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Mauler F, Boudabbous S, Beaulieu JY. Midsectional Magnetic Resonance Imaging Analysis of the Sigmoid Notch of the Distal Radioulnar Joint. J Wrist Surg 2023; 12:170-176. [PMID: 36926209 PMCID: PMC10010902 DOI: 10.1055/s-0042-1750874] [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: 01/22/2022] [Accepted: 05/22/2022] [Indexed: 10/17/2022]
Abstract
Purpose This study describes the anatomy and analyzes the variations of the midsectional morphology of the sigmoid notch. Methods The wrists of 50 patients with suspected scaphoid fracture were evaluated by magnetic resonance imaging (MRI). Sigmoid notch length, volar and dorsal rim heights, insertion length of the volar radioulnar ligament, and Tolat morphology classification were measured on T1-weighted axial plane MRI. Ulnar variance and distal radioulnar joint (DRUJ) inclination were assessed on anteroposterior radiographs. Results The most common sigmoid notch shapes were types C (C-shaped, 60%) and B (ski-slope, 30%), followed by types D (S-shaped, 6%) and A (flat, 4%). Types A and B had a flat dorsal rim (mean 0.77 ± 1.09 mm, range 0.0-1.54 mm, and mean 0.22 ± 0.3 mm, range 0.0-0.76 mm, respectively). Types C and D had more prominent dorsal rims (means 1.47 ± 0.59 mm, range 0.66-2.57 mm, and mean 1.6 ± 0.97 mm, range 0.8-2.68 mm, respectively). The average volar lip length was 1.60 ± 1.11 mm (range, 0.0-4.10). The dorsovolar length of the radius was 18.4 ± 2.01 mm; the length of the sigmoid notch was 14.3 ± 1.73 mm. The type of sigmoid notch according to Tolat was significantly associated with volar lip length ( p = 0.005). The type of sigmoid notch was not associated with ulnar variance or DRUJ inclination. The length of the sigmoid notch was significantly associated with the type of sigmoid notch ( p = 0.005). The analysis demonstrated a negative association between the sigmoid notch length and the volar insertion of the radioulnar ligament ( p = 0.019). Conclusions The transversal morphology of the sigmoid notch was either flat with the least congruence (similar to type A of Tolat), with volar congruence only (similar to type B), or with volar and dorsal congruence (similar to types C and D). A shorter sigmoid notch may be compensated by a broader insertion of the volar radioulnar ligament. Clinical Relevance The measurements and correlations demonstrated in this study can be a guide when considering reconstructive procedures or dealing with the instability of the DRUJ.
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Affiliation(s)
- Flavien Mauler
- Department of Plastic Surgery and Hand Surgery, Cantonal Hospital Aarau, Aarau, Switzerland
- The Hand Clinic - Geneva, Geneva, Switzerland
| | - Sana Boudabbous
- Diagnostic Department, Division of Radiology, Geneva University Hospitals, Geneva, Switzerland
- Clinical Medicine Section, Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland
| | - Jean-Yves Beaulieu
- Division of Orthopaedics and Trauma Surgery, Hand Surgery Unit, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, Anatomy Sector, University of Geneva, Geneva, Switzerland
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Hwang JS, Shim BJ, Li Q, Kim J, Baek GH. The Natural History of Kienböck’s Disease Diagnosed at More than Fifty Years of Age. Clin Orthop Surg 2022; 14:450-457. [PMID: 36061838 PMCID: PMC9393282 DOI: 10.4055/cios22022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/23/2022] [Accepted: 05/18/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Ji Sup Hwang
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Bum Jin Shim
- Department of Orthopaedic Surgery, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Qingyuan Li
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
- Department of Hand and Microsurgery, Tianjin Hospital, Tianjin, China
| | - Jihyeung Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Goo Hyun Baek
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
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Casagrande DJ, Morris RP, Carayannopoulos NL, Buford WL. Relationship Between Ulnar Variance, Cortical Bone Density, and Load to Failure in the Distal Radius at the Typical Site of Fracture Initiation. J Hand Surg Am 2016; 41:e461-e468. [PMID: 27707565 DOI: 10.1016/j.jhsa.2016.08.021] [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: 01/21/2016] [Revised: 08/24/2016] [Accepted: 08/28/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE Increased ulnar variance has been shown to lead to diminished load borne by the distal radius. The purpose of this study was to determine the correlations among ulnar variance, bone mineral density, and load to failure at the distal radius. METHODS Posteroanterior radiographs and computed tomographic scans were taken of 12 cadaveric forearms in neutral rotation. Ulnar variance was measured for each wrist by the method of perpendiculars. Measurements of cortical, trabecular, and combined bone density were made at the distal radius. We performed linear regression analysis and correlation analysis to determine the relationship between bone densities and ulnar variance measurements. Next, we loaded the 12 cadaveric radii to failure under axial compression. Linear regression analysis and correlation analysis were then performed to determine the relationship between load to failure and both ulnar variance and cortical density. RESULTS Increased ulnar variance was significantly correlated with decreased cortical bone density at the distal radius and both were correlated with decreased load to failure. We found no correlation between ulnar variance and trabecular density or combined trabecular and cortical bone density at the distal radius. CONCLUSIONS Our study found that increased ulnar variance and decreased cortical bone mineral density correlates with decreased load to failure under axial compression. CLINICAL RELEVANCE Ulnar variance is linked to both bone quality and load to failure at the distal radius.
