Carpal Kinematics in Madelung Deformity

Pure traumatic unstable radiocarpal dislocation over pre-existing ulnar impingement syndrome, extensively arched carpus and medially rotated scaphoid: An exceptional and complex case report

Introduction and importance

Radiocarpal dislocation is a rare and severe injury that demands urgent diagnosis and treatment. In this case report, we present the unique scenario of a 32-year-old male who suffered a traumatic pure unstable radiocarpal dislocation. This dislocation was associated with ulnar impingement syndrome, an extensively arched carpus, and a medially rotated scaphoid. The complexity of this injury underscores the importance of timely intervention and comprehensive management.

Case presentation

The patient had a pre-existing short ulnar head with radial-sided deformity, radioulnar convergence, negative ulnar variance, erosive scalloping of the distal radius, subchondral sclerosis of the ulnar head, scapholunate diastasis, and distal radioulnar joint (DRUJ) diastasis. Following a high-velocity motor vehicle accident, the initial treatment involved closed reduction and radio-metacarpal external fixation. Additionally, surgical intervention was required for an open dislocation of the metatarsophalangeal (MTP) joint of the left hallux.

Clinical discussion

The subsequent management of this complex case included the Sauvé-Kapandji procedure, ulnolunate and ulnotriquetral ligamentoplasty using the palmaris longus tendon, and scapholunate fusion. The patient reported no prior wrist instability or injury upon awakening, but mild mechanical wrist pain persisted after exertion. Follow-up assessments revealed residual pain during prono-supination, along with slightly limited radial inclination. This exceptional case highlights the biomechanical challenges and the need for a multidisciplinary approach in treating such injuries.

Conclusion

To the best of our knowledge, this is the first documented instance of a traumatic pure unstable radiocarpal dislocation associated with ulnar impingement syndrome, an extensively arched carpus, and a medially rotated scaphoid. Despite the complexity, proper bone healing and favorable functional outcomes were achieved through meticulous surgical management. This case underscores the importance of individualized treatment strategies for rare and challenging wrist injuries.

Assessment of 3.0 Tesla magnetic resonance imaging in Madelung's deformity: findings and implications

OBJECTIVE

The aim of the study was to investigate the 3.0 Tesla magnetic resonance imaging (MRI) features of Madelung's deformity.

MATERIALS AND METHODS

The wrist MRI scans of 19 patients clinically diagnosed with Madelung's deformity and 20 patients without deformity were consecutively selected from Beijing Jishuitan Hospital between April 2019 and December 2022 for observation, in the case group and control group, respectively. Multiple linear regression was used to analyze the factors affecting tilting angle and width of central disc (CD, also termed as triangular fibrocartilage, the main component of triangular fibrocartilage complex), while the chi-square test was used to compare the occurrences of CD (radial) attachment displacement, VL, and RTL. p < 0.05 indicated statistical significance.

RESULTS

Madelung's deformity significantly contributed to the tilting and thickening of the CD. In the case group, the tilting angle and thickness of CD were (51.46 ± 1.33)° and (0.23 ± 0.01) cm, respectively, which was statistically significant (p < 0.05); the radial attachment of the CD significantly shifted away from the distal articular surface level (χ2 = 39.00, p < 0.001), with a mean displacement of (0.97 ± 0.38) cm. Furthermore, the cases demonstrated abnormally developed Vickers ligament (χ2 = 35.19, p < 0.001) and radiotriquetral ligament (χ2 = 25.66, p < 0.001).

CONCLUSION

MRI provides a notable advantage in diagnosing Madelung's deformity. Compared with the control group, patients with Madelung's deformity exhibited tilting and thickening of the CD. Additionally, the radial attachment of the CD was significantly shifted proximally with abnormal development of Vickers and radiotriquetral ligaments.

Abnormal Wrist Sagittal Kinematics in Gymnasts With Dorsal Wrist Pain: A New Syndrome

BACKGROUND

The pathology of dorsal wrist pain in gymnasts without abnormal radiographic findings remains unclear.

PURPOSE/HYPOTHESIS

The purpose of this study was to identify abnormal wrist sagittal kinematics in gymnasts with dorsal wrist pain. It was hypothesized that gymnasts with dorsal wrist pain would show abnormal sagittal kinematics with reversible hypermobility of the intercarpal joint.

STUDY DESIGN

Controlled laboratory study.

METHODS

Participants included 19 wrists in male gymnasts with dorsal wrist pain, 18 wrist in male gymnasts without wrist pain, and 20 adult men without a history of wrist pain. Magnetic resonance imaging (T2-weighted sagittal images) findings at 0°, 30°, 60°, and 90° of wrist extension were used in kinematic analysis. The angles and translations of the radiolunate, capitolunate, and third carpometacarpal joint were measured and compared between the 3 groups.

RESULTS

At 90° of wrist extension, gymnasts with dorsal wrist pain had a significantly lower radiolunate joint angle (28.70°± 6.28° vs 36.19°± 7.81°; P = .020) and a significantly higher capitolunate joint angle (57.99°± 6.15° vs 50.50°± 6.98°; P = .004) and distal translation (1.17 ± 0.50 mm vs 0.46 ± 0.62 mm; P = .002) than gymnasts without dorsal wrist pain.

CONCLUSION

Gymnasts with dorsal wrist pain showed abnormal wrist sagittal kinematics. These novel findings may facilitate understanding of dorsal wrist pain, which can be recognized as a new syndrome termed "gymnast's lunate dyskinesia."

Computed Tomography: State-of-the-Art Advancements in Musculoskeletal Imaging

ABSTRACT

Although musculoskeletal magnetic resonance imaging (MRI) plays a dominant role in characterizing abnormalities, novel computed tomography (CT) techniques have found an emerging niche in several scenarios such as trauma, gout, and the characterization of pathologic biomechanical states during motion and weight-bearing. Recent developments and advancements in the field of musculoskeletal CT include 4-dimensional, cone-beam (CB), and dual-energy (DE) CT. Four-dimensional CT has the potential to quantify biomechanical derangements of peripheral joints in different joint positions to diagnose and characterize patellofemoral instability, scapholunate ligamentous injuries, and syndesmotic injuries. Cone-beam CT provides an opportunity to image peripheral joints during weight-bearing, augmenting the diagnosis and characterization of disease processes. Emerging CBCT technologies improved spatial resolution for osseous microstructures in the quantitative analysis of osteoarthritis-related subchondral bone changes, trauma, and fracture healing. Dual-energy CT-based material decomposition visualizes and quantifies monosodium urate crystals in gout, bone marrow edema in traumatic and nontraumatic fractures, and neoplastic disease. Recently, DE techniques have been applied to CBCT, contributing to increased image quality in contrast-enhanced arthrography, bone densitometry, and bone marrow imaging. This review describes 4-dimensional CT, CBCT, and DECT advances, current logistical limitations, and prospects for each technique.