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Luria S, Verstreken F, Vochteloo A, Tägil M, Immerman I. Round table discussion. Malunion of the distal radius. J Hand Surg Eur Vol 2025; 50:436-442. [PMID: 39989080 DOI: 10.1177/17531934241307513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2025]
Affiliation(s)
- Shai Luria
- Faculty of Medicine, Hebrew University of Jerusalem and the Orthopedic Surgery Department, Hand and Microsurgery Unit, Hadassah Medical Center, Israel
| | | | - Anne Vochteloo
- Centre for Orthopaedic Surgery OCON, Hengelo, The Netherlands
| | - Magnus Tägil
- Department of Clinical Sciences Lund, Orthopaedics, Skåne University Hospital and Lund University, Lund, Sweden
| | - Igor Immerman
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
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Bezirgan U, Acar E, Yoğun Y, Savran MD, Keskin ÖH, Armangil M. Treatment Effectiveness of Volar Plates in Distal Radius Dorsal Rim Fractures. Rev Bras Ortop 2024; 59:e981-e990. [PMID: 39711624 PMCID: PMC11663069 DOI: 10.1055/s-0044-1790579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 06/23/2024] [Indexed: 12/24/2024] Open
Abstract
Objective To assess the efficacy of distal radius volar plates in cases involving dorsal fragments at the Ulnar Corner (UC) and Lister Tubercle (LT). Methods A retrospective study that included patients with distal radius fractures (DRFs) featuring UC and LT dorsal fragments treated with volar plates. The exclusion criteria comprised lunate facet fractures, UC fragment ratio below 25%, and patients treated with dorsal plates. Radiographic and tomographic measurements included radial length (RL), radial inclination (RI), ulnar variance (UV), palmar tilt (PT), fragment areas, UC fragment ratio, and displacement. The scores on the Gartland Werley (GW) classification and on the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, as well as grip strength, and range of motion (ROM), were assessed. Results The study involved 17 male and 5 female subjects (mean age: 39.7 ± 10.7 years). The UC and LT fragments displayed mean areas of 1.6 ± 0.7cm 2 and UC fragment ratio of 0.4 ± 0.1. The fixation rates for UC and LT fragments were of 18.2% and 31.8% respectively. Improved RI, UV, and PT were noted postoperatively. The mean GW and DASH scores were of 2.1 ± 2.0 and 4.3 ± 3.2 respectively. Grip strength on the operated side was of 89.5 ± 9.8% of the healthy side, and at least 90.9% of the patients achieved adequate ROM. Conclusion While volar plates are the standard treatment for intra-articular DRFs, displaced dorsal fragments can impact the outcomes. Mini dorsal incisions may aid in the fixation of UC fragments that are challenging to secure with volar plates, preserving joint health.
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Affiliation(s)
- Uğur Bezirgan
- Departamento de Ortopedia, Traumatologia e Cirurgia da Mão, Faculdade de Medicina, Ankara University, Altındağ, Ankara, Turquia
| | - Erdinç Acar
- Departamento de Ortopedia, Traumatologia e Cirurgia da Mão, Ankara Bilkent City Hospital, Çankaya, Ankara, Turquia
| | - Yener Yoğun
- Departamento de Ortopedia, Traumatologia e Cirurgia da Mão, Faculdade de Medicina, Ankara University, Altındağ, Ankara, Turquia
| | - Merve Dursun Savran
- Departamento de Ortopedia, Traumatologia e Cirurgia da Mão, Faculdade de Medicina, Ankara University, Altındağ, Ankara, Turquia
| | - Ömer Halit Keskin
- Departamento de Ortopedia, Traumatologia e Cirurgia da Mão, Ankara Bilkent City Hospital, Çankaya, Ankara, Turquia
| | - Mehmet Armangil
- Departamento de Ortopedia, Traumatologia e Cirurgia da Mão, Faculdade de Medicina, Ankara University, Altındağ, Ankara, Turquia
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Wang L, Huang Z, Xie W, Luo D, Liu H, Lian K, Lin D. Comparative Analysis of Radial Corrective Osteotomy and Sauvé-Kapandji Procedure for Malunited Distal Radius Fractures in Older Adults. J Hand Surg Am 2024; 49:1089-1094. [PMID: 39066761 DOI: 10.1016/j.jhsa.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 05/16/2024] [Accepted: 06/05/2024] [Indexed: 07/30/2024]
Abstract
PURPOSE Malunited distal radius fractures frequently occur in the older population, posing a dilemma in selecting ideal management for symptomatic patients. Radial corrective osteotomy (RCO) and the Sauvé-Kapandji procedure (SK) have been used to treat this challenging condition. However, it remains unknown which approach is better for the older population. The objective of this study was to compare the outcomes of RCO with those of SK for the treatment of symptomatic distal radius malunion in older adults. METHODS Thirty-three patients aged ≥60 years, with malunited distal radius fractures, were randomized to be treated with either RCO or SK and followed for a minimum of 2 years. The primary evaluation parameter was grip strength, and secondary outcome parameters were surgical time, range of motion of the wrist, exercise-related wrist pain assessment using visual analog scale scores, radiographic results, patient-reported outcomes evaluated using the Disability of the Arm, Shoulder, and Hand (DASH), and Patient-Related Wrist Evaluation (PRWE) scores. RESULTS The average follow-up duration was 36.7 ± 10.2 months. The grip strength was significantly higher in the RCO group. The surgical time was shorter in the SK group than in the RCO group. The postoperative wrist range of motion and visual analog scale scores for exercise-related pain alleviation were similar in both groups. The ulnar variance decreased in both groups and was similar when compared with the postoperative images. The DASH and PRWE scores were similar between the RCO and SK groups. CONCLUSIONS Radial corrective osteotomy and SK surgeries have similar clinical and functional outcomes in patients aged ≥60 years. Grip strength is higher in the RCO group than in the SK group. However, the operating time to accomplish SK is shorter than RCO. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic II.
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Affiliation(s)
- Lei Wang
- Department of Orthopedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou, China; Institute of Orthopedics, Xijing Hospital, The Air Force Medical University, Xi'an, China
| | - Ziyang Huang
- Department of Orthopedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou, China
| | - Wei Xie
- Department of Orthopedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou, China
| | - Deqing Luo
- Department of Orthopedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou, China
| | - Hui Liu
- Department of Orthopedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou, China
| | - Kejian Lian
- Department of Orthopedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou, China
| | - Dasheng Lin
- Department of Orthopedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou, China; Department of Orthopedic Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
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Liu TY, Yang CY. Management of Extra-Articular and Intra-Articular Distal Radius Malunion. Life (Basel) 2024; 14:1177. [PMID: 39337960 PMCID: PMC11433060 DOI: 10.3390/life14091177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2024] [Revised: 09/09/2024] [Accepted: 09/16/2024] [Indexed: 09/30/2024] Open
Abstract
This article presents a comprehensive overview of managing extra-articular and intra-articular distal radius malunions (DRM), discussing the pathoanatomy, clinical, and radiologic evaluation, conservative treatment, and surgical strategies. Corrective osteotomy remains the primary surgical intervention for symptomatic DRM. Surgical planning should consider factors such as timing, approach, correction technique, implant, graft, and associated injuries. The correction of extra-articular malunion necessitates brachioradialis tenotomy, circumferential periosteum release, and intrafocal elevation with grafting to facilitate distal radius realignment following osteotomy. Computer-assisted planning with 3D-printed patient-specific instrumentation (PSI) could help execute extra-articular osteotomy with high precision. As for the management of intra-articular malunion, it may require wrist arthrotomy, arthroscopy, or PSI assistance for precise articular osteotomy and reduction of the joint surface. This review highlights the importance of early intervention, thorough preoperative planning, and appropriate surgical techniques to optimize outcomes and minimize complications. Future research should focus on large-scale randomized controlled trials to compare different surgical methods, particularly for intra-articular DRM.
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Affiliation(s)
- Ting-Yu Liu
- Department of Orthopedic Surgery, Kuang Tien General Hospital, Taichung 433401, Taiwan
- Department of Nursing, Hungkuang University, Taichung 433304, Taiwan
| | - Chen-Yuan Yang
- Department of Orthopedic Surgery, Kuang Tien General Hospital, Taichung 433401, Taiwan
- Department of Nursing, Hungkuang University, Taichung 433304, Taiwan
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Labbe F, Daoulas T, Letissier H, Liverneaux P, Ducournau F. Distal radius fracture osteosynthesis by volar locking plate: influence of epiphyseal screw positioning on risk of loss of reduction. HAND SURGERY & REHABILITATION 2024; 43:101743. [PMID: 38914233 DOI: 10.1016/j.hansur.2024.101743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 05/28/2024] [Accepted: 05/29/2024] [Indexed: 06/26/2024]
Abstract
Ulnar variance is an important radiological parameter for good functional outcome after distal radius fracture osteosynthesis. Secondary loss of reduction due to radial shortening is a common complication after volar locking plate fixation. Some authors recommend beginning by placing the most ulnar epiphyseal screw, ensuring that it is positioned as close as possible to the distal radioulnar and radiocarpal joints. The hypothesis of our study was that the positioning of the ulnar epiphyseal screw relative to the distal radioulnar and radiocarpal joints influences the maintenance of reduction during follow-up. 190 distal radius fractures were treated with volar locking plate fixation and divided into two cohorts: cohort A with <2 mm and cohort B with ≥2 mm loss of ulnar variance. Minimum follow-up was 45 days. The positioning of the most ulnar epiphyseal screw was evaluated using a single variable, the ulno-distal index. Means were compared using t-tests and proportions using chi-squared tests. The alpha risk was set at 5%. The intra- and inter-observer reliability of the ulno-distal index measurement were assessed. Mean ulno-distal index was significantly lower in cohort A at 11.28 mm, compared to 13.33 mm in cohort B; p < 0.0001. Ulno-distal index <12 mm was a significant protective factor: p < 0.0001 and relative risk 0.558. No other intrinsic or extrinsic factors of secondary loss of reduction significantly influenced the risk of ulnar variance alteration. The study confirmed the hypothesis that, in distal radius fracture treated with volar locking plate fixation, the closer the ulnar epiphyseal screw to the distal radioulnar joint and radiocarpal joint, the lower the risk of ulnar variance alteration.
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Affiliation(s)
- François Labbe
- Département de Chirurgie Orthopédique, CHU Cavale Blanche, Brest, France.
| | - Thomas Daoulas
- Département de Chirurgie Orthopédique, CHU Cavale Blanche, Brest, France.
| | - Hoel Letissier
- Département de Chirurgie Orthopédique, CHU Cavale Blanche, Brest, France.
| | - Philippe Liverneaux
- Département de chirurgie de la main, CHU de Strasbourg, FMTS, 1 avenue Molière, 67200 Strasbourg, France. Service de Santé Publique, Université de Strasbourg, GMRC, 67091 Strasbourg, France. ICube CNRS UMR7357, Université de Strasbourg, 2-4 rue Boussingault, 67000 Strasbourg, France.
| | - François Ducournau
- Département de Chirurgie de la Main et du Membre Supérieur, Clinique du Sport, Bordeaux13 Mérignac, France.
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Shiode R, Miyamura S, Kazui A, Yamamoto N, Miyake T, Iwahashi T, Tanaka H, Otake Y, Sato Y, Murase T, Abe S, Okada S, Oka K. Reproduction of forearm rotation dynamic using intensity-based biplane 2D-3D registration matching method. Sci Rep 2024; 14:5518. [PMID: 38448504 PMCID: PMC10918057 DOI: 10.1038/s41598-024-55956-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 02/29/2024] [Indexed: 03/08/2024] Open
Abstract
This study aimed to reproduce and analyse the in vivo dynamic rotational motion of the forearm and to clarify forearm motion involvement and the anatomical function of the interosseous membrane (IOM). The dynamic forearm rotational motion of the radius and ulna was analysed in vivo using a novel image-matching method based on fluoroscopic and computed tomography images for intensity-based biplane two-dimensional-three-dimensional registration. Twenty upper limbs from 10 healthy volunteers were included in this study. The mean range of forearm rotation was 150 ± 26° for dominant hands and 151 ± 18° for non-dominant hands, with no significant difference observed between the two. The radius was most proximal to the maximum pronation relative to the ulna, moved distally toward 60% of the rotation range from maximum pronation, and again proximally toward supination. The mean axial translation of the radius relative to the ulna during forearm rotation was 1.8 ± 0.8 and 1.8 ± 0.9 mm for dominant and non-dominant hands, respectively. The lengths of the IOM components, excluding the central band (CB), changed rotation. The transverse CB length was maximal at approximately 50% of the rotation range from maximum pronation. Summarily, this study describes a detailed method for evaluating in vivo dynamic forearm motion and provides valuable insights into forearm kinematics and IOM function.