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Affiliation(s)
- Danielle J Casagrande
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, TX.
| | - Randal P Morris
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, TX
| | | | - William L Buford
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, TX
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Erhart S, Schmoelz W, Arora R, Lutz M. The biomechanical effects of a deepened articular cavity during dynamic motion of the wrist joint. Clin Biomech (Bristol, Avon) 2012; 27:557-61. [PMID: 22289408 DOI: 10.1016/j.clinbiomech.2012.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Revised: 01/09/2012] [Accepted: 01/10/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND A deepened articular cavity of the distal radius due to a metaphyseal comminution zone is associated with early osteoarthritis and reduced joint motion. As this deformity has not been investigated biomechanically, the purpose of this study was to evaluate the effects of a deepened articular cavity on contact biomechanics and motion range in a dynamic biomechanical setting. METHODS Six fresh frozen cadaver forearms were tested in a force controlled test bench during dynamic flexion and extension and intact mean contact pressure and contact area as well as range of motion were evaluated. Malunion was then simulated and intraarticular as well as motion data were obtained. Intact and malunion data were compared for the scaphoid and lunate facet and the total radial joint surface. FINDINGS Due to malunion simulation, cavity depth increased significantly. Motion decreased significantly to 54-69% when compared to the intact state. Malunion simulation led to a significant decrease of contact area in maximum extension for all locations (by ~50%). In maximum flexion and neutral position, contact area decrease was significant for the scaphoid fossa (by 51-54%) and the total radial joint surface (by 47-50%). Contact pressure showed a significant increase in maximum extension in the scaphoid fossa (by 129%). INTERPRETATION Already a small cavity increase led to significant alterations in contact biomechanics of the radiocarpal joint and to a significant range of motion decrease. This could be the biomechanical cause for degenerative changes after the investigated type of malunion. We think that restoration of the normal distal radius shape can minimize osteoarthritis risk post trauma and improve radiocarpal motion.
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Affiliation(s)
- Stefanie Erhart
- Medical University of Innsbruck, Department for Trauma Surgery, Anichstrasse 35, Innsbruck, Austria
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Ramos-Escalona J, García-Bordes L, Martínez-Galarza P, Yunta-Gallo A. Ulnar variance and scaphoid fracture. J Hand Surg Eur Vol 2010; 35:195-7. [PMID: 20007423 DOI: 10.1177/1753193409352281] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Between 1997 and 2006, radiographs of 66 scaphoid fractures were retrospectively reviewed to evaluate ulnar variance. Twenty-one (31.8%) patients had an 'ulna neutral' wrist, six (9.1%) had an 'ulna plus' and 39 (59.1%) had an 'ulna minus' wrist. The mean ulnar variance was -1.3 (SD 1.8) mm (range -5.5, 2.5). We observed a significant difference in the distribution of ulnar variance (P < 0.00001) and in the proportion of cases with ulna minus (OR = 5.0; 95% CI: 2.7, 9.3) compared to previous publications.
