DRUJ半切除成形术 资料
本方案指导您在桡尺远侧关节（DRUJ）半切除加间置成形术后的康复过程。该手术通过重塑前臂磨损的末端，以恢复前臂舒适、无痛的旋转功能，由基兰·希尔帕拉（Kieran Hirpara）医生在罗克汉普顿 Mater 私人医院实施。方案首先介绍您的家庭锻炼计划，随后是专为您的手部治疗师制定的结构化临床方案；请在首次治疗时携带此页面或其 PDF 版本，以确保康复过程协调一致。您的治疗师可能会根据您的康复进展调整该计划。
如果您对术后伤口有任何疑虑，请与诊室联系。拍摄伤口照片并通过电子邮件发送以供审查通常很有帮助。
预期情况
远尺桡关节（DRUJ）是位于手腕小指侧的小关节，前臂的两块骨头（桡骨和尺骨）在此处相接。该关节使您能够旋转前臂，使手掌朝上（旋后）和手掌朝下（旋前）。当该关节磨损并发生关节炎时，旋转前臂会引发疼痛。
在半切除成形术中，仅将尺骨头磨损、发生关节炎的部分磨除（部分切除：“hemi”意为一半），并将一小块您自身的软组织塞入间隙，以防止表面相互摩擦。该手术保留了关键的稳定结构，包括三角纤维软骨复合体（TFCC，即支撑该侧手腕的软骨和韧带悬床）、尺骨茎突以及软组织附着点，从而使尺骨远端得到支撑。这正是其与完全切除尺骨头（Darrach 手术）的区别所在。
由于关节表面是经过重塑而非修复或重建，因此没有肌腱或韧带需要在保护下愈合数月。该手术的目标是无痛的前臂旋转，康复过程中最重要的部分是尽早恢复旋转活动。在夹板中进行短暂的保护以让软组织稳定后，恢复前臂旋转（手掌朝上和朝下）将成为您康复的重点。随后再逐渐增加力量和更重的负荷。
注意事项与限制
- 在最初的两到三周内，请按照指示佩戴夹板；夹板可轻柔地限制前臂旋转，以便间隙组织稳定。在此期间，请保持手指活动，并在获准的情况下活动手腕。
- 一旦获准停用夹板，请将前臂旋转作为重点，保持无痛且无负荷状态。早期旋转应在手部无负重（空手）的情况下进行，切勿对抗负重。
- 切勿在早期使前臂承受旋转负荷：在获准进行强化训练之前（通常为六至八周），请勿进行拧开瓶盖、拧干抹布、使用螺丝刀或在该侧手提重物等动作。
- 当通过前臂施加推力或负荷时，请注意小指侧手腕是否出现疼痛或不稳感，因为这是手术作用的区域。请向您的手部治疗师说明此情况，切勿强行忍受。
- 从一开始就应保持手指、拇指、肘部和肩部的自由活动，并在舒适范围内将手部用于日常轻体力活动，前提是这些活动不涉及强制或负重的扭转。
关于伤口、肿胀和瘢痕管理，请参阅本诊所的伤口护理指南。
您的锻炼
这些是您讲义中的锻炼项目。仅在 Hirpara 医生和您的手部治疗师的指导下开始，并严格遵循您被允许的关节活动范围和限制。手指活动应立即开始。前臂旋转（本手术的核心锻炼）和手腕活动在拆除夹板后开始，通常在术后两到三周，此后旋转将成为您的主要锻炼重点。疤痕按摩在伤口完全愈合后开始。握力和旋转力量训练属于后期阶段，必须在获得明确许可后方可开始。如果小指侧手腕出现锐痛，请立即停止任何相关动作。
您的临床方案
本页面其余部分为桡尺远侧关节半切除间置成形术后的分期康复临床方案。本节内容将提供给您的手部治疗师，每个阶段均以通俗易懂的语言解释当前正在进行的康复内容。这是一种关节重塑（成形术）手术，而非修复手术：不存在需要数月保护的高张力结构。主动限制期较短：仅通过短期支具固定，使软组织间置物和关节囊得以稳定，此后早期恢复前臂旋转是明确的首要目标，因为旋转正是该手术旨在恢复的功能。整个过程中需遵循的主要负荷是桡骨远端的旋转负荷，这是引发疼痛性尺骨残端不稳定和尺桡骨汇聚的原因。
治疗前，请核查患者的手术记录和既往病史，并与主刀医生沟通任何同期进行的手术（如三角纤维软骨复合体修复、桡骨远端截骨术、骨间背神经切断术、伸肌重建术）、术中评估的尺骨残端稳定性，以及处方支具和旋转活动度上限。若同期进行了三角纤维软骨复合体修复或桡骨远端截骨术，则受保护期延长；单纯因退行性或创伤性关节炎行半切除术的患者，则遵循下方较短的康复路径。Hirpara 医生保留三角纤维软骨复合体、尺骨茎突及尺侧软组织附着，因此尺骨远端仍得到支撑，康复方案因此可优先强调早期旋转。
第一阶段 — 支具保护下的稳定期（第0至2-3周）
最初的两到三周旨在保护软组织嵌顿和关节囊，同时保持肢体其余部分的活动能力。前臂置于支具中（通常为限制前臂旋转的超肘支具/Muenster型支具或石膏），仅在卫生清洁需要时取下；在该阶段末期，可进行首次轻柔的旋转活动。手指从术后第一天起即可活动。
致您的手治疗师：
教育与注意事项 - 按处方使用支具固定（超肘/Muenster型，或遵医嘱），限制前臂旋转；仅在卫生清洁和经批准的运动时取下 - 禁止负重前臂旋转；避免通过患侧前臂承重或扭转 - 安抚患者，告知早期握力减弱和尺侧肿胀属预期现象
管理措施 - 伤口：按指示进行外科敷料处理；监测感染迹象 - 水肿：抬高患肢，轻柔的手部泵动练习，必要时冰敷 - 运动：从第一天起进行手指、拇指以及（若未被支具阻挡）肩关节的主动活动度训练；根据支具允许情况轻柔进行肘关节活动度训练；若外科医生允许早期取下支具，则在该阶段最后几天引入轻柔的无痛主动前臂旋转
进展标准 - 伤口愈合稳定；支具固定期（孤立性半切除术后约2-3周）完成；经外科医生批准可进行主动旋转
第二阶段——前臂早期旋转（优先阶段）（第2-3周至第6周）
这是决定性阶段。脱离支具后，主动旋前和旋后成为康复的核心：轻柔、频繁、无痛且无负荷。加入腕关节活动。旋转是手术恢复的功能，因此在当前阶段积极进行旋转训练，同时仍避免负荷。