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Affiliation(s)
- Ryoya Shiode
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Satoshi Miyamura
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Arisa Kazui
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Natsuki Yamamoto
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Tasuku Miyake
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Toru Iwahashi
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hiroyuki Tanaka
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yoshito Otake
- Division of Information Science, Nara Institute of Science and Technology, 8916-5 Takayama, Ikoma, Nara, 630-0192, Japan
| | - Yoshinobu Sato
- Division of Information Science, Nara Institute of Science and Technology, 8916-5 Takayama, Ikoma, Nara, 630-0192, Japan
| | - Tsuyoshi Murase
- Department of Orthopaedic Surgery, Bell Land General Hospital, 500-3 Higashiyama, Naka-ku, Sakai, Osaka, 599-8247, Japan
| | - Shingo Abe
- Department of Orthopaedic Surgery, Toyonaka City Hospital, 4-14-1 Shibahara, Toyonaka, Osaka, 560-8565, Japan
| | - Seiji Okada
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Kunihiro Oka
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
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Straatman L, Norman E, Knowles N, Walton D, Suh N, Lalone E. Use it or lose it: The relationship between two image-based biomarkers in better understanding osteoarthritis progression in the wrist. J Biomech 2023; 161:111849. [PMID: 37931557 DOI: 10.1016/j.jbiomech.2023.111849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 09/01/2023] [Accepted: 10/22/2023] [Indexed: 11/08/2023]
Abstract
Bone tissue is influenced by its mechanical environment and adapts in response to its mechanical load. This is supported by studies analyzing bone adaptation in the knee and hip. Changes to the bone have also been found to precede cartilage degeneration in diseases such as osteoarthritis (OA). Our objective was to demonstrate the relationship between joint contact and bone density in the wrists of healthy adults. Static CT scans with a calibration phantom were taken to obtain measures of bone mineral density (vBMD) in 3 normalized depths; 0 - 2.5, 2.5 - 5, and 5 - 7.5 mm. Participants underwent a four-dimensional CT scan (4DCT) while performing maximum wrist extension to maximum wrist flexion. 3D bone models of the distal radius, scaphoid, and lunate were made, and analyzed vBMD and joint contact area (JCA) in the radiolunate (RL) and radioscaphoid (RS) joints separately. Correlation coefficients were calculated where vBMD was the dependent variable, and kinematic JCA throughout every 10 degrees of motion were the independent variables. Statistically significant independent variables associated with vBMD were assessed using a regression model and were entered in steps; (1) significant correlations, (2) sex, and (3) age.An increase in vBMD was significantly, positively associated with an increase in JCa. Notably, in the deeper regions (5 - 7.5 mm) of the radius that is primarily composed of trabecular bone. Sex contributed to the variance in vBMD, while age did not. Subchondral bone changes are influenced by wrist position, demonstrating that the wrist serves to bear load similar to the knee and hip.
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Affiliation(s)
- Lauren Straatman
- Department of Health and Rehabilitation Science, Western University, Canada; Department of Mechanical and Materials Engineering, Western University, Canada; Bone and Joint Institute, Western University, Canada.
| | - Elizabeth Norman
- Department of Mechanical and Materials Engineering, Western University, Canada; Bone and Joint Institute, Western University, Canada
| | - Nikolas Knowles
- Kinesiology and Health Science, University of Waterloo, Canada
| | - David Walton
- Department of Physical Therapy, Western University, Canada
| | - Nina Suh
- Department of Orthopedics, Emory University, United States
| | - Emily Lalone
- Department of Mechanical and Materials Engineering, Western University, Canada; Bone and Joint Institute, Western University, Canada
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Haines SC, Bott A. Current Concepts: Corrective Osteotomy for Extra-Articular Deformity Following a Distal Radius Fracture. Cureus 2023; 15:e47019. [PMID: 37965406 PMCID: PMC10642188 DOI: 10.7759/cureus.47019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2023] [Indexed: 11/16/2023] Open
Abstract
Fracture malunion alters wrist and distal radioulnar joint (DRUJ) biomechanics, resulting in incongruence and instability of the DRUJ. Selected patients with painful functional limitation and significant deformity of the radius, but without advanced degenerative joint disease, may benefit from corrective distal radial osteotomy. Non-union and complications arising from metalwork are the most common reasons for reoperation. Surgeons should have a good understanding of risks and complications in order to fully inform their patients and manage expectations. This article reviews the biomechanical effects of radial malunion and the current concepts for treatment. Distal radial osteotomy is suitable for symptomatic patients with angular radial deformity and shortening. Evidence supports a volar approach without bone grafts for modest corrections. Bone grafts or synthetic bone substitutes are appropriate for larger corrections. Functional improvements are reported regardless of technique. Despite a high complication rate, patient satisfaction with the corrective radial osteotomy is high.
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Affiliation(s)
- Samuel C Haines
- Trauma and Orthopaedics, Bristol Royal Infirmary, Bristol, GBR
| | - Alasdair Bott
- Trauma and Orthopaedics, Southmead Hospital, Bristol, GBR
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Bezirgan U, Acar E, Yoğun Y, Savran MD, Keskin ÖH, Armangil M. Nascent Malunion of Distal Radius Fractures Treated with Fixed Angled Volar Plates without Using Bone Grafts. Indian J Orthop 2023; 57:533-542. [PMID: 37006733 PMCID: PMC10050669 DOI: 10.1007/s43465-023-00864-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 03/08/2023] [Indexed: 03/30/2023]
Abstract
Purpose Malunion of the distal radius is a common complication. Using bone grafts is common to restore the bone to an acceptable level. This study aimed to verify if it is necessary to use bone grafts in nascent malunion of distal radius fractures treated with fixed angled volar plates and which radiographic parameters are essential to obtain satisfactory outcomes. Methods This single-centered prospective study included 11 patients who underwent corrective osteotomy of the radius for malunion. Patients with a metaphyseal, extraarticular osteotomy stabilized by a volar fixed angle plate within 3 months after the fracture are included. Patients underwent a standard radiological evaluation at postoperative 1 month, 3 months, 6 months, 1 year, and annually thereafter. Radial inclination, radial height, ulnar variance, and palmar tilt were measured. Wrist ranges of motion are measured throughout follow-up with a goniometer. Grip strength is measured using a Jamar Hand Dynamometer. The function is evaluated via the Gartland-Werley (GW) score and the Disabilities of the Arm, Shoulder, and Hand (DASH) score. Results The mean age of 11 patients, 9 (81.82%) males, included in the study was 41.45 ± 14.89 years. The mean post-fracture admission time is 39.3 ± 15.1 days. Radial inclination, radial length, and ulnar variance improved significantly after surgery (p = 0.0023, 0.0002, 0.0037). Radial inclination values are within normal limits for all patients at admission. The radial length was in the normal range for 72.73%, the ulnar variance was in the normal range for 72.73%, and palmar tilt was in the normal range for 100% of the patients. Extension 54.55%, flexion 72.73%, radial deviation 81.82%, ulnar deviation 63.64%, pronation 90.91%, and supination 72.73% were achieved after surgery. GW average was 3.09 ± 3.24 DASH score average was 12.24 ± 13.48. The mean grip strength was 29.27 ± 7.21 on the operated side, while it was 34.91 ± 5.32, on the healthy side, with a significant difference (p = 0.0108). Conclusion It is possible to get good results without using bone grafts in corrective osteotomy of distal radius malunions.
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Affiliation(s)
- Uğur Bezirgan
- Faculty of Medicine, Orthopedics and Traumatology Department, Ibn’i Sina Hospital, Ankara University, Hand Surgery Unit, Sıhhiye/ANKARA TR, Ankara, Turkey
| | - Erdinç Acar
- Orthopedics and Traumatology Department, Ankara City Hospital, Hand Surgery Unit, Ankara, Turkey
| | - Yener Yoğun
- Faculty of Medicine, Orthopedics and Traumatology Department, Ibn’i Sina Hospital, Ankara University, Hand Surgery Unit, Sıhhiye/ANKARA TR, Ankara, Turkey
| | - Merve Dursun Savran
- Faculty of Medicine, Orthopedics and Traumatology Department, Ankara University, Ankara, Turkey
| | - Ömer Halit Keskin
- Orthopedics and Traumatology Department, Ankara City Hospital, Ankara, Turkey
| | - Mehmet Armangil
- Faculty of Medicine, Orthopedics and Traumatology Department, Ankara University, Hand Surgery Unit, Ankara, Turkey
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Furrer PR, Kabelitz M, Schweizer A. Quantification of Malalignment and Corrective Osteotomies in Patients With Malunion After Elastic Stable Intramedullary Nailing of Pediatric Forearm Fractures. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023. [DOI: 10.1016/j.jhsg.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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Schmitt S, Eisa A, Radosavljevic J, van Schoonhoven J. Dynamic palmar dislocation of the ulnar head at the distal radioulnar joint (DRUJ) after radius shaft malunion. Arch Orthop Trauma Surg 2022; 143:2781-2787. [PMID: 36346445 DOI: 10.1007/s00402-022-04684-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/26/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Palmar instability of the distal radioulnar joint (DRUJ) is a rare condition, which is, in contrast to the dorsal dislocation, scarcely represented in the literature. This palmar instability can result from a dorsally angulated malunion of the radial shaft after forearm fracture in childhood. Treating such a condition is controversial in the literature and was described in small case series. This study represents the largest case series in the literature that dealt with this condition, alongside a review of the key papers in the English literature. MATERIALS AND METHODS This is a retrospective case series. Ten patients were operated between 2007 and 2014. Six patients could be followed up clinically and radiologically after radius corrective osteotomy at the site of malunion with a mean time of 5.6 years. Patient history revealed a conservatively treated forearm fracture in childhood, a symptom-free period of several years [mean of 21.5 (min-max: 9.4-26.5) years] and a minor trauma as a trigger for clinical symptoms. All patients had clinically a DRUJ instability with palmar luxation of the ulnar head at supination. A diagnostic key feature is a radiograph of the whole forearm, revealing malunion of the radius at shaft level. Retrospective patient history, diagnostic imaging, operative technique and clinical results (DASH, modified Mayo Wrist Score, pain, grip strength, range of motion) were analyzed. RESULTS Four patients were lost to follow-up. In all patients, a radius corrective osteotomy could stabilize the DRUJ. In one patient, the osteosynthesis was revised due to metal failure after one month. In all the six patients, bony union of the osteotomy was achieved. In another patient, an additional ulnar shortening osteotomy was done one year later due to a positive ulnar variance. Postoperative range of motion of the wrist had an average of 136° in extension/flexion and 149° in pronation/supination, and grip strength was 89% of the opposite side. With an average of 12.5 points at the DASH score and 82 at the modified Mayo Wrist Score, patients rated their hand function as good. CONCLUSIONS In this patient cohort, a simple corrective osteotomy of the radial shaft at the malunion site was adequate to treat the dynamic palmar instability of DRUG. A soft tissue procedure was not required. Forearm radiographs are the mainstay of diagnostic tools.
