Fifty preserved cadaver wrist specimens were studied. The anatomy of the distal radioulnar joint is complex, with varying configurations in the transverse and midcoronal planes. There is disparity in the radii of curvature of the sigmoid notch and the ulna-articular surface in the transverse plane, with resultant articular incongruity. Motion at the distal radioulnar joint is, hence, likely to be a combination of sliding and rotation with a small area of true appositional contact. The palmar osteocartilaginous lip of the sigmoid notch, along with the interosseous membrane, may be of importance in distal radioulnar stability. Palmar and dorsal radioulnar ligaments may act as "check-rein" ligaments, especially when seen with the "flat face" (type A) sigmoid notch.

Five cases of symptomatic acquired positive ulnar variance are described. All cases occurred due to premature physeal closure of the growth plate in teenage girl gymnasts. All cases demonstrated ulnocarpal impingement, for which we describe a clinical test. Arthroscopic assessment of the wrist allowed us to assess the integrity of the TFCC (triangular fibrocartilaginous complex) and decide on the most appropriate surgery. Two patients needed distal ulna recession and one needed shaving for a TFCC perforation, with a good result.

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We report a long-term follow-up of 6 to 11.8 years (mean = 8 years) of our first 50 Swanson wrist arthroplasties. All patients had long standing sero-positive rheumatoid arthritis with a mean age of 48 years. A detailed clinical and radiologic assessment was carried out on all the wrists. There was excellent sustained pain relief (mean score = 1.7) with improved activities of daily living. A mean range of wrist movement of 25 degrees of extension and 31 degrees of flexion was obtained. The prosthetic fracture rate was 22% of which 14% were symptomatic and needed re-operation. Carpal collapse was seen in all wrists, but was often symmetrical and accompanied by radial new bone formation on X-ray (86%). We feel that our long-term results justify the continued selective use of the Swanson wrist in the low-demand patient with quiescent disease who desires pain-free limited mobility and sophisticated grasp.

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