供手部治疗师参考：
评估 - 主动和被动前臂旋前/旋后（目标恢复至结果系列中报告的每个方向约80°）；腕关节和手指活动度；尺侧腕部疼痛；肿胀；伤口/瘢痕复查
教育和注意事项 - 前臂旋转是优先事项： 频繁、无痛、无负荷的主动旋前/旋后，肘部紧贴身体侧面以隔离前臂 - 在约6-8周前，禁止进行抗阻或负重旋转、禁止大力抓握、禁止扭转动作 - 某些支具在拆除石膏后的几周内进一步限制终末范围的旋转；请遵守任何规定的限制上限
管理 - 练习：以主动和辅助主动旋前/旋后为主要重点；主动腕关节屈曲/伸展和桡偏/尺偏；继续手指和抓握活动度（暂不进行抗阻抓握）；伤口完全愈合后开始瘢痕管理 - 根据需要处理水肿和瘢痕的物理因子治疗
进阶标准 - 舒适、可控、接近全范围的无痛主动前臂旋转；伤口愈合；疼痛≤3/10；轻柔旋转时无诱发性尺侧疼痛
第三阶段——强化与回归（第6-8周及以后）
一旦旋转功能恢复且无痛，即可开始强化训练，并逐步增加负荷：首先进行握力训练，随后进行负重前臂旋转，需特别观察在负荷下是否出现疼痛性尺骨残端不稳或尺桡骨汇聚现象。回归重体力劳动和运动需基于既定标准。
致您的手治疗师：
评估 - 握力与健侧对比（结果系列报告恢复至健侧的约85-90%）；前臂旋转力量，以及负重旋转时是否有任何疼痛或不稳；根据需要进行功能性和工作/运动特异性测试
教育与注意事项 - 首先引入抗阻握力，随后从第6至8周开始进行分级负重前臂旋转（例如使用轻重量进行锤击动作）；缓慢增加负荷 - 监测轴向或旋转负荷下出现的疼痛性尺骨残端不稳/尺桡骨汇聚： 若诱发疼痛，应减少负荷并与外科医生沟通
管理 - 练习：渐进式握力/橡皮泥训练；分级抗阻旋前/旋后（轻→中）；任务特异性负荷；继续任何残留的活动度训练 - 一旦旋转和握力功能良好且接近对称，并实现了适当的功能恢复，可考虑出院 - 若恢复出现平台期，或存在提示残端不稳或汇聚的持续性尺侧负荷疼痛，可考虑转诊回主治医生
回归负荷/运动的标准 - 握力和旋转力量接近对称；负重旋转无痛；功能测试中无不稳
重返工作与活动
从治疗初期开始，鼓励在舒适范围内进行日常轻度手部活动（如进食、书写、轻度自理），前提是前臂不涉及强制或负重的旋转。由于您的前臂早期已使用夹板固定，且您必须能够安全地控制方向盘（包括转动方向盘），因此在最初几周内请安排他人协助交通；待拆除夹板后，经复查确认您能够舒适且安全地旋转前臂以操控方向盘时，方可恢复驾驶。
涉及负重的旋转任务（如拧开僵硬的瓶盖、拧干物品、使用螺丝刀、在该侧手提重物）需等到强化训练获准后方可进行（通常在六至八周左右），并应逐步增加强度。重返较重的手工劳动和运动同样遵循基于标准的渐进原则，取决于是否恢复无痛且接近对称的前臂旋转及握力，由Hirpara医生及您的手部治疗师进行评估，而非仅依据日历时间。
术后方案
本方案与诊所的一般康复建议并行；请参阅术后疼痛管理、伤口护理和瘢痕管理。如果您的下尺桡关节（DRUJ）问题继发于腕部骨折，则桡骨远端骨折固定方案可作为有益的补充。上述分阶段计划反映了远端桡尺关节半切除成形术后的康复指南，您的后续康复将由Hirpara医生和您的手部治疗师根据前臂的恢复情况个体化指导。
Evidence & references
This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.
Topic scope: post-operative rehabilitation after hemiresection-interposition arthroplasty (HIT) of the distal radioulnar joint (DRUJ) — the Bowers procedure — for painful DRUJ arthritis (degenerative, post-traumatic, or inflammatory). The arthritic portion of the ulnar head is partially resected and a soft-tissue spacer is interposed, preserving the TFCC, ulnar styloid and ulnar soft-tissue attachments so the distal ulna remains supported. This is a joint-reshaping arthroplasty, not a repair or reconstruction: the rehab is therefore an early-rotation pathway built around a short protected settling phase, then prioritised restoration of forearm pronation/supination, then graded loading — not months of construct protection.