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Affiliation(s)
- Stefanie Schmitt
- Clinic for Hand Surgery, Rhoen Klinikum Campus Bad Neustadt, Von-Guttenberg-Straße 11, 97616, Bad Neustadt an der Saale, Germany. .,, Robert-Koch-Str. 18, 77815, Buehl, Germany.
| | - Amr Eisa
- Clinic for Hand Surgery, Rhoen Klinikum Campus Bad Neustadt, Von-Guttenberg-Straße 11, 97616, Bad Neustadt an der Saale, Germany
| | - Jelena Radosavljevic
- Clinic for Hand Surgery, Rhoen Klinikum Campus Bad Neustadt, Von-Guttenberg-Straße 11, 97616, Bad Neustadt an der Saale, Germany
| | - Joerg van Schoonhoven
- Clinic for Hand Surgery, Rhoen Klinikum Campus Bad Neustadt, Von-Guttenberg-Straße 11, 97616, Bad Neustadt an der Saale, Germany
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Straatman L, Knowles N, Suh N, Walton D, Lalone E. The Utility of Quantitative CT (QCT) to Detect Differences in Subchondral Bone Mineral Density Between Healthy People and People with Pain Following Wrist Trauma. J Biomech Eng 2022; 144:1131490. [PMID: 35044448 DOI: 10.1115/1.4053594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Indexed: 11/08/2022]
Abstract
The mechanisms underlying chronic pain development following musculoskeletal trauma are complex and multifactorial. In their search, some researchers are turning to the subchondral bone as a potential contributor to pain due to its vascularity, using a depth-specific imaging technique. However, this technique has been mainly used in the knee. We propose the use of a quantitative computed tomography (QCT) depth-specific analysis to measure subchondral bone following wrist trauma. Ten participants (n=5 post-trauma; n=5 healthy) underwent bilateral CT scans of their wrist accompanied by a calibration phantom with known densities. Average subchondral vBMD was studied at three depths from the subchondral surface (0 to 2.5, 2.5 to 5, 5 to 7.5mm) according to radial articular surface contact in both wrists of each participant. Percentage differences and Cohen's d effect sizes were calculated to analyze bilateral vBMD and vBMD differences between groups. This image-based tool demonstrated subject-specific, depth-specific, and joint-specific measures of vBMD within the wrist. This methodology highlighted the differences between depth-specific vBMD in healthy people and people who have experienced wrist trauma. Overall, the healthy cohort demonstrated higher vBMD across all three depths and both articular surfaces. This imaging technique further distinguished between subchondral cortical and trabecular bone, wherein clinical implications can be drawn from these distinctions in future work. Our study therefore supports the utility of a QCT imaging technique in detecting differences in depth-specific vBMD in the wrist.
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Affiliation(s)
- Lauren Straatman
- Department of Health and Rehabilitation Sciences, Western University; Department of Mechanical and Materials Engineering, Western University; Roth McFarlane Hand and Upper Limb Centre, Western University, Rm. EC1458, 1201 Western Rd.London, Ontario N6G 1H1
| | | | - Nina Suh
- Roth McFarlane Hand and Upper Limb Centre; Schulich School of Medicine and Dentistry, Western University
| | - David Walton
- Department of Health and Rehabilitation Sciences, Western University; School of Physical Therapy, Western University
| | - Emily Lalone
- Department of Mechanical and Materials Engineering, Western University; Roth McFarlane Hand and Upper Limb Centre
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13
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Peymani A, de Roo MGA, Dobbe JGG, Streekstra GJ, McCarroll HR, Strackee SD. Carpal Kinematics in Madelung Deformity. J Hand Surg Am 2021; 46:622.e1-622.e12. [PMID: 33849749 DOI: 10.1016/j.jhsa.2020.11.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 10/03/2020] [Accepted: 11/20/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE Various skeletal and soft tissue abnormalities have been identified in Madelung deformity and have been hypothesized to play a causal role in its progressive symptomatology; however, our pathological understanding of these changes remains limited. In this study, we biomechanically assessed the Madelung deformity wrist, using 4-dimensional computed tomography imaging. METHODS Nine Madelung deformity wrists (5 patients; age, 24 ± 5 y) and 18 healthy wrists (9 volunteers; age, 28 ± 3 y) underwent 4-dimensional imaging during flexion-extension motion and radioulnar deviation. Carpal kinematics and radiocarpal joint parameters were quantified and compared. RESULTS In Madelung deformity wrists, significantly decreased rotation was seen in the lunate (-4.6°) and the triquetrum (-4.8°) during flexion-extension motion. During radioulnar deviation, significant decreases were visible in lunate bone translation (-0.7 mm), triquetrum bone translation (-0.6 mm), and triquetrum bone rotation (-1.9°). Patients had significantly decreased articulating surface areas of the scaphoid (1.4 ± 0.2 cm2 versus 1.6 ± 0.2 cm2) and lunate (1.2 ± 0.4 cm2 versus 1.5 ± 0.3 cm2) fossa, and significantly increased radioscaphoid (1.3 ± 0.1 mm versus 1.2 ± 0.1 mm) and radiolunate (1.6 ± 0.2 mm versus 1.3 ± 0.3 mm) joint space thicknesses. CONCLUSIONS There is a decreased mobility of the lunate and triquetrum bones in Madelung deformity. CLINICAL RELEVANCE Four-dimensional imaging could be used in future studies that investigate the effect of surgical ligament release on carpal kinematics and subsequent wrist mobility.
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Affiliation(s)
- Abbas Peymani
- Department of Plastic, Reconstructive and Hand Surgery; Department of Biomedical Engineering and Physics.
| | - Marieke G A de Roo
- Department of Plastic, Reconstructive and Hand Surgery; Department of Biomedical Engineering and Physics
| | | | - Geert J Streekstra
- Department of Biomedical Engineering and Physics; Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Henry R McCarroll
- Department of Orthopaedic Surgery, California Pacific Medical Center, San Francisco, CA
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14
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Abstract
In this article, we discuss the incidence and types of injuries to the distal radioulnar joint (DRUJ) that occur in the setting of a distal radius fracture. We review the anatomy of the distal radioulnar joint, which is critical to understanding its biomechanics, and how injury could cause symptomatic incongruency and instability. We highlight how patients with an injury to the distal radioulnar joint might present both at the time of injury and after treatment of a distal radius fracture, the appropriate workup, the available treatment options, and the evidence-based literature.
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Affiliation(s)
- Christina Nypaver
- Department of Orthopaedic Surgery, University of Pennsylvania, 3737 Market Street, Philadelphia, PA 19104, USA.
| | - David J Bozentka
- Department of Orthopaedic Surgery, University of Pennsylvania, Penn Presbyterian Medical Center, 3737 Market Street, Philadelphia, PA 19104, USA
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15
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Ranota P, Zhang Y, Lalone EA, Suh N. Four-Dimensional Computed Tomography to measure distal radial-ulnar and radio-carpal joint congruency following distal radius fractures. J Orthop 2021; 25:31-39. [PMID: 33867752 DOI: 10.1016/j.jor.2021.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/21/2021] [Indexed: 10/21/2022] Open
Abstract
Four-dimensional computed tomography (4DCT) allows for the assessment of the wrist contact mechanics and kinematics during motion. The purpose of this study was to employ 4DCT to measure the differences in joint surface area (JSA) (3D joint space) at the radioscaphoid, radiolunate, and distal radioulnar joints between a cohort of participants with a distal radius fracture (DRF) and an age-matched cohort of healthy participants. Our results indicated that following a DRF, there was a 20% decrease in JSA at the DRUJ when compared to the healthy (control) cohort. This study demonstrated the use of a non-invasive tool to examine wrist contact mechanics.
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Affiliation(s)
- Puneet Ranota
- School of Biomedical Engineering, Faculty of Engineering, The University of Western Ontario, London, Canada
| | - Yiyang Zhang
- Department of Surgery, The University of Western Ontario, London, Canada.,Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada
| | - Emily A Lalone
- School of Biomedical Engineering, Faculty of Engineering, The University of Western Ontario, London, Canada.,Department of Surgery, The University of Western Ontario, London, Canada.,Department of Mechanical and Materials Engineering, The University of Western Ontario, London, Canada.,Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada
| | - Nina Suh
- Department of Surgery, The University of Western Ontario, London, Canada.,Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada
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16
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Dobbe JGG, Peymani A, Roos HAL, Beerens M, Streekstra GJ, Strackee SD. Patient-specific plate for navigation and fixation of the distal radius: a case series. Int J Comput Assist Radiol Surg 2021; 16:515-524. [PMID: 33575933 PMCID: PMC7946677 DOI: 10.1007/s11548-021-02320-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 01/26/2021] [Indexed: 11/28/2022]
Abstract
Purpose Corrective osteotomy of a malunited distal radius conventionally relies on 2D imaging techniques for alignment planning and evaluation. However, this approach results in suboptimal bone repositioning, which is associated with poor patient outcomes. In this case series, we evaluate the use of novel patient-specific plates (PSPs), which feature navigation and fixation of bone segments as preoperatively planned in 3D. Methods Ten participants with distal radius malunion underwent CT scans for preoperative alignment planning. Patient-specific guides and plates were designed, 3D-printed, and sterilized for use in corrective surgery of the distal radius. Pre- and postoperative results were compared in regard to clinical, functional, and radiographic outcomes. Results The application of a PSP was successful in 7 of the 10 cases. After treatment, the residual alignment error was reduced by approximately 50% compared with conventional treatment. The use of PSPs reduced pain significantly. Pre- and postoperative results were pooled and demonstrated significant correlations between: (1) pain and malpositioning, (2) the range of pro- and supination motion, the MHOQ score, the EQ-5D-5L score and dorsovolar angulation, and (3) MHOQ score and proximodistal translation. Conclusion The correlation between malalignment and MHOQ score, EQ-5D-5L score, pain, and range of motion shows that alignment should be restored as well as possible. Compared to the conventional approach, which relies on 2D imaging techniques, corrective osteotomy based on 3D preoperative planning and intraoperative fixation with a PSP has been shown to improve bone alignment and reduce pain. Level of evidence IV.
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Affiliation(s)
- Johannes G G Dobbe
- Department of Biomedical Engineering and Physics, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Room No L0-113-3, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Abbas Peymani
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Hendrika A L Roos
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Maikel Beerens
- Xilloc Medical, Urmonderbaan 22, Sittard-Geleen, The Netherlands
| | - Geert J Streekstra
- Department of Biomedical Engineering and Physics, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Room No L0-113-3, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Simon D Strackee
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
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17
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Lalone EA, MacDermid J, King G, Grewal R. The Effect of Distal Radius Fractures on 3-Dimensional Joint Congruency. J Hand Surg Am 2021; 46:66.e1-66.e10. [PMID: 32763051 DOI: 10.1016/j.jhsa.2020.05.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 04/13/2020] [Accepted: 05/26/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE Whereas the goal of distal radius fracture treatment is anatomical restoration, controversy exists as to whether it is the severity of the disruption of joint alignment at the time of fracture or residual malalignment after healing that determines outcome. The objective of this study was to compare joint contact mechanics bilaterally a minimum of 3 years following a distal radius fracture. Our hypothesis was that 3-dimensional joint space would be reduced in individuals following wrist fracture and that these changes in joint load lead to the development of degenerative arthritis. To test the hypothesis, an interbone spacing algorithm was used to determine whether 3-dimensional joint space and contact mechanics were altered in the distal radioulnar (DRUJ) and radiocarpal joints following a wrist fracture. METHODS In 16 subjects with previous unilateral wrist fractures, 3-dimensional interbone distance (joint space), a measure of joint congruency and 3-dimensional alignment, was quantified from reconstructed computed tomography bone models of the distal radius, ulna, scaphoid, and lunate. RESULTS At an average of 8 years following fracture, joint interbone spacing area was reduced in the radiolunate joint of the injured wrist in comparison with the uninjured wrist. The joint interbone spacing area was decreased in the DRUJ and radioscaphoid joint of the injured wrist compared with the uninjured wrist but this difference was not statistically significant. CONCLUSIONS This study demonstrates the use of a noninvasive tool that can be used to examine joint loading and suggests that further investigation into the association between altered joint loading and the development of posttraumatic arthritis is needed, especially in the radiocarpal joints. CLINICAL RELEVANCE This paper provides a noninvasive image-based framework that can be used to examine joint contact area over time and provides preliminary data examining the effect of a distal radius fracture on the joint congruency of the DRUJ and radiocarpal joints.