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Affiliation(s)
- J Ramos-Escalona
- Department of Orthopaedic Surgery and Traumatology, Hospital General de Granollers, Granollers, Barcelona, Spain
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The changes in bone mineral density of the forearm and distal radius–ulna subcortical bone due to ulnar variance. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2009. [DOI: 10.1007/s00590-009-0430-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Polk JD, Blumenfeld J, Ahluwalia D. Knee Posture Predicted from Subchondral Apparent Density in the Distal Femur: An Experimental Validation. Anat Rec (Hoboken) 2008; 291:293-302. [DOI: 10.1002/ar.20653] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Patel BA, Carlson KJ. Bone density spatial patterns in the distal radius reflect habitual hand postures adopted by quadrupedal primates. J Hum Evol 2007; 52:130-41. [PMID: 17055031 DOI: 10.1016/j.jhevol.2006.08.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2006] [Revised: 07/10/2006] [Accepted: 08/03/2006] [Indexed: 11/16/2022]
Abstract
Primates adopt diverse hand postures during terrestrial and above-branch quadrupedal locomotion--knuckle-walking, digitigrady, and palmigrady--that incorporate varying degrees of wrist dorsiflexion (i.e., extension). Although relationships between hand postures, wrist joint range of motion, and the external properties of wrist bones (e.g., surface morphology) have been examined, the relationship between hand postures and the internal properties of wrist bones (e.g., bone density) remains largely unexplored. Because articular joint surfaces transmit mechanical loads between conjoining limb bones, measures of density (e.g., magnitudes and patterns) in the subchondral cortical plate of bone of the distal radius can be used to evaluate load regimes experienced by the wrist joint in different hand postures. We assessed apparent (i.e. optical) density patterns in several extant catarrhine primate taxa partitioned into different hand posture groups: knuckle-walking apes, digitigrade monkeys, and palmigrade monkeys. Computed tomography osteoabsorptiometry (CT-OAM) was used to construct maximum intensity projection (MIP) maps of apparent densities. High apparent density areas were characterized relative to a dorsal-volar reference plane and compared across hand posture groups. All groups had large percentage areas of high apparent density in the dorsal region of the distal radial articular surface. Only knuckle-walking apes, however, had a large percentage area of high apparent density in the volar region of the distal radial articular surface. These patterns are consistent with radiocarpal articulations in specific hand postures as evidenced by available radiographic data and suggest that the different habitual hand postures adopted by monkeys and African apes during quadrupedal locomotion have different stereotypic loading patterns. This has implications for understanding the functional morphology and evolution of knuckle-walking and digitigrade hand postures in primates.
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Affiliation(s)
- Biren A Patel
- Interdepartmental Doctoral Program in Anthropological Sciences, Stony Brook University, Stony Brook, NY 11794-4364, USA.
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Carlson KJ, Patel BA. Habitual use of the primate forelimb is reflected in the material properties of subchondral bone in the distal radius. J Anat 2006; 208:659-70. [PMID: 16761969 PMCID: PMC2100237 DOI: 10.1111/j.1469-7580.2006.00555.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2006] [Indexed: 11/30/2022] Open
Abstract
Bone mineral density is directly proportional to compressive strength, which affords an opportunity to estimate in vivo joint load history from the subchondral cortical plate of articular surfaces in isolated skeletal elements. Subchondral bone experiencing greater compressive loads should be of relatively greater density than subchondral bone experiencing less compressive loading. Distribution of the densest areas, either concentrated or diffuse, also may be influenced by the extent of habitual compressive loading. We evaluated subchondral bone in the distal radius of several primates whose locomotion could be characterized in one of three general ways (quadrupedal, suspensory or bipedal), each exemplifying a different manner of habitual forelimb loading (i.e. compression, tension or non-weight-bearing, respectively). We employed computed tomography osteoabsorptiometry (CT-OAM) to acquire optical densities from which false-colour maps were constructed. The false-colour maps were used to evaluate patterns in subchondral density (i.e. apparent density). Suspensory apes and bipedal humans had both smaller percentage areas and less well-defined concentrations of regions of high apparent density relative to quadrupedal primates. Quadrupedal primates exhibited a positive allometric effect of articular surface size on high-density area, whereas suspensory primates exhibited an isometric effect and bipedal humans exhibited no significant relationship between the two. A significant difference between groups characterized by predominantly compressive forelimb loading regimes vs. tensile or non-weight-bearing regimes indicates that subchondral apparent density in the distal radial articular surface distinguishes modes of habitually supporting of body mass.