Defining principle of the rehab here: the operation exists to restore pain-free forearm rotation, and nothing is sutured under tension that must heal protected for months. The deliberate restraint is a brief splinted phase (commonly an above-elbow / Muenster-type splint limiting forearm rotation for ~2-3 weeks in the isolated case) to let the soft-tissue interposition and capsule settle. After that, early active pronation/supination is the explicit priority — rotation is the function the operation restores. The single load to respect throughout is rotational/axial loading of the distal ulna, which provokes the characteristic failure mode: painful ulnar-stump instability and radioulnar convergence. The main branch point that lengthens the protected phase is a concurrent procedure (TFCC repair, distal radius osteotomy, extensor reconstruction).
A. PROCEDURE OUTCOMES (hemiresection-interposition arthroplasty)
The Bowers HIT is a long-established, generally reliable salvage for the arthritic DRUJ. The evidence base is level IV (retrospective cohorts and case series, no randomised trials), but it is consistent across decades: most patients gain durable pain relief and improved, stable forearm rotation, with the principal residual concern being ulnar-stump instability / radioulnar convergence under load.
- The original Bowers series established the procedure and its rationale. Bowers' 1985 description (38 patients, mean ~2.5 yr) reported stable, painless rotation in the great majority — in rheumatoid patients ~85% achieved stable painless rotation (pronation ~84°, supination ~77°), and degenerative/post-traumatic patients achieved painless rotation averaging ~80° in each direction. The technique was explicitly designed to preserve the functional ulnocarpal ligament complex [Bowers, J Hand Surg Am 1985]. Level IV (foundational case series).
- Long-term outcomes are durable but with a defined complication rate. A long-term cohort (66 patients, mean follow-up 8.6 years) reported low residual pain (median NRS 1/10), an overall complication rate of ~14% and reoperation ~8%; reported complications included stylocarpal impingement, ulnar subluxation, exostoses and tendon rupture. Inflammatory-arthritis patients had lower pain than post-traumatic patients (median 0 vs 5). The same series found PIN neurectomy associated with improved pain scores [HIT long-term outcome study, Hand (N Y) 2019]. Level IV (cohort).