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Affiliation(s)
- Emily A Lalone
- School of Biomedical Engineering, The University of Western Ontario, London, Canada; Department of Surgery, The University of Western Ontario, London, Canada; Department of Mechanical and Materials Engineering, The University of Western Ontario, London, Canada; Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada.
| | - Joy MacDermid
- Department of Surgery, The University of Western Ontario, London, Canada; Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada; School of Physical Therapy, The University of Western Ontario, London, Canada
| | - Graham King
- Department of Surgery, The University of Western Ontario, London, Canada; Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada
| | - Ruby Grewal
- Department of Surgery, The University of Western Ontario, London, Canada; Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada
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18
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Affiliation(s)
- David M Brogan
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Richard A Berger
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Sanjeev Kakar
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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19
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Katt B, Seigerman D, Lutsky K, Beredjiklian P. Distal Radius Malunion. J Hand Surg Am 2020; 45:433-442. [PMID: 32220492 DOI: 10.1016/j.jhsa.2020.02.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 02/18/2020] [Accepted: 02/18/2020] [Indexed: 02/02/2023]
Abstract
Malunion remains the most common complication of nonsurgical treatment of fractures of the distal radius and represents a common clinical entity. Symptomatic treatment often involves corrective osteotomy. Surgical correction is a challenging problem with unpredictable clinical outcomes. Prevention of malunion of a distal radius fracture is the best course of action. With maintenance of volar cortical contact and the use of volar fixed-angle devices, bone grafting may not be necessary in certain cases of malunion correction. New technologies such as 3-dimensional modeling and computer-generated osteotomy guides are likely to have a positive impact on the outcomes of surgical treatment.
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Affiliation(s)
- Brian Katt
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, PA.
| | - Daniel Seigerman
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, PA
| | - Kevin Lutsky
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, PA
| | - Pedro Beredjiklian
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, PA
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20
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Lameijer CM, Ten Duis HJ, Haag CMSC, El Moumni M, van der Sluis CK. The evolution of radiological measurements and the association with clinician and patient reported outcome following distal radius fractures in non-osteoporotic patients: what is clinically relevant? Disabil Rehabil 2020; 43:3777-3788. [PMID: 32356451 DOI: 10.1080/09638288.2020.1753247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Introduction: Following distal radius fractures in young non-osteoporotic patients, clinical relevancy of outcome has been scarcely reported. Outcome can be put in perspective by using measurement errors of radiological measurements and Minimal Important Change when reporting on clinician and patient reported outcome. Aim of this study was to assess the clinical relevance of radiological measurements, clinician and patient reported outcomes following distal radius fractures in young non-osteoporotic patients.Methods: Retrospective cohort study. Non-osteoporotic patients following a distal radius fracture were selected. Radiographs of both wrists were obtained at baseline, 6 weeks and at follow-up. Active range of motion and grip strength measurements were obtained at the follow-up visit and 4 questionnaires were answered to assess pain, upper extremity functioning, and health status.Results: Seventy-three patients (32 women, 41 men) with a mean age of 33.5 (SD 9.2) years at the time of injury were included. Median follow up was 62 months (IQR 53.0-84.5). Several radiological measurements evolved statistically significantly over time, however none exceeded measurement errors. Flexion/extension difference of injured compared to uninjured wrist (mean difference 11.2°, t = -7.5, df = 72, p < 0.001), exceeded Minimal Important Change, while grip strength differences did not. When comparing patients with DRFs to healthy controls, only the differences on Patient Reported Wrist Evaluation subscales "pain", "function" and total scores exceeded minimal important change (8, 10 and 13 points, respectively). Multivariable regression analysis revealed statistically significant relationships between residual step-off and respectively diminished flexion/extension (B = -36.8, 95% CI -62; -11.1, p = 0.006), diminished radial/ulnar deviation (B = -17.9, 95% CI -32.0; -3.9, p = 0.013) and worse ShortForm-36 "mental component score" (B = -15.4, 95% CI -26.6; -4.2, p < 0.001).Conclusion: Radiological measurements following distal radius fractures seem to evolve over time, but differences were small and were probably not clinically relevant. Range of motion, in particular flexion/extension, was impaired to such extend that it was noticeable for a patient, whereas grip strength was not impaired. The Patient Reported Wrist Evaluation was clinically relevantly diminished. Residual articular incongruency seems to influence range of motion.Implications for rehabilitationReporting Minimal Important Change regarding clinician and patient reported outcome following distal radius fractures is of more clinical value than reporting on statistical significance.Following distal radius fractures, the changes in radiological measurements do not seem to reflect a clinical relevant change.Range of motion, in particular flexion/extension, should be measured following distal radius fractures, as this might be impaired in a clinically relevant way.Measuring grip strength is of less importance following distal radius fractures, because grip strength does not seem to be affected.Residual articular incongruency seems to influence range of motion and therefore should be reduced to a minimum when treating non-osteoporotic patients.
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Affiliation(s)
- Charlotte M Lameijer
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Henk Jan Ten Duis
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Charlotte M S C Haag
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Mostafa El Moumni
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Corry K van der Sluis
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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21
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Gray RJ, Thom M, Riddle M, Suh N, Burkhart T, Lalone E. Image-Based Comparison Between the Bilateral Symmetry of the Distal Radii Through Established Measures. J Hand Surg Am 2019; 44:966-972. [PMID: 31311681 DOI: 10.1016/j.jhsa.2019.05.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 02/20/2019] [Accepted: 05/31/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Anthropometric assessment of bony structures in the body is important for preoperative computer-aided surgery, implant design, finite element modeling, and biomechanical studies investigating joint structure and function. The use of the contralateral limb in surgery and clinical practice relies on the assumption that the right and left limbs of an individual are symmetric. Therefore, the purpose of this study was to quantify the bilateral symmetry of the bony structures of the distal radius using 3-dimensional (3D) computed tomography. METHODS We collected computed tomography images of 37 paired, fresh-frozen, healthy cadaveric male upper limbs (aged 75.4 ± 8.3 years). Three-dimensional reconstructed models were created using semiautomatic segmentation. Using the 3D models, we measured 3D radial inclination, 3D volar tilt, 3D radial height, medial volar cortical angle, middle volar cortical angle, and lateral volar cortical angle and compared them between sides. RESULTS There were no statistically significant differences measured between right and left distal radius in 37 paired wrists. Mean radial height was 12.81 mm (SD, 1.74 mm) on the left and 12.88 mm (SD, 1.72 mm) on the right. Mean volar tilt was 10.74° (SD, 3.74°) and 10.77° (SD, 3.19°) and radial inclination was 24.05° (SD, 2.63°) and 24.18° (SD, 3.41°) on the left and right, respectively. Mean volar cortical angle across the radius was 140.9° (SD, 7.9°) on the left and 140.1° (SD, 7.9°) on the right. CONCLUSIONS Direct bilateral comparison of the distal radius and wrist joints is useful to predict normal anatomy of the injured radius, because bilateral similarities exist. CLINICAL RELEVANCE This article provides a comprehensive list of measurements of the distal radius compared bilaterally using a 3D model. From this study, we found that the contralateral radius can be used as a benchmark with which to compare fracture reduction and to manage malunions during the preoperative planning of corrective osteotomies. It can also be used to define normal anatomy.
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Affiliation(s)
- Robert J Gray
- Department of Mechanical and Materials Engineering, University of Western Ontario, Ontario, Canada
| | - Mitchell Thom
- Department of Mechanical and Materials Engineering, University of Western Ontario, Ontario, Canada
| | - Michael Riddle
- Department of Mechanical and Materials Engineering, University of Western Ontario, Ontario, Canada
| | - Nina Suh
- Roth-McFarlane Hand and Upper Limb Centre, St Joseph's Hospital, University of Western Ontario, Ontario, Canada
| | - Timothy Burkhart
- Department of Mechanical and Materials Engineering, University of Western Ontario, Ontario, Canada
| | - Emily Lalone
- Department of Mechanical and Materials Engineering, University of Western Ontario, Ontario, Canada.
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22
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Abe S, Oka K, Miyamura S, Shigi A, Tanaka H, Sugamoto K, Yoshikawa H, Murase T. Three-Dimensional In Vivo Analysis of Malunited Distal Radius Fractures With Restricted Forearm Rotation. J Orthop Res 2019; 37:1881-1891. [PMID: 31038231 DOI: 10.1002/jor.24332] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 04/16/2019] [Indexed: 02/04/2023]
Abstract
Malunited distal radius fractures (DRFs) occasionally restrict forearm rotation, but the underlying pathology remains unclear. We aimed to elucidate the mechanism of rotational restriction by retrospective analysis of 23 patients with unilateral malunited DRFs who presented restricted forearm rotation. We conducted computed tomography during forearm rotation on both sides. Three-dimensional (3D) bone surface models of the forearm were created, and 3D deformity of the distal radius, translation of the distal radius relative to the ulna, distal radioulnar joint (DRUJ) contact area, and estimated path length (EPL) of distal radioulnar ligaments (DRUL) during forearm rotation were evaluated. In total, 18 patients had dorsal angular deformities (DA group) and five had volar angular deformities (VA group). In the DA group, the closest point between the distal radius and ulna on DRUJ was displaced to the volar side during supination and pronation (p < 0.001); DRUJ contact area was not significantly different between the DA and normal groups. In bone-ligament model simulation, the EPL of dorsal DRUL was longer in the DA group than in the normal group (p < 0.001); opposite phenomena were observed in the VA group. In the DA group, translation of the distal radius in a volar direction relative to the ulna during pronation was impaired presumably due to dorsal DRUL tightness. Anatomical normal reduction of the distal radius by corrective osteotomy may improve forearm rotation by improving triangular fibrocartilage complex tightness and normalizing translation of the distal radius relative to the ulna. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1881-1891, 2019.
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Affiliation(s)
- Shingo Abe
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan.,Department of Orthopaedic Surgery, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan
| | - Kunihiro Oka
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Satoshi Miyamura
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Atsuo Shigi
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Hiroyuki Tanaka
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Kazuomi Sugamoto
- Department of Orthopaedic Biomaterial Science, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Tsuyoshi Murase
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
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23
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Yu X, Yu Y, Shao X, Bai Y, Zhou T. Volar locking plate versus external fixation with optional additional K-wire for treatment of AO type C2/C3 fractures: a retrospective comparative study. J Orthop Surg Res 2019; 14:271. [PMID: 31455394 PMCID: PMC6712714 DOI: 10.1186/s13018-019-1309-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 08/07/2019] [Indexed: 12/28/2022] Open
Abstract
Purpose This study aimed to compare the radiographic and functional results of Arbeitsgemeinschaftfür Osteosynthesefragen (AO) type C2/C3 fracture of distal radius between volar locking plate (VLP) and external fixation (EF). Methods It was a retrospective comparative study. Between January 2015 and March 2018, a total of 62/117 patients who underwent EF (23) or VLP fixation (39) for AO type C2/C3 distal radius fractures were assessed. The follow-up period was at least 12 months. Gartland–Werley scale and the disabilities of the arm, shoulder, and hand (DASH) scale were used to evaluate the overall functional outcomes; wrist range of motion and grip strength were measured. The radiographic parameters included radial inclination, volar tilt, radial length, ulnar variance, and articular step-off. All of the comparisons were performed using SPSS 21.0. Results The mean follow-up time was 17.1 months. At final visit, VLP performed better in wrist flexion (69.7° vs 62.3°, p < 0.001), forearm pronation (73.1° vs 64.8°, p = 0.027) and supination (70.6° vs 63.1°, p = 0.033) than EF, but not different with regard to other kinematic parameters. No significant difference was found between two groups, in term of Gartland-Werley or DASH score (p > 0.05). The ulnar variance and articular step-off was significantly more improved in VLP than EF group, being 0.6 vs 1.6 mm (p = 0.002) and 0.5 vs 1.2 mm (p = 0.007). The overall rate of complications did not differ in both groups (28.2% vs 34.5%) (p = 0.587). Conclusions Compared to EF, VLP fixation showed better performance in wrist mobility, correction of ulnar variance, and improving articular congruence, but with the comparable overall functional outcomes and complication rate.
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Affiliation(s)
- Xiaofei Yu
- Department of Hand Surgery, The Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Yadong Yu
- Department of Hand Surgery, The Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China. .,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.
| | - Xinzhong Shao
- Department of Hand Surgery, The Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Yanbin Bai
- Department of Hand Surgery, The Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Tong Zhou
- Department of Hand Surgery, The Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
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24
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Abstract
PURPOSE OF REVIEW Malunion remains a common complication in the treatment of distal radius fractures. The purpose of this review was to discuss the various approaches in planning and surgical management for extra- and intra-articular distal radius malunions. RECENT FINDINGS Several recent studies have reported good results with surgical correction of distal radius malunions utilizing a number of preoperative planning methods and surgical approaches. Three-dimensional models and custom cutting guides have recently become more popular, but their benefit in comparison to other methods remains unclear. Regardless of preoperative planning method or surgical approach, good results can be achieved with correction of distal radius malunion with careful attention to patient selection, indications, and surgical technique.
