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Gosselin C, Rieussec C, Mansat P, Girard M, Delclaux S, Barret H. Isolated volar dislocation of the distal radioulnar joint: Current concepts review and case report. ANN CHIR PLAST ESTH 2024; 69:449-456. [PMID: 39003223 DOI: 10.1016/j.anplas.2024.06.006] [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: 12/18/2023] [Accepted: 06/09/2024] [Indexed: 07/15/2024]
Abstract
Isolated volar distal radioulnar joint (DRUJ) dislocation is a rare condition with only a few cases reported in the literature. Its diagnosis is often overlooked in the acute phase, and there is no consensus in its management. We present the case of a 20-year-old male patient with an isolated volar radioulnar dislocation, together with a review of the literature. The aim is to present and summarize the acute management of this condition and propose a therapeutic algorithm.
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Affiliation(s)
- Cerise Gosselin
- Chirurgie orthopédique et traumatologique, CHU de Toulouse, 1, place Joseph Baylac, 31000 Toulouse, France.
| | - Clémentine Rieussec
- Chirurgie plastique et reconstructrice des membres, chirurgie de la main et des nerfs, CHU de Grenoble, boulevard de la Chantourne, 38700 La Tronche, France
| | - Pierre Mansat
- Chirurgie orthopédique et traumatologique, CHU de Toulouse, 1, place Joseph Baylac, 31000 Toulouse, France
| | - Mathieu Girard
- Chirurgie orthopédique et traumatologique, CHU de Toulouse, 1, place Joseph Baylac, 31000 Toulouse, France
| | - Stéphanie Delclaux
- Chirurgie orthopédique et traumatologique, CHU de Toulouse, 1, place Joseph Baylac, 31000 Toulouse, France
| | - Hugo Barret
- Chirurgie orthopédique et traumatologique, CHU de Toulouse, 1, place Joseph Baylac, 31000 Toulouse, France
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Wieschollek S, Megerle K. [Concomitant injuries of the wrist, distal ulna and distal radioulnar joint in distal radius fractures : Primary operative cotreatment vs. healing with no additional treatment]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2024; 127:430-436. [PMID: 38592447 DOI: 10.1007/s00113-024-01424-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 04/10/2024]
Abstract
Distal radius fractures are the most common fractures in adults and account for one quarter of all fractures, with increasing incidence. The number of patients and the requirement of an exact treatment are high. Continuous developments in diagnostic and operative possibilities enable in many cases a high-quality treatment with good clinical outcome; however, radius fractures rarely occur alone but in combination with additional fractures or ligamentous injuries. The frequency and extent of these injuries are not linked to the complexity of the primary injury. The aim is to recognize and correctly diagnose potential concomitant injuries. Many injuries do not need immediate treatment but heal without additional treatment after the radius has been treated. It is important to recognize those injuries which can cause severe complications if untreated; however, exactly this is often difficult. In many cases there is still no consensus if and how concomitant injuries should be treated. This article highlights the most frequent concomitant injuries in distal radius fractures with the possible advantages and disadvantages of cotreatment in order to facilitate decision making.
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Affiliation(s)
- Stefanie Wieschollek
- Zentrum für Handchirurgie, Mikrochirurgie und plastische Chirurgie, Schön Klinik München Harlaching, Harlachinger Straße 51, 81547, München, Deutschland.