- Forearm rotation, grip and pain all improve measurably. A capsuloretinacular HIT series (21 wrists, mean ~2 yr 10 mo) reported significant gains: pronation 56.8°→83.0°, supination 60.0°→82.0°, grip 66.0%→87.4% of the contralateral side, VAS pain 62→23 mm, DASH 37.7→25.0, PRWE 48.1→24.4, with no post-operative DRUJ instability reported in that series [HIT capsuloretinacular series, J Wrist Surg 2023]. Level IV (cohort).
- HIT sits within a family of DRUJ salvage options (Darrach distal ulna resection, Sauvé-Kapandji arthrodesis-pseudarthrosis, matched/hemiresection variants, and ulnar-head implant arthroplasty), each with its own instability/convergence profile; HIT's selling point is preservation of the ulnar support structures to reduce stump instability versus a formal Darrach [Bowers 1985; Glowacki, Hand Clin 2005; Chidgey, JAAOS 1995; Rekant, Hand Clin 2012; Murray, Hand Clin 2011]. Mechanistic / narrative-review.
B. REHABILITATION / THERAPY EVIDENCE
There is no trial-level evidence for any specific rehabilitation regimen after DRUJ HIT. Protocols are surgeon- and technique-derived expert consensus, reported as the post-operative methods of the outcome series and operative-technique articles above. The consensus is consistent on its key features.
- A brief protected settling phase, not prolonged immobilisation. In the isolated hemiresection (no distal radius osteotomy, no TFCC repair), a long-arm plaster splint for ~10 days followed by a removable Muenster splint for a further 2-3 weeks is typical; cohort series report an upper-arm cast ~3 weeks then a forearm cast 1-2 weeks. Where a distal radius osteotomy or TFCC repair is added, immobilisation is longer (e.g. a long-arm cast in ~45° supination for ~4 weeks) [Pillukat & van Schoonhoven, Oper Orthop Traumatol 2009; HIT capsuloretinacular series, J Wrist Surg 2023]. Weak / expert consensus.
- Early forearm rotation is the explicit priority once protection ends. The whole point of the operation is rotation, so active pronation/supination is pursued early and frequently. Some protocols further limit end-range rotation by splint for ~4 more weeks after the cast comes off before unrestricted motion and load [Pillukat & van Schoonhoven 2009]. Weak / expert consensus.
- Loading is added last, watching for the characteristic failure mode. Range and load are returned to normal after the rotation-limited window; the specific thing to watch is painful ulnar-stump instability and radioulnar convergence under axial/rotational load, which is the biomechanically demonstrated weak point of distal-ulna procedures [Sauerbier et al., J Hand Surg Br 2002; Douglas et al., J Hand Surg Am 2014; Barret et al., Orthop Traumatol Surg Res 2020]. Mechanistic (biomechanical) + consensus.
- Finger, thumb, elbow and shoulder motion from day one is standard to prevent stiffness, as in any forearm/wrist immobilisation pathway. Consensus.
Recovery trajectory (expected, evidence-anchored)
| Phase | Window | Restraint | Hand use / therapy focus | Strength / load | Notes |
|---|---|---|---|---|---|
| I — Protected settling | Week 0 to 2-3 | Splint limiting forearm rotation (Muenster / above-elbow type) | Active finger/thumb/shoulder ROM from day 1; elbow ROM as splint allows; first gentle pain-free rotation toward end of phase | None through forearm | Longer if concurrent TFCC repair or distal radius osteotomy (cast in supination ~4 wk) |
| II — Early forearm rotation (priority) | Week 2-3 to 6 | Unloaded; some protocols cap end-range rotation a few more weeks | Active pronation/supination as the main focus, elbow tucked; add wrist ROM; finger/grip ROM; scar massage once healed | No resisted/loaded rotation, no heavy grip | Target restoration toward ~80° each direction; pain-free is the rule |
| III — Strengthening & return | Week 6-8+ | Restrictions lifted progressively | Resisted grip first, then graded loaded rotation (hammer turns); task-specific loading | Build load slowly; grip recovers toward ~85-90% contralateral | Watch for ulnar-stump instability / radioulnar convergence under load |
(Phase windows mirror the precautions and phase tables in the patient protocol; they are typical expert-consensus guides, not trial-derived deadlines, and lengthen with concurrent procedures.)