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Affiliation(s)
- Brady T Evans
- Department of Orthopaedic Surgery, Division of Hand and Upper Extremity Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jesse B Jupiter
- Department of Orthopaedic Surgery, Division of Hand and Upper Extremity Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Gammon B, Lalone E, Nishiwaki M, Willing R, Johnson J, King GJW. The Effect of Dorsal Angulation on Distal Radioulnar Joint Arthrokinematics Measured Using Intercartilage Distance. J Wrist Surg 2019; 8:10-17. [PMID: 30723596 PMCID: PMC6358445 DOI: 10.1055/s-0038-1667303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 06/15/2018] [Indexed: 10/28/2022]
Abstract
Background The effects of dorsal angulation deformity on in vitro distal radioulnar joint (DRUJ) contact patterns are not well understood. Purpose The purpose of this study was to utilize intercartilage distance to examine the effects of forearm rotation angle, distal radius deformity, and triangular fibrocartilage complex (TFCC) sectioning on DRUJ contact area and centroid position. Methods An adjustable implant permitted the creation of simulated intact state and dorsal angulation deformities of 10, 20, and 30 degrees. Three-dimensional cartilage models of the distal radius and ulna were created using computed tomography data. Using optically tracked motion data, the relative position of the cartilage models was rendered and used to measure DRUJ cartilage contact mechanics. Results DRUJ contact area was highest between 10 and 30 degrees of supination. TFCC sectioning caused a significant decrease in contact area with a mean reduction of 11 ± 7 mm 2 between the TFCC intact and sectioned conditions across all variables. The position of the contact centroid moved volarly and proximally with supination for all variables. Deformity had a significant effect on the location of the contact centroid along the volar-dorsal plane. Conclusion Contact area in the DRUJ was maximal between 10 and 30 degrees of supination during the conditions tested. There was a significant effect of simulated TFCC rupture on contact area in the DRUJ, with a mean contact reduction of 11 ± 7 mm 2 after sectioning. Increasing dorsal angulation caused the contact centroid to move progressively more volar in the sigmoid notch.
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Affiliation(s)
- Braden Gammon
- Division of Orthopedics, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Emily Lalone
- Department of Mechanical and Materials Engineering, University of Western Ontario, London, Ontario, Canada
| | - Masao Nishiwaki
- Department of Orthopaedic Surgery, Kawasaki Municipal Hospital, Kawasaki-ku, Kawasaki, Japan
| | - Ryan Willing
- Department of Mechanical and Materials Engineering, University of Western Ontario, London, Ontario, Canada
| | - James Johnson
- Department of Mechanical and Materials Engineering, Lawson Health Research Institute, London, Ontario, Canada
| | - Graham J. W. King
- Division of Orthopedic Surgery, Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada
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26
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Abe S, Murase T, Oka K, Shigi A, Tanaka H, Yoshikawa H. In Vivo Three-Dimensional Analysis of Malunited Forearm Diaphyseal Fractures with Forearm Rotational Restriction. J Bone Joint Surg Am 2018; 100:e113. [PMID: 30180062 DOI: 10.2106/jbjs.17.00934] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of this study was to clarify the mechanisms of rotational restriction in malunited forearm diaphyseal fractures. METHODS We retrospectively analyzed the cases of 18 patients with malunited forearm diaphyseal fractures and rotational restriction. All patients underwent bilateral computed tomography (CT) of the forearm in maximum supination, pronation, and neutral positions. From these images, we created 3-dimensional (3-D) bone surface models. We quantified the 3-D deformities, identified instances of osseous impingement between the radius and the ulna during forearm rotation, calculated the path length of the central band (CB) of the interosseous membrane, and measured forearm range of motion. RESULTS Sixteen patients had extension deformity of the radius (the RE group) and 2 had flexion deformity (the RF group). In the RE group, extension deformity of the radius and valgus deformity of the ulna had significant negative correlation with pronation range of motion (R = -0.50, p = 0.046) and supination range of motion (R = -0.63, p = 0.027), respectively. Osseous impingement was mainly observed during pronation (15 of 16 patients). The CB path with the largest changes in length originated from the distal CB attachment area of the radius and ran toward the proximal area of the ulna (the transverse CB). The transverse CB significantly increased in length in supination compared with that in pronation (p < 0.001). Therefore, tightness of the transverse CB appeared to cause supination restriction in the RE group. In the RF group, osseous impingement caused supination restriction. The greatest increases in the transverse CB length were observed in pronation in the RF group, which appeared to cause pronation restriction. CONCLUSIONS In the RE group, pronation restriction was associated with osseous impingement that was due to extension deformity of the radius, and supination restriction was associated with CB tightness that was due to valgus deformity of the ulna. In the RF group, our results suggested that pronation restriction was caused by CB tightness and that supination restriction was caused by osseous impingement. CLINICAL RELEVANCE Three-dimensional corrective osteotomy for extension deformity of the radius in malunited forearm diaphyseal fractures would improve rotational restriction by relieving osseous impingement during pronation and CB tightness during supination.
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Affiliation(s)
- Shingo Abe
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tsuyoshi Murase
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kunihiro Oka
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Atsuo Shigi
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiroyuki Tanaka
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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Arthrokinematics of the Distal Radioulnar Joint Measured Using Intercartilage Distance in an In Vitro Model. J Hand Surg Am 2018; 43:283.e1-283.e9. [PMID: 28951101 DOI: 10.1016/j.jhsa.2017.08.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 06/27/2017] [Accepted: 08/14/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Current techniques used to measure joint contact rely on invasive procedures and are limited to statically loaded positions. We sought to examine native distal radioulnar joint (DRUJ) contact mechanics using nondestructive imaging methods during simulated active and passive forearm rotation. METHODS Testing was performed using 8 fresh-frozen cadaveric specimens that were surgically prepared by isolating muscles involved in forearm rotation. A wrist simulator allowed for the evaluation of differences between active and passive forearm rotation. Three-dimensional cartilage surface reconstructions were created using volumetric data acquired from computed tomography. Using optically tracked motion data, the relative position of the cartilage models was rendered and used to measure DRUJ cartilage contact mechanics. The effects of forearm movement method and rotation angle on centroid coordinate data and DRUJ contact area were examined. RESULTS The DRUJ contact area was maximal at 10° supination. There was more contact area in supination than pronation for both active and passive forearm rotation. The contact centroid moved volarly with supination, with magnitudes of 10.5 ± 2.6 mm volar for simulated active motion and 8.5 ± 2.6 mm volar for passive motion. Along the proximal-distal axis, the contact centroid moved 5.7 ± 2.4 mm proximal during simulated active motion. These findings were statistically significant. The contact centroid moved 0.2 ± 3.1 mm distal during passive motion (not significant). CONCLUSIONS It is possible to examine cartilage contact mechanics of the DRUJ nondestructively while undergoing simulated, continuous active and passive forearm rotation. The contact centroid moved volarly and proximally with supination. There were higher contact area values in supination compared with pronation, with a peak value at 10° supination. CLINICAL RELEVANCE This study documented normal DRUJ arthrokinematics using a nondestructive in vitro approach. It further reinforced the established biomechanical and clinical literature on contact patterns at the native DRUJ during forearm rotation.
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Mauler F, Langguth C, Schweizer A, Vlachopoulos L, Gass T, Lüthi M, Fürnstahl P. Prediction of normal bone anatomy for the planning of corrective osteotomies of malunited forearm bones using a three-dimensional statistical shape model. J Orthop Res 2017; 35:2630-2636. [PMID: 28390188 DOI: 10.1002/jor.23576] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 03/29/2017] [Indexed: 02/04/2023]
Abstract
Corrective osteotomies of the forearm based on 3D computer simulation using contralateral anatomy as a reconstruction template is an approved method. Limitations are existing considerable differences between left and right forearms, and that a healthy contralateral anatomy is required. We evaluated if a computer model, not relying on the contralateral anatomy, may replace the current method by predicting the pre-traumatic healthy shape. A statistical shape model (SSM) was generated from a set of 59 CT scans of healthy forearms, encoding the normal anatomical variations. Three different configurations were simulated to predict the pre-traumatic shape with the SSM (cross-validation). In the first two, only the distal or proximal 50% of the radius were considered as pathological. In a third configuration, the entire radius was assumed to be pathological, only the ulna being intact. Corresponding experiments were performed with the ulna. Accuracy of the prediction was assessed by comparing the predicted bone with the healthy model. For the radius, mean rotation accuracy of the prediction between 2.9 ± 2.2° and 4.0 ± 3.1° in pronation/supination, 0.4 ± 0.3° and 0.6 ± 0.5° in flexion/extension, between 0.5 ± 0.3° and 0.5 ± 0.4° in radial-/ulnarduction. Mean translation accuracy along the same axes between 0.8 ± 0.7 and 1.0 ± 0.8 mm, 0.5 ± 0.4 and 0.6 ± 0.4 mm, 0.6 ± 0.4 and 0.6 ± 0.5 mm, respectively. For the ulna, mean rotation accuracy between 2.4 ± 1.9° and 4.7 ± 3.8° in pronation/supination, 0.3 ± 0.3° and 0.8 ± 0.6° in flexion/extension, 0.3 ± 0.2° and 0.7 ± 0.6° in radial-/ulnarduction. Mean translation accuracy between 0.6 ± 0.4 mm and 1.3 ± 0.9 mm, 0.4 ± 0.4 mm and 0.7 ± 0.5 mm, 0.5 ± 0.4 mm and 0.8 ± 0.6 mm, respectively. This technique provided high accuracy, and may replace the current method, if validated in clinical studies. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2630-2636, 2017.
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Affiliation(s)
- Flavien Mauler
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Christoph Langguth
- Department of Mathematics and Computer Science, University of Basel, Basel, Switzerland
| | - Andreas Schweizer
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Lazaros Vlachopoulos
- Computer Assisted Research and Development Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Tobias Gass
- Computer Vision Laboratory, ETH Zurich, Zurich, Switzerland
| | - Marcel Lüthi
- Department of Mathematics and Computer Science, University of Basel, Basel, Switzerland
| | - Philipp Fürnstahl
- Computer Assisted Research and Development Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Omokawa S, Abe Y, Imatani J, Moritomo H, Suzuki D, Onishi T. Treatment of Intra-articular Distal Radius Fractures. Hand Clin 2017; 33:529-543. [PMID: 28673629 DOI: 10.1016/j.hcl.2017.04.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This review of current literature discusses the morphology of the volar aspect of the distal radius; the surgical procedure, arthroscopic findings, and clinical results of a plate presetting and arthroscopic reduction technique for acute intra-articular fractures; and a novel simulation guidance system for malunited intra-articular fractures. Classification of intra-articular distal radius fractures is also discussed, focusing on central depression fracture fragments, associated soft tissue injuries, and results for measuring scapholunate distances at different sites. Problems of the distal radioulnar joint are reviewed, in particular, functional outcomes of the authors' prospective cohort study on unstable intra-articular fractures involving the distal radioulnar joint.
