A declared special interest, not an incidental one
The DRUJ is among the areas Professor Warwick is known for
The distal radioulnar joint is one of Professor Warwick's stated special interests and one of the areas in which he publishes. He is first author of Indications and early to mid-term results of ulnar head replacement in the Annals of the Royal College of Surgeons of England, and first author of published correspondence on the Sauvé-Kapandji and Darrach procedures for DRUJ dysfunction following Colles' fracture.
He is also a co-author of the 2026 systematic review of prosthetic arthroplasty of the distal radioulnar joint in the Journal of Hand Surgery (European Volume), and contributed to the NICE review of total DRUJ replacement.
Ulnar-sided wrist pain is among the harder areas to opine on credibly, because presentation is variable and imaging is often equivocal. An opinion from someone who operates on these problems weekly carries weight a general orthopaedic opinion does not.
What the report can address
Three questions are addressed in every report: whether the treatment chosen fell within the range a reasonable hand surgeon would have offered, whether a complication reflects a recognised risk or a departure from acceptable practice, and what is attributable to the natural history of the condition rather than to the treatment given. Beyond those, the report addresses the issues pleaded, and states a range of opinion where one genuinely exists.
Clinical negligence
Whether ulnar-sided wrist pathology was reasonably identified and investigated, or whether persistent symptoms were attributed to soft tissue injury without adequate assessment.
Whether the procedure selected, whether Darrach, Sauvé-Kapandji, ulnar head replacement or soft tissue reconstruction, fell within the range a reasonable surgeon would adopt.
Causation
Whether DRUJ instability or degeneration is attributable to the index injury, to a malunited distal radius fracture, or to pre-existing change.
Where the literature does not support a confident conclusion either way, the report says so plainly rather than overstating the position.
Condition, prognosis and quantum
Forearm rotation, grip strength, instability and pain on loading, and the effect on work and daily activities.
The likelihood of further surgery, the durability of any prosthesis, and reasonable costings for future treatment.
Peer-reviewed research
A selection of Professor Warwick's published work in this area, all indexed on PubMed.
How to instruct
Instructions are accepted from Claimant and Defendant solicitors, insurers and medico-legal agencies, and as Single Joint Expert. Examinations are held in Southampton, Winchester and Jersey, and the practice accepts instructions nationwide.
Separate rates apply for NHS Resolution panel solicitors. Fixed report fees and deferred payment terms are available. Professor Warwick's medico-legal work is fully indemnified by Sempris, and he is registered with the General Medical Council with entry on the Specialist Register.