C. KEY CONTROVERSIES / EVIDENCE QUALITY
- HIT vs Darrach. The Darrach (complete distal ulna resection) is simpler but sacrifices the ulnar support structures and is more prone to painful proximal ulnar-stump instability and radioulnar convergence, especially in younger, higher-demand or post-traumatic patients. HIT preserves the TFCC/styloid/attachments to mitigate this — but biomechanical work shows HIT also converges under load, just to a different degree, so convergence is a spectrum, not a HIT-vs-Darrach binary [Sauerbier et al., J Hand Surg Br 2002; Douglas et al., J Hand Surg Am 2014]. Darrach remains reasonable in low-demand/elderly patients. *Moderate (biomechanical
- cohort).*
- HIT vs Sauvé-Kapandji. Sauvé-Kapandji fuses the DRUJ and creates a controlled proximal pseudarthrosis, preserving the ulnar head/buttress for the carpus; it is often favoured where ulnar translation of the carpus is a concern (e.g. rheumatoid), but it too can develop painful proximal-stump instability. Long-term Sauvé-Kapandji and modified-Sauvé-Kapandji series report durable function with that caveat [Reissner et al., J Hand Surg Eur 2021; Zimmermann et al., Arch Orthop Trauma Surg 2003]. Choice is patient- and pathology-specific, not evidence-mandated. Moderate.
- HIT vs ulnar-head (implant) replacement. Implant ulnar-head arthroplasty is an alternative — particularly for failed resection/instability salvage — restoring a load-bearing buttress, but it adds implant-specific complications. Long-term implant series report good outcomes; it is increasingly used to rescue a painful, unstable stump after resection-type procedures [Kakar et al., J Hand Surg Am 2010; Adams, Hand Clin 2010; Watts et al., Hand Clin 2010; Rekant, Hand Clin 2012]. Moderate.
- The rehab regimen itself is consensus, not trial-derived. No RCT compares immobilisation length, rotation timing or loading progression after HIT. The "brief protection → early rotation → graded load" structure is inferred from technique articles and the methods of level-IV outcome series. Exact phase timings are typical, not deadlines, and shift with concurrent procedures. Weak / expert consensus.
- Patient selection drives results. Inflammatory-arthritis patients report lower residual pain than post-traumatic patients in long-term follow-up; adjunct PIN neurectomy is associated with better pain scores. Both point to outcome being substantially a selection/technique matter, not a rehab one [HIT long-term cohort, Hand 2019]. Moderate (within level-IV data).
D. EVIDENCE STRENGTH FLAGS (summary)
- STRONG (RCT / SR): none. There are no randomised trials of DRUJ HIT or of its rehabilitation.
- MODERATE: the biomechanical basis of radioulnar convergence / ulnar-stump instability under load across distal-ulna procedures (cadaveric studies); the comparative trade-offs among HIT / Darrach / Sauvé-Kapandji / ulnar-head replacement (consistent cohort + mechanistic data).
- LEVEL IV (cohort / case series — the outcome evidence): pain relief, grip recovery (~85-90% contralateral), pronation/supination gains (toward ~80° each), ~14% complication and ~8% reoperation rates, durability to ~8-9 years. Consistent but uncontrolled and surgeon-reported.
- WEAK / EXPERT CONSENSUS (the rehab regimen): the specific brief-protection → early-rotation → graded-load programme, the Muenster/above-elbow splint choice, the ~2-3 week protected window, and all exact phase timings — derived from technique articles and the methods sections of level-IV series, lengthened by concurrent procedures. No comparative rehab evidence exists.