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Affiliation(s)
- Shohei Omokawa
- Department of Hand Surgery, Nara Medical University, 840 Shijyo-cho, Kashihara, Nara 634-8521, Japan.
| | - Yukio Abe
- Department of Orthopaedic Surgery, Saiseikai Shimonoseki General Hospital, 8-5-1 Yasuoka-cho, Shimonoseki, Yamaguchi 759-6603, Japan
| | - Junya Imatani
- Department of Orthopaedic Surgery, Okayama Saiseikai General Hospital, 2-25 Kokutaicho Kita-ku, Okayama, Okayama 700-8511, Japan
| | - Hisao Moritomo
- Yukioka Hospital Hand Center, Osaka Yukioka College of Health Science, 2-2-3 Ukita, Kita-ku, Osaka, Osaka 530-0021, Japan
| | - Daisuke Suzuki
- Hand Surgery Center, Nishi-Nara Central Hospital, 1-15 Tsurumainishi, Nara, Nara 631-0024, Japan
| | - Tadanobu Onishi
- Department of Orthopaedic Surgery, Nara Medical University, 840 Shijyo-cho, Kashihara, Nara 634-8521, Japan
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30
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Greybe D, Boland MR, Wu T, Mithraratne K. Examining the influence of distal radius orientation on distal radioulnar joint contact using a finite element model. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2016; 32:e02766. [PMID: 26728190 DOI: 10.1002/cnm.2766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 12/11/2015] [Accepted: 12/11/2015] [Indexed: 06/05/2023]
Abstract
Distal radius malunion is a problem that is common to distal radius fractures and can affect the contact mechanics of the distal radioulnar joint (DRUJ). The goal of this study was to use a computational model of the DRUJ to investigate the influence distal radius orientation has on its contact mechanics. Detailed, finite element models of the radius and ulna bones were constructed from magnetic resonance imaging data. The orientation of the distal radius was rotated in 2° increments about three orthogonal axes representing dorsal-palmar rotation, radial-ulnar rotation and anteversion-retroversion. A computational model was used to predict joint contact at the DRUJ in each condition. Joint contact was found to be most sensitive to dorsal rotation of the distal radius, while radial and ulnar rotation did not substantially affect joint contact pressure. Slight retroversion was found to lower joint contact pressure. In most cases, more than 6° rotation in a given direction resulted in dislocation of the DRUJ, so that adaptation at the joint would be required to maintain articular contact. The joint contact model implemented in this study allowed the relationship between distal radius orientation and DRUJ contact to be examined systematically, in a way that is difficult to achieve using a cadaver-based approach. The results demonstrated the distal radius displacements most critical for maintaining healthy joint mechanics at the DRUJ. It is important that clinicians consider the influence of distal radius malunion and its treatment on DRUJ mechanics, in addition to its consequences for wrist function and forearm rotation. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Desney Greybe
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand.
| | - Michael R Boland
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - Tim Wu
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Kumar Mithraratne
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
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31
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Malone PSC, Shaw OG, Lees VC. Anatomic Relationships of the Distal and Proximal Radioulnar Joints Articulating Surface Areas and of the Radius and Ulna Bone Volumes - Implications for Biomechanical Studies of the Distal and Proximal Radioulnar Joints and Forearm Bones. Front Bioeng Biotechnol 2016; 4:61. [PMID: 27468411 PMCID: PMC4942467 DOI: 10.3389/fbioe.2016.00061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 06/29/2016] [Indexed: 12/02/2022] Open
Abstract
Background Previous work from this laboratory has evidenced the biomechanical role of forearm osseoligamentous structures in load transfer of applied forces. It has shown that forces transmitted across the distal radioulnar joint (DRUJ) and proximal radioulnar joint (PRUJ) are similar, though not identical, under axial loading conditions. The purpose of the study was to assess the articulating surface areas of the radioulnar joints and the volumes of the forearm bones addressing the hypothesis that there may be anatomic adaptations that reflect the biomechanical function of the integrated forearm unit. Methods The articulating surface areas of PRUJ and DRUJ were assessed using a laser scanner in 24 cadaver forearms. The articulating joint surfaces were additionally delineated from standardized photographs assessed by three observers. The surface areas of matched pairs of joints were compared on the null hypothesis that these were the same within a given forearm specimen. An additional 44 pairs of matched forearm bone volumes were measured using water displacement technique and again compared through statistical analysis (paired sample t-test and Bland–Altman analysis). Results The findings of this study are that the articulating surface areas of the DRUJ and PRUJ as well as the bone volumes are significantly different and, yet, strongly correlated. The paired sample t-test showed a significant difference between the surface areas of the DRUJ and PRUJ (p < 0.05). The PRUJ articulating surface area was marginally larger than the DRUJ with a PRUJ:DRUJ ratio of 1.02. Paired sample t-test showed a significant difference between the two bone volumes (p < 0.01) with a radius to ulna bone volume ratio of 0.81. When the olecranon was disregarded, radius volume was on average of 4% greater than ulna volume. Conclusion This study demonstrates and defines the anatomical relationships between the two forearm bones and their articulating joints when matched for specimen. The data obtained are consistent with the theory of integrated forearm function generated from published biomechanical studies.
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Affiliation(s)
- Paul S C Malone
- Department of Plastic Surgery, Institute of Inflammation and Repair, Wythenshawe Hospital, University Hospital of South Manchester NHS Foundation Trust, University of Manchester, Manchester, UK; Department of Plastic Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Oliver G Shaw
- Department of Plastic Surgery, Institute of Inflammation and Repair, Wythenshawe Hospital, University Hospital of South Manchester NHS Foundation Trust, University of Manchester , Manchester , UK
| | - Vivien C Lees
- Department of Plastic Surgery, Institute of Inflammation and Repair, Wythenshawe Hospital, University Hospital of South Manchester NHS Foundation Trust, University of Manchester , Manchester , UK
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32
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Omori S, Miyake J, Oka K, Tanaka H, Yoshikawa H, Murase T. In vivo three-dimensional elbow biomechanics during forearm rotation. J Shoulder Elbow Surg 2016; 25:112-9. [PMID: 26422527 DOI: 10.1016/j.jse.2015.07.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 07/22/2015] [Accepted: 07/23/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND It is unclear how elbow kinematics changes during forearm rotation. This study investigated in vivo 3-dimensional elbow kinematics during forearm rotation. METHODS We studied 12 normal elbows using in vivo 3-dimensional computed tomography data in maximum forearm supination, neutral, and maximum pronation with the elbows in extension. We measured the motion of the radius and ulna relative to the humerus using a markerless bone registration technique and the contact area of the radiocapitellar joint, proximal radioulnar joint, and ulnohumeral joint using a proximity mapping method. RESULTS When the forearm rotated from the supinated position to the pronated position, the radius showed significant varus rotation, internal rotation, and extension relative to the humerus. The center of the radial head significantly translated anteriorly, proximally, and laterally. The ulna significantly rotated in valgus, and the deepest point on the sagittal ridge of the trochlear notch translated medially with forearm pronation. The contact area of the radiocapitellar joint was largest in pronation. The contact area of the proximal radioulnar joint was largest in supination. The contact area of the ulnohumeral joint showed no significant change during forearm rotation. CONCLUSIONS In pronation, because of the proximal migration of the radial head, the radiocapitellar joint was most congruent compared with other positions. The proximal radioulnar joint was most congruent in supination. The ulnohumeral joint congruency was not affected by forearm rotation. This study provides useful information for understanding 3-dimensional elbow motion and joint osseous stability related to forearm rotation.
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Affiliation(s)
- Shinsuke Omori
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Junichi Miyake
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kunihiro Oka
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiroyuki Tanaka
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tsuyoshi Murase
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
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Xing SG, Chen YR, Xie RG, Tang JB. In Vivo Contact Characteristics of Distal Radioulnar Joint With Malunited Distal Radius During Wrist Motion. J Hand Surg Am 2015; 40:2243-8. [PMID: 26442798 DOI: 10.1016/j.jhsa.2015.07.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 07/31/2015] [Accepted: 07/31/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine whether distal radioulnar joint (DRUJ) contact characteristics were altered in patients with malunited distal radius fractures. METHODS We obtained computed tomography scans at 5 positions of both wrists of 6 patients who had unilateral malunited distal radius fractures with dorsal angulation from 10° to 20° and ulnar variance less than 3 mm. We reconstructed 3-dimensional images and mapped contact regions of DRUJ by calculating the shortest distance between the 2 opposing bones. The contact areas of the DRUJ were measured and the contact region centers were calculated and analyzed. The values of the malunited side were compared with those of the contralateral uninjured side. RESULTS In the uninjured wrist, the contact areas of the DRUJ increased slightly from wrist flexion to extension and ulnar deviation. In the malunited wrist, we found the contact areas of DRUJ to be progressively reduced from 20° flexion to neutral, 40° extension, and 20° extension, to ulnar deviation. The centroid of this area on the sigmoid notch moved to distal from flexion to extension. Compared with the contralateral uninjured wrist, the contact area significantly decreased during wrist extension and ulnar deviation, and significantly increased during wrist flexion. The centroids of this area on sigmoid notch all moved volarly in all selected wrist positions. CONCLUSIONS The contact areas of the DRUJ and the centroid of contact area on sigmoid notch are altered in patients with malunited distal radius fractures. The contact area of the DRUJ increases during wrist flexion and decreases during wrist extension and ulnar deviation. The centroids of the contact area on sigmoid notch move volarly during wrist flexion-extension and ulnar deviation. CLINICAL RELEVANCE The in vivo findings suggest that alterations in joint mechanics may have an important role in the dysfunction associated with these injuries.
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Affiliation(s)
- Shu Guo Xing
- Department of Hand Surgery, Hand Surgery Research Center, Affiliated Hospital of Nantong University, Nantong, Jiangsu
| | - Yan Rong Chen
- Department of Orthopaedics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Ren Guo Xie
- Department of Hand Surgery, Hand Surgery Research Center, Affiliated Hospital of Nantong University, Nantong, Jiangsu
| | - Jin Bo Tang
- Department of Hand Surgery, Hand Surgery Research Center, Affiliated Hospital of Nantong University, Nantong, Jiangsu.
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34
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Walenkamp MMJ, de Muinck Keizer RJO, Dobbe JGG, Streekstra GJ, Goslings JC, Kloen P, Strackee SD, Schep NWL. Computer-assisted 3D planned corrective osteotomies in eight malunited radius fractures. Strategies Trauma Limb Reconstr 2015; 10:109-16. [PMID: 26350551 PMCID: PMC4570883 DOI: 10.1007/s11751-015-0234-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 09/01/2015] [Indexed: 11/30/2022] Open
Abstract
In corrective osteotomy of the radius, detailed preoperative planning is essential to optimising functional outcome. However, complex malunions are not completely addressed with conventional preoperative planning. Computer-assisted preoperative planning may optimise the results of corrective osteotomy of the radius. We analysed the pre- and postoperative radiological result of computer-assisted 3D planned corrective osteotomy in a series of patients with a malunited radius and assessed postoperative function. We included eight patients aged 13–64 who underwent a computer-assisted 3D planned corrective osteotomy of the radius for the treatment of a symptomatic radius malunion. We evaluated pre- and postoperative residual malpositioning on 3D reconstructions as expressed in six positioning parameters (three displacements along and three rotations about the axes of a 3D anatomical coordinate system) and assessed postoperative wrist range of motion. In this small case series, dorsopalmar tilt was significantly improved (p = 0.05). Ulnoradial shift, however, increased by the correction osteotomy (6 of 8 cases, 75 %). Postoperative 3D evaluation revealed improved positioning parameters for patients in axial rotational alignment (62.5 %), radial inclination (75 %), proximodistal shift (83 %) and volodorsal shift (88 %), although the cohort was not large enough to confirm this by statistical significance. All but one patient experienced improved range of motion (88 %). Computer-assisted 3D planning ameliorates alignment of radial malunions and improves functional results in patients with a symptomatic malunion of the radius. Further development is required to improve transfer of the planned position to the intra-operative bone. Level of evidence IV.
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Affiliation(s)
- M M J Walenkamp
- Trauma Unit, Department of Surgery, Academic Medical Centre, University of Amsterdam, room G4-137, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - R J O de Muinck Keizer
- Trauma Unit, Department of Surgery, Academic Medical Centre, University of Amsterdam, room G4-137, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - J G G Dobbe
- Biomedical Engineering and Physics, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - G J Streekstra
- Biomedical Engineering and Physics, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.,Department of Radiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - J C Goslings
- Trauma Unit, Department of Surgery, Academic Medical Centre, University of Amsterdam, room G4-137, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - P Kloen
- Department of Orthopaedic Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - S D Strackee
- Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - N W L Schep
- Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands
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Nishiwaki M, Welsh M, Gammon B, Ferreira LM, Johnson JA, King GJW. Volar subluxation of the ulnar head in dorsal translation deformities of distal radius fractures: an in vitro biomechanical study. J Orthop Trauma 2015; 29:295-300. [PMID: 25591036 DOI: 10.1097/bot.0000000000000273] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To quantify the effects of dorsal translation deformities of the distal radius with and without dorsal angulation on volar displacement of the ulnar head during simulated active forearm rotation, both with the triangular fibrocartilage complex (TFCC) intact and sectioned conditions. METHODS Eight fresh-frozen cadaveric upper extremities were mounted in an active forearm motion simulator, and distal radial deformities of 0, 5, and 10 mm of dorsal translation with 0, 10, 20, and 30 degrees of dorsal angulation were simulated. Volar displacement of the ulnar head at the distal radioulnar joint as a result of each distal radial deformity was quantified during simulated active supination. The data were collected with the TFCC intact and after sectioning the TFCC at its ulnar insertion. RESULTS Increasing isolated dorsal translation deformities increased volar displacement of the ulnar head when the TFCC was intact (P < 0.001). Increasing dorsal translation combined with dorsal angulation increased volar displacement of the ulnar head compared with isolated dorsal angulation deformities (P < 0.001). Sectioning the TFCC increased the volar displacement of the ulnar head caused by each distal radial deformity (P = 0.001). CONCLUSIONS These results emphasize the clinical importance of evaluating the magnitude of both dorsal translation and dorsal angulation when managing displaced distal radius fractures and malunions.
