimmerman, MD, et al. Arthritis from the Distal Radioulnar Joint: From Darrach to Total Joint Arthroplasty. In Journal of the American Academy of Orthopaedic Surgeons. October 2012. Vol. 20. No. 10. Pp. 623-632.
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