CITATIONS
RAG corpus (180,000+ Orthopaedic articles)
- Glowacki KA. Hemiresection arthroplasty of the distal radioulnar joint. Hand Clin. 2005. DOI: 10.1016/j.hcl.2005.08.002
- Sauerbier M, Fujita M, Hahn ME, et al. The dynamic radioulnar convergence of the Darrach procedure and the ulnar head hemiresection interposition arthroplasty: a biomechanical study. J Hand Surg Br. 2002. DOI: 10.1054/jhsb.2002.0763
- Douglas KC, Parks BG, Tsai MA, et al. The biomechanical stability of salvage procedures for distal radioulnar joint arthritis. J Hand Surg Am. 2014. DOI: 10.1016/j.jhsa.2014.03.028
- Barret H, Lazerges C, Chammas P, et al. Modification of matched distal ulnar resection for distal radio-ulnar joint arthropathy: analysis of distal instability and radio-ulnar convergence. Orthop Traumatol Surg Res. 2020. DOI: 10.1016/j.otsr.2020.07.008
- Chidgey LK. The distal radioulnar joint: problems and solutions. J Am Acad Orthop Surg. 1995. DOI: 10.5435/00124635-199503000-00005
- Murray PM. Current concepts in the treatment of rheumatoid arthritis of the distal radioulnar joint. Hand Clin. 2011. DOI: 10.1016/j.hcl.2010.10.002
- Lee SK, Hausman MR. Management of the distal radioulnar joint in rheumatoid arthritis. Hand Clin. 2005. DOI: 10.1016/j.hcl.2005.08.009
- Ozer K. Management of complications of distal radioulnar joint. Hand Clin. 2015. DOI: 10.1016/j.hcl.2014.12.003
- Zimmerman RM, Jupiter JB. Instability of the distal radioulnar joint. J Hand Surg Eur Vol. 2014. DOI: 10.1177/1753193414527052
- Rekant M. Distal ulna arthroplasties. Hand Clin. 2012. DOI: 10.1016/j.hcl.2012.08.016
- Watts AC, Hayton MJ, Stanley JK. Salvage of failed distal radioulnar joint reconstruction. Hand Clin. 2010. DOI: 10.1016/j.hcl.2010.05.004
- Kakar S, Swann R, Perry K, et al. Distal radioulnar joint implant arthroplasty: a long-term outcome analysis. J Hand Surg Am. 2010. DOI: 10.1016/j.jhsa.2010.05.010
- Adams BD. Complications of wrist arthroplasty. Hand Clin. 2010. DOI: 10.1016/j.hcl.2010.01.006
- Reissner L, Schweizer A, Unterfrauner I, et al. Long-term results of the Sauvé-Kapandji procedure. J Hand Surg Eur Vol. 2021. DOI: 10.1177/17531934211004459
- Zimmermann R, Gschwentner M, Arora R, et al. Treatment of distal radioulnar joint disorders with a modified Sauvé-Kapandji procedure: long-term outcome with special attention to the DASH questionnaire. Arch Orthop Trauma Surg. 2003. DOI: 10.1007/s00402-003-0529-5
- Nypaver C, Bozentka DJ. Distal radius fracture and the distal radioulnar joint. Hand Clin. 2021. DOI: 10.1016/j.hcl.2021.02.011
- Pillukat T, van Schoonhoven J. Die Hemiresektions-Interpositionsarthroplastik des distalen Radioulnargelenks nach Bowers [The hemiresection-interposition arthroplasty of the distal radioulnar joint]. Oper Orthop Traumatol. 2009. DOI: 10.1007/s00064-009-1913-2
DRUJ hemiresection literature (URLs)
- Bowers WH. Distal radioulnar joint arthroplasty: the hemiresection-interposition technique. J Hand Surg Am. 1985;10(2):169-178. https://www.jhandsurg.org/article/S0363-5023(85)80100-3/abstract (PMID: 3980927)
- Hemiresection interposition arthroplasty of the distal radioulnar joint: a long-term outcome study. Hand (N Y). 2019. DOI: 10.1177/1558944719873430. https://pmc.ncbi.nlm.nih.gov/articles/PMC8461192/
- Hemiresection capsuloretinacular interposition arthroplasty for distal radioulnar joint osteoarthritis. J Wrist Surg. 2023. DOI: 10.1055/s-0043-1771341. https://pmc.ncbi.nlm.nih.gov/articles/PMC11606672/
- Mid- to long-term functional results after Bowers' hemiresection interposition arthroplasty of the distal radio-ulnar joint. PubMed. https://pubmed.ncbi.nlm.nih.gov/35238965/
- Pillukat T, van Schoonhoven J. The hemiresection-interposition arthroplasty of the distal radioulnar joint (operative technique). Oper Orthop Traumatol. 2009. https://link.springer.com/article/10.1007/s00064-009-1913-2 (PMID: 20058126)
- Ulnar head hemiresection with interposition and extensor reconstruction — surgical technique. OrthOracle. https://www.orthoracle.com/library/ulnar-head-hemiresection-with-interposition-and-extensor-reconstruction/