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Affiliation(s)
- Masao Nishiwaki
- *Department of Orthopaedic Surgery, Kawasaki Municipal Hospital, Kawasaki, Japan; †Hand and Upper Limb Center, St Joseph's Health Care London, London, Ontario, Canada; and ‡Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ontario, Canada
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Oura K, Oka K, Kawanishi Y, Sugamoto K, Yoshikawa H, Murase T. Volar morphology of the distal radius in axial planes: a quantitative analysis. J Orthop Res 2015; 33:496-503. [PMID: 25487066 DOI: 10.1002/jor.22780] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 10/18/2014] [Accepted: 10/30/2014] [Indexed: 02/04/2023]
Abstract
To investigate the cause of rupture of the flexor pollicis longus (FPL) after volar plate fixation of distal radius fractures, previous studies have examined the shape of the distal radius in the sagittal plane or in the lateral view. However, there are no reports on the anatomical shape of the volar surface concavity of the distal radius in the axial plane. We hypothesized that this concavity might contribute to the mismatch between the plate and the surface of the radius. To test this hypothesis, we constructed three-dimensional models of the radius and FPL based on computed tomography scans of 70 normal forearms. We analyzed axial cross-sectional views with 2 mm intervals. In all cases, the volar surface of the distal radius was concave in the axial plane. The concavity depth was maximum at 6 mm proximal to the palmar edge of the lunate fossa and progressively decreased toward the proximal radius. FPL was closest to the radius at 2 mm proximal to the palmar edge of the lunate fossa. The volar surface of the distal radius was externally rotated from proximal to distal. These results may help to develop new implants which fit better to the radius and decrease tendon irritation.
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Affiliation(s)
- Keiichiro Oura
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
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Mifsud C, Drew T. Pathomechanics of the wrist following fractures of the distal radius. HAND THERAPY 2015. [DOI: 10.1177/1758998315574352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
IntroductionThe wrist positions the hand in space and allows load transmission from the hand to the forearm. This research study aimed to explain the biomechanical changes that occur at the wrist following a fracture of the distal radius and to explore the effect of this fracture on wrist and hand range of motion and muscle strength. It was hypothesised that a fracture of the distal radius interferes with the biomechanical integrity of the wrist limiting the available wrist and hand range of motion. This in turn affects hand muscle strength.MethodsThis prospective research study adopted a quantitative quasi-experimental time-series design where 109 patients followed an occupational therapy programme for 12 weeks. Measurements of forearm, wrist and hand range of motion and hand muscle strength were taken on the initial assessment, and on the 6th and 12th weeks of intervention. A standard evaluation procedure was followed to ensure reliability of the results. Data were analysed using SPSS (PASW version 18).ResultsForearm and wrist range of motion and muscle strength were significantly impaired. Hand range of motion was also affected even though the hand itself was not directly involved in the injury. Improvements in range of motion were accompanied by an increase in hand muscle strength. Patients with intra-articular fractures experienced greater limitations compared to their counterparts.ConclusionsThese results supported the initial hypothesis. Clinically, this highlights the need for orthopaedic management and rehabilitation to be based on a sound knowledge of the biomechanical interaction of the different structures involved.
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Affiliation(s)
- Charmaine Mifsud
- Allied Health Practitioner (Occupational Therapist), Mater Dei Hospital, Malta
| | - Tim Drew
- Senior Lecturer at the University of Dundee, Department of Orthopaedic and Trauma Surgery, Dundee, Scotland, UK
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Load transfer at the distal ulna following simulated distal radius fracture malalignment. J Hand Surg Am 2015; 40:217-23. [PMID: 25499840 DOI: 10.1016/j.jhsa.2014.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 10/07/2014] [Accepted: 10/07/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To measure the effects of distal radius malalignment on loading at the distal ulna. METHODS Using an adjustable mechanism to simulate angulated and translated malalignments, clinically relevant distal radius deformities were simulated in a cadaveric model. A custom-built load cell was inserted just proximal to the native ulna head to measure the resultant force and torque in the distal ulna. Loads were measured before and after transecting the triangular fibrocartilage complex (TFCC). RESULTS There was an increase in distal ulna load and torque with increasing dorsal translation and angulation. Combined conditions of angulation and translation increased force and torque in the distal ulna to a greater extent than with either condition in isolation. Transecting the TFCC resulted in a reduction in distal ulna load and torque. CONCLUSIONS A progressive increase in load at the distal ulna was observed with increasing severity of malalignment, which may be an important contributor to residual ulnar wrist pain and dysfunction. However, no clear-cut threshold of malalignment of a dorsally angulated and translated distal radius fracture was identified. These observations suggest that radius deformities cause articular incongruity, which increases TFCC tension and distal radioulnar joint load. Cutting of the TFCC decreased distal ulna loading, likely by releasing the articular constraining effect of the TFCC on the distal radioulnar joint, allowing the radius to rotate more freely with respect to the ulna. CLINICAL RELEVANCE Anatomical reduction of a distal radius fracture minimizes the forces in the distal ulna and may reduce residual ulnar wrist pain and dysfunction.
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Abstract
UNLABELLED Small variations within normal range of radiographic parameters, except ulnar variance and volar tilt, do not influence the final functional outcome in distal radius fractures. INTRODUCTION There are many reports in the literature on the relationship between radiographic variables and their influence on the final outcome of distal radius fractures. Most authors report that a good functional result depends on anatomical restoration of the articular surface and extra-articular alignment. The aim of this study was to verify if it is really necessary to restore anatomic radiographic parameters to obtain satisfactory functional outcome in distal radius fractures treated with volar plate. MATERIALS AND METHODS We retrospectively evaluated 51 patients treated with volar locked plate for articular unstable distal radius fractures from December 2006 to March 2009. Each fracture was evaluated according to the AO classification. The average follow-up was 40.5 months. Radiological measurements were performed considering radial height, radial inclination, volar tilt and ulnar variance, both preoperatively and postoperatively, to estimate the correction value. We examined range of motion (ROM), grip strength with a Jamar(®) dynamometer and Disabilities of the Arm, Shoulder and Hand (DASH) score. The τ Student test was performed for statistical analysis. RESULTS The persistence of articular step-off was assessed in 35.3% of patients. Normal radial inclination (21-25°) was restored in 74.5% of patients (range 15-27.5°). Normal radial height (10-13 mm) was restored in 66.6% of patients (range 6.8-17.3mm). Normal volar tilt (7-15°) was achieved in 90.2% of patients (range 3-17°). Normal ulnar variance (0.7-1.5mm) was restored in 86.3% of patients (range 0.7-4.1mm). There was a statistically significant difference between the preoperative and postoperative radiographic values (p<0.01). The majority of patients showed complete recovery of ROM, with no statistically significant difference (p>0.05) in extension, flexion, supination and pronation compared with the contralateral hand. Eight patients who had postoperative volar tilt and/or ulnar variance out of range had a statistically significant difference (p<0.05) in ROM compared with the non-operated side. At final follow-up, all patients had a statistically significant difference (p<0.05) in grip strength compared with the contralateral side, even with good strength values. The mean DASH score was 12.2 (range 0-61). DISCUSSION AND CONCLUSION Our experience suggests that ulnar variance and volar tilt are the most important radiographic parameters to be restored to obtain good functional outcome in distal radius fracture. Small variations of other radiographic parameters seem to not affect the final outcome at minimum 3 years' follow-up.
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Liu J, Wu Z, Li S, Li Z, Wang J, Yang C, Yu L, Chen D. Should distal radioulnar joint be fixed following volar plate fixation of distal radius fracture with unstable distal radioulnar joint? Orthop Traumatol Surg Res 2014; 100:599-603. [PMID: 25168452 DOI: 10.1016/j.otsr.2014.02.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 12/16/2013] [Accepted: 02/20/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Distal radioulnar joint (DRUJ) instability often accompanies distal radial fractures. The goal of this study was to investigate whether DRUJ should be fixed to prevent recurrent DRUJ instability in distal radius fracture patients with unstable DRUJ following open reduction and volar plate fixation of the radius. METHODS A retrospective chart review was performed on forty-nine consecutive patients presenting distal radius fracture who were diagnosed with distal radioulnar instability after radius fixation with volar plate. Group one consisted of 24 patients whose DRUJs were fixed in neutral for 6 weeks with 1∼2 Kirschner wires (8 cases combined with casting), whereas group two consisted of 25 patients without DRUJ fixation. All patients had radiographic evaluation of their wrist and DRUJ for stabilities and underwent functional evaluation using modified Gartland and Werley demerit scoring system (GW score). RESULTS All patients were followed-up for an average of 15 months (12-24 months) after surgery. No significant difference was noted between the two groups with respect to gender, age, fracture types and damage types (no noteworthy medical comorbidities in either group). At the latest follow-up, patients in both groups had comparable grip strength, wrist motion, and visual analogue scale (VAS) and GW scores. Only one patient (2.4%) demonstrated DRUJ chronic instability, but did not require any additional surgery. CONCLUSION The results suggest that in patients with distal radius fractures, fixation of unstable DRUJs in neutral for 6 weeks does not have an advantage over non-fixation. LEVEL OF EVIDENCE III.
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Affiliation(s)
- J Liu
- Department of Orthopaedics, the Tenth People's Hospital of Shanghai, Tongji University, Shanghai Trauma and Emergency Center, 200072, Shanghai, PR China
| | - Z Wu
- Department of Orthopaedics, the Tenth People's Hospital of Shanghai, Tongji University, Shanghai Trauma and Emergency Center, 200072, Shanghai, PR China
| | - S Li
- Department of Orthopaedics, the Tenth People's Hospital of Shanghai, Tongji University, Shanghai Trauma and Emergency Center, 200072, Shanghai, PR China.
| | - Z Li
- Department of Orthopaedics, the Tenth People's Hospital of Shanghai, Tongji University, Shanghai Trauma and Emergency Center, 200072, Shanghai, PR China
| | - J Wang
- Department of Orthopaedics, the Tenth People's Hospital of Shanghai, Tongji University, Shanghai Trauma and Emergency Center, 200072, Shanghai, PR China
| | - C Yang
- Department of Orthopaedics, the Tenth People's Hospital of Shanghai, Tongji University, Shanghai Trauma and Emergency Center, 200072, Shanghai, PR China
| | - L Yu
- Department of Orthopaedics, the Tenth People's Hospital of Shanghai, Tongji University, Shanghai Trauma and Emergency Center, 200072, Shanghai, PR China
| | - D Chen
- Department of Orthopaedics, the Tenth People's Hospital of Shanghai, Tongji University, Shanghai Trauma and Emergency Center, 200072, Shanghai, PR China
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Abstract
The forearm is a complex anatomical and functional unit with unique osseous, soft tissue and articular relationships. Disruption of these important relations can have a significant impact, leading to pain, instability of the radio-ulnar articulation and reduced range of motion. The gold standard for treating forearm fractures in adults remains anatomic reduction, stable plate fixation and preservation of the surrounding blood supply. Failure to achieve these goals may lead to malunion, requiring reconstructive surgery, which can be technically challenging. In this review, we discuss the essential aspects of anatomy and pathomechanics, clinical and radiological assessment and the state of the art in pre-operative planning and deformity correction surgery.