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Affiliation(s)
- Kristian J Carlson
- Department of Anatomical Sciences, School of Medicine, Stony Brook University, USA.
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Coskun N, Deniz Akman-Mutluay S, Erkilic M, Koebke J. Densitometric analysis of the human first tarsometatarsal joint. Surg Radiol Anat 2005; 28:135-41. [PMID: 16374570 DOI: 10.1007/s00276-005-0064-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2005] [Accepted: 10/10/2005] [Indexed: 02/04/2023]
Abstract
The first tarsometatarsal (TMT) joint has a complex role in regulating joint pressure in the midfoot. Despite its importance, there have been only a few studies of the functional morphology and biomechanical function of this joint. Here we report about the densitometric pattern of the subchondral bone layer of the articulating elements of the human first TMT joint. We studied dry bones of the first metatarsal and medial cuneiform bones in 64 human cadavers to establish the pattern of the density distribution and to correlate it with the biomechanical function of the joint. The articular surfaces of both the bones were analyzed planimetrically. Half of the specimens (n=32) were sectioned in the sagittal plane and the other 32 articulations were in the transverse plane. In all the sections, the subchondral bone density of the first TMT joint was measured. We found that in sagittal slices the dorsal area of the lateral parts and intermediate parts in females and the dorsal area of the lateral parts, the medial parts and intermediate parts in males were denser than the plantar area and that its density decreased towards the plantar area. The dorsal parts of transverse slices in males were the densest and its density decreased towards the plantar part. In the dorsal, middle and plantar parts in females in transverse slices, the lateral and intermediate areas were denser than the medial areas (P<0.05). There was no significant difference between the bone densities of females and males.
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Affiliation(s)
- Nigar Coskun
- Department of Anatomy, Faculty of Medicine, Akdeniz University, 07070, Antalya, Turkey.
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Giunta RE, Krolak C, Biemer E, Müller-Gerbl M. Patterns of subchondral bone mineralization in the distal radioulnar joint. J Hand Surg Am 2005; 30:343-50. [PMID: 15781358 DOI: 10.1016/j.jhsa.2004.09.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2004] [Accepted: 09/29/2004] [Indexed: 02/02/2023]
Abstract
PURPOSE Studies have shown that it is possible to derive direct knowledge about the actual mechanical conditions of the wrist by analyzing the subchondral mineralization. The aim of the present study was to evaluate the distribution of the subchondral bone mineralization of the distal radioulnar joint (DRUJ) noninvasively in living subjects by using computed tomography (CT) osteoabsorptiometry to gain new information about the long-term loading conditions. METHODS Twenty-two wrist joints were investigated in 11 healthy young subjects by means of CT osteoabsorptiometry. The CT scans of the DRUJ were taken in the axial plane in neutral position of the forearm and in both maximum pronation and supination. The CT datasets of 1.5-mm sections were obtained and then transferred to an image-analyzing system. The subchondral bone plate in each section was isolated, reconstructed in 3 dimensions, and converted into a false color series. RESULTS The maximum subchondral bone density in the sigmoid notch of the radius was found along the distal border in all wrists. It was located dorsally in 10 wrists, palmarly in 8 wrists, and centrally in 4 wrists. The maximum bone density on the corresponding articular surface of the ulna was found dorsally in 10 cases, centrally in 8 cases, and palmarly in 4 cases. In 13 cases the maximum bone density was found in direct opposition on radius and ulna in neutral position. A statistically significant difference could not be detected in subjects with an ulna minus variance nor in those with a DRUJ angulation greater than 10 degrees . CONCLUSIONS Our results show that in the sigmoid notch the load is transmitted through either the dorsal or palmar parts of the joint. In contrast the maximum bone density on the side of the ulna was found dorsally and centrally. We conclude that the ulna receives the maximum load in neutral position and supination, whereas because of the dorsopalmar translation of the ulnar head the radius may lead the ulna with either its palmar or dorsal borders during pronosupination. The ligamentous apparatus, the shape of the joint, and the ulna variance, however, may influence load transmission.
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Affiliation(s)
- Riccardo E Giunta
- Department of Plastic and Reconstructive Surgery, University of Technology, Munich, Germany
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