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Chen YR, Wu YF, Tang JB, Giddins G. Contact areas of the scaphoid and lunate with the distal radius in neutral and extension: correlation of falling strategies and distal radial anatomy. J Hand Surg Eur Vol 2014; 39:379-83. [PMID: 24127465 DOI: 10.1177/1753193413507810] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The functional neutral of wrist movement is about 10° extension yet the distal radius has a volar tilt. This has not previously been explained. Assuming that the contact area between the carpus and the distal radius increased in wrist extension this would also help stabilize the carpus on the distal radius in positions where typically there is greater loading. To test this hypothesis we reconstructed three-dimensional structures of the carpal bones and distal radius using computed tomography scans of 13 normal wrists. The contact areas of the scaphoid with the distal radius were measured and were found progressively increased from flexion 20°, neutral, extension 20°, to extension 40°. The maximal increases in the contact area of the scaphoid and the distal radius was at full wrist extension. No significant changes in the contact areas of the lunate with the distal radius were found between the different positions. The contact characteristics provide greater stability to the carpus on the distal radius, and to help spread forces from impact to the wrist reducing the transmitted peak forces and thus the risk of distal radius and carpal injuries.
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Affiliation(s)
- Y R Chen
- 1Department of Hand Surgery, The Hand Surgery Research Center, Affiliated Hospital of Nantong University, Nantong, China
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CT-based three-dimensional kinematic comparison of dart-throwing motion between wrists with malunited distal radius and contralateral normal wrists. Clin Radiol 2014; 69:462-7. [DOI: 10.1016/j.crad.2013.09.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 09/22/2013] [Accepted: 09/25/2013] [Indexed: 11/20/2022]
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Graf M, Diether S, Vlachopoulos L, Fucentese S, Fürnstahl P. Automatic string generation for estimating in vivo length changes of the medial patellofemoral ligament during knee flexion. Med Biol Eng Comput 2014; 52:511-20. [PMID: 24752419 DOI: 10.1007/s11517-014-1156-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 04/07/2014] [Indexed: 10/25/2022]
Abstract
Modeling ligaments as three-dimensional strings is a popular method for in vivo estimation of ligament length. The purpose of this study was to develop an algorithm for automated generation of non-penetrating strings between insertion points and to evaluate its feasibility for estimating length changes of the medial patellofemoral ligament during normal knee flexion. Three-dimensional knee models were generated from computed tomography (CT) scans of 10 healthy subjects. The knee joint under weight-bearing was acquired in four flexion positions (0°-120°). The path between insertion points was computed in each position to quantify string length and isometry. The average string length was maximal in 0° of flexion (64.5 ± 3.9 mm between femoral and proximal patellar point; 62.8 ± 4.0 mm between femoral and distal patellar point). It was minimal in 30° (60.0 ± 2.6 mm) for the proximal patellar string and in 120° (58.7 ± 4.3 mm) for the distal patellar string. The insertion points were considered to be isometric in 4 of the 10 subjects. The proposed algorithm appears to be feasible for estimating string lengths between insertion points in an automatic fashion. The length measurements based on CT images acquired under physiological loading conditions may give further insights into knee kinematics.
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Affiliation(s)
- Matthias Graf
- Computer Assisted Research and Development Group, University Hospital Balgrist, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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Distal radioulnar joint kinematics in simulated dorsally angulated distal radius fractures. J Hand Surg Am 2014; 39:656-63. [PMID: 24594268 DOI: 10.1016/j.jhsa.2014.01.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 01/10/2014] [Accepted: 01/10/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To examine the effects of dorsal angulation deformities of the distal radius with and without triangular fibrocartilage complex (TFCC) rupture on the 3-dimensional kinematics of the distal radioulnar joint (DRUJ) during simulated active motion. METHODS Nine fresh-frozen cadaveric specimens were tested in a forearm simulator that produced active forearm rotation. Dorsal angulation deformities of the distal radius with 10°, 20°, and 30° angulation were created. Changes in the position of the ulna relative to the radius at the DRUJ as a consequence of each dorsal angulation deformity were quantified during simulated active supination in terms of volar, ulnar, and distal displacement of the ulna. Testing was performed initially with the TFCC intact and repeated after complete sectioning of the TFCC at its ulnar insertion. RESULTS Increasing dorsal angulation deformities of the distal radius significantly increased volar, ulnar, and distal displacement of the ulna when the TFCC was intact. Sectioning of the TFCC significantly increased volar displacement of the ulna in dorsal angulation deformities. As little as 10° of dorsal angulation significantly increased distal displacement of the ulna with the TFCC intact and resulted in a significant increase in volar, ulnar, and distal displacement of the ulna with sectioned TFCC. CONCLUSIONS Dorsal angulation deformities of the distal radius affect the 3-dimensional kinematics of the DRUJ, especially with the TFCC sectioned. CLINICAL RELEVANCE The progressive change in DRUJ kinematics with increasing dorsal angulation may partially explain the relationship between the magnitude of dorsal angulation of distal radius fractures and functional outcomes in younger patients. The status of the TFCC should be evaluated carefully, as well as the magnitude of osseous deformity in patients with distal radius fractures and malunions, because changes in DRUJ kinematics caused by dorsal angulation are greater when the TFCC is ruptured.
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Abstract
Background Malunions following distal radius fractures are common, with shortening, translation, and rotation occurring. The patients frequently lose forearm rotation, but there is no data to indicate whether this is due to mechanical misalignment between the radius and the ulna or to contracture of the soft tissues. Material and Methods Seven fresh cadaveric specimens were used to determine the loss of forearm rotation with varying simulated distal radius fracture malalignment patterns. Uniplanar malunion patterns consisting of dorsal tilt, radioulnar translation, or radial shortening were simulated by creating an osteotomy at the distal end of the radius. Description of Technique By orienting the distal fragment position using an external fixator and maintaining the position with wedges and a T-plate, varying degrees of malunion of the distal radius could be simulated. Rotation of the forearm was produced by fixing the elbow in a flexed position and applying a constant torque to the forearm using deadweights. Forearm rotation was measured with a protractor. Results Dorsal tilt to 30° and radial translation to 10 mm led to no significant restriction in forearm pronation or supination ranges of motion. A 5-mm ulnar translation deformity resulted in a mean 23% loss of pronation range of motion. Radial shortening of 10 mm reduced forearm pronation by 47% and supination by 29%. Conclusion Because a severe osseous misalignment was required to produce a significant loss in rotation, contracture of the soft tissues is most likely the cause of the loss of rotation in most cases.
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Affiliation(s)
- Andrew Bronstein
- Bellevue Hand Surgery, University of Washington, Bellevue, Washington
| | - Dennis Heaton
- Bellevue Hand Surgery, University of Washington, Bellevue, Washington
| | - Allan F. Tencer
- Bellevue Hand Surgery, University of Washington, Bellevue, Washington
| | - Thomas E. Trumble
- Bellevue Hand Surgery, University of Washington, Bellevue, Washington
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Jones CW, Lawson RD. One size does not fit all: distal radioulnar joint dysfunction after volar locking plate fixation. J Wrist Surg 2014; 3:42-45. [PMID: 24533245 PMCID: PMC3922856 DOI: 10.1055/s-0033-1364096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background Fractures of the distal radius are among the most common injuries treated by orthopedic surgeons worldwide. Failure to restore distal radius alignment can lead to fracture malunion and poor clinical outcomes, including distal radioulnar joint (DRUJ) instability and limitation of motion. Case Description We present a unique case of DRUJ dysfunction following volar plate fixation of bilateral distal radius fractures and analyze the biomechanical causes of this complication. As a result of a relatively excessive tilt of the precontoured locking plate (in comparison to the patient's particular anatomy), the fracture on one side was "over-reduced," disrupting the biomechanics of the DRUJ, causing a supination block. Clinical Relevance Volar locking plates are not a panacea to all distal radius fractures. Plate selection and fixation technique must include consideration of patient anatomy. Robust plates offer the advantage of providing rigid fixation but can be difficult to contour when reconstructing normal anatomy. Restoration of patient-specific anatomy is crucial to the management of distal radius fractures.
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Affiliation(s)
- Christopher W. Jones
- Orthopaedic Registrar, NSW Northside Training Program, Royal Australian College of Surgeons, Victoria, Australia
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Omori S, Moritomo H, Murase T, Miyake J, Kataoka T, Kawanishi Y, Sugamoto K, Yoshikawa H. Changes in length of the radioulnar ligament and distal oblique bundle after Colles' fracture. J Plast Surg Hand Surg 2013; 47:409-14. [PMID: 23802187 DOI: 10.3109/2000656x.2013.775139] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The purpose of this study was to investigate changes in length of the radioulnar ligament and distal oblique bundle (DOB) within the distal interosseous membrane after Colles' fracture and correlate the magnitude of the changes in length with clinical features. This study investigated 10 patients with malunion of a Colles' fracture. In three-dimensional computed tomography, the paths of the four limbs of the radioulnar ligament (superficial and deep, dorsal, and palmar limbs) and DOB were modelled and each path length was computed. Differences in length between the affected and contralateral unaffected side were calculated and correlated with the radiographic parameters of deformity on plain X-ray, subluxation of the DRUJ on CT, and limited range of forearm rotation in the clinical examination. In the malunited radius, the superficial and deep dorsal limbs of the radioulnar ligament were significantly elongated and DOB was significantly shortened compared with the contralateral side. These length changes correlated with radiographic radial shortening, subluxation of the DRUJ, and inversely correlated with limited range of forearm pronation. This study suggests that the dorsal radioulnar ligament would be overstretched and disrupted in Colles' fracture with severely increased radial shortening, producing laxity of the distal radioulnar joint that could negate limitation of pronation.
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Affiliation(s)
- Shinsuke Omori
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine , Suita , Japan
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Chen YR, Tang JB. Changes in contact site of the radiocarpal joint and lengths of the carpal ligaments in forearm rotation: an in vivo study. J Hand Surg Am 2013; 38:712-20. [PMID: 23474161 DOI: 10.1016/j.jhsa.2013.01.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 01/12/2013] [Accepted: 01/14/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To examine the contact site of the radiocarpal joint and lengths of carpal ligaments at different forearm rotations in vivo. Rotation of the forearm could exert noteworthy influence on mechanics of the wrist, and understanding how forearm rotation influences wrist mechanics may help treat carpal disorders because wrist position closely relates to forearm rotation. METHODS We obtained computed tomography scans of the wrists of 8 volunteers at the following 7 positions of forearm rotation: neutral; 30°, 60°, and 90° of pronation; and 30°, 60°, and 90° of supination. Three-dimensional images of the carpals and distal radius and ulna were reconstructed with software. Subsequently, the contact site of the scaphoid and lunate on the radial articular surface and the lengths of 8 carpal ligaments between their respective origin and insertion points were measured and compared among different positions of forearm rotation. RESULTS We found that the contact site of the scaphoid on the distal radius moved between 0.2 and 2.0 mm during forearm rotation. The lengths of the 3 ulnar carpal ligaments (ie, ulnocapitate [UC], ulnolunate [UL], and ulnotriquetral [UT] ligaments) showed the greatest and significant change. From neutral position to pronation, the UC, UL, and UT ligaments shortened significantly. From neutral position to supination, the UT ligament lengthened significantly, but the radioscaphocapitate, UC, UL, and dorsal intercarpal ligaments decreased significantly. CONCLUSIONS During forearm rotation, the contact site of the scaphoid and the lunate on the distal radial articular surface changed minimally. The lengths of 3 ulnar carpal ligaments (UC, UL, and UT ligaments) changed substantially. CLINICAL RELEVANCE Our findings will help elucidate carpal biomechanics during forearm rotation. The findings may inform decisions about how to reduce the load to these carpal ligaments when treating the carpal disorders.
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Affiliation(s)
- Yan Rong Chen
- Department of Orthopedics, First Affiliated Hospital of Soochow University, Jiangsu, China
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50
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Abstract
Complex distal radius fractures are high-energy injuries of the wrist with articular disruption, ligamentous instability, significant comminution, soft tissue injury, and/or neurovascular impairment. The management of these injuries requires a thorough understanding of wrist functional anatomy and familiarity with a wide selection of approach and fixation options. This article reviews an approach that involves structured evaluation, aggressive soft tissue management, early reduction and skeletal stabilization, and a columnar approach to definitive care. Outcome is determined by multiple factors and depends greatly on the soft tissue injury, patient factors, and management and the adequacy of restoration of osseous and ligamentous relationships.
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Affiliation(s)
- Stephen A Kennedy
- Hand and Microvascular Surgery, Department of Orthopaedics and Sports Medicine, University of Washington-Roosevelt II, Seattle, WA 98105, USA
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