| | - Kai Megerle
- Zentrum für Handchirurgie, Mikrochirurgie und plastische Chirurgie, Schön Klinik München Harlaching, Harlachinger Straße 51, 81547, München, Deutschland
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Kim S, Salloum M, Millrose M, Goelz L, Eisenschenk A, Haralambiev L, Bakir S, Asmus A. Weight-bearing test of traumatic triangular fibrocartilage complex lesion with unstable radioulnar joint. J Hand Ther 2024; 37:38-43. [PMID: 37777442 DOI: 10.1016/j.jht.2023.08.002] [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: 03/06/2022] [Revised: 08/02/2023] [Accepted: 08/08/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Ulnar-sided wrist pain might be caused by a lesion of the triangular fibrocartilage complex (TFCC). Patients with TFCC lesion may show an instability of the distal radioulnar joint (DRUJ). Before arthroscopic assessment, conservative therapy using a brace or splint may result in alleviation of symptoms. The results of our previous study showed that patients with a traumatic TFCC lesion and instability of the DRUJ had the smallest weight-bearing capacity and had the largest increase in application of the wrist brace (WristWidget). PURPOSE In this prospective study, we wanted to test if the weight-bearing capacity with and without the wrist brace can be used as a diagnostic tool to differentiate between patients with traumatic TFCC lesion and instability of the DRUJ. We tested if patients with traumatic TFCC lesion and instability of the DRUJ (1) have a lower weight-bearing capacity and (2) show a higher increase of weight-bearing capacity after application of a wrist brace compared to all other types of injury. STUDY DESIGN This was a prospective cohort study. METHODS Forty-eight patients presented to an outpatient clinic with suspected TFCC lesion. We measured the dynamic weight-bearing capacity of both hands with and without the wrist brace (WristWidget) by letting the patients lean on an analog scale with extended arm and wrist. The stability of the DRUJ was assessed by clinical examination by a hand surgeon preoperatively and intraoperatively. Forty-five patients received an arthroscopy and were included in the analysis. During arthroscopy, the surgeon determined if there was a traumatic TFCC lesion and DRUJ instability. Patients with a traumatic lesion of the TFCC and DRUJ instability were compared to all other cases. We used the t-test for normally distributed values, Mann-Whitney U test for nonnormally distributed values, and the Chi-square test for categorical variables, respectively Fisher's exact if the expected cell count was less than five. RESULTS Patients with a traumatic TFCC lesion and DRUJ instability had a higher weight-bearing capacity (22.8 kg) than all other cases (13.8 kg; p < 0.01). This is in contrast to our previous study, in which patients with a traumatic lesion of the TFCC had the tendency to show lower values of weight-bearing capacity than those with a degenerative lesion. While the wrist brace was worn, the relative gain was not significantly lower in patients with traumatic TFCC lesions and DRUJ instability compared to all other cases (21% vs 54%, p = 0.16). All included cases showed the same absolute increase of about 4 kg in weight-bearing capacity with the wrist brace (p = 0.93) CONCLUSIONS: The weight-bearing test cannot be used to identify patients with traumatic TFCC lesion and DRUJ instability among those with suspected TFCC lesion. The results of our previous study could be confirmed that the weight-bearing capacity on the injured side was higher with brace than without.
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Affiliation(s)
- S Kim
- Klinik und Poliklinik für Unfall-, Wiederherstellungschirurgie und Rehabilitative Medizin, Universitätsmedizin Greifswald, Greifswald, Germany; Leibniz Institut für Plasmaforschung und Technologie (INP Greifswald), Greifswald, Germany.
| | - Mouataz Salloum
- Abteilung für Hand-, Replantations, und Mikrochirurgie, Unfallkrankenhaus Berlin, Berlin, Germany
| | - Michael Millrose
- Klinik und Poliklinik für Unfall-, Wiederherstellungschirurgie und Rehabilitative Medizin, Universitätsmedizin Greifswald, Greifswald, Germany; Abteilung für Unfallchirurgie, Sportorthopädie und Kindertraumatologie, Klinikum Garmisch-Partenkirchen, Garmisch-Partenkirchen, Germany; Klinik für Orthopädie und Unfallchirurgie, Paracelsus Medizinische Privatuniversität Nürnberg, Nürnberg, Germany
| | - Leonie Goelz
- Institut für Radiologie und Neuroradiologie, Unfallkrankenhaus Berlin, Berlin, Germany
| | - Andreas Eisenschenk
- Klinik und Poliklinik für Unfall-, Wiederherstellungschirurgie und Rehabilitative Medizin, Universitätsmedizin Greifswald, Greifswald, Germany; Abteilung für Hand-, Replantations, und Mikrochirurgie, Unfallkrankenhaus Berlin, Berlin, Germany
| | - Lyubomir Haralambiev
- Klinik und Poliklinik für Unfall-, Wiederherstellungschirurgie und Rehabilitative Medizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Sinan Bakir
- Klinik und Poliklinik für Unfall-, Wiederherstellungschirurgie und Rehabilitative Medizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Ariane Asmus
- Klinik und Poliklinik für Unfall-, Wiederherstellungschirurgie und Rehabilitative Medizin, Universitätsmedizin Greifswald, Greifswald, Germany; Abteilung für Hand-, Replantations, und Mikrochirurgie, Unfallkrankenhaus Berlin, Berlin, Germany
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Minhas S, Kakar S, Wall LB, Goldfarb CA. Foveal Triangular Fibrocartilage Complex Tears: Recognition of a Combined Tear Pattern. J Hand Surg Am 2023; 48:1063.e1-1063.e6. [PMID: 35550309 DOI: 10.1016/j.jhsa.2022.03.010] [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: 04/23/2021] [Revised: 01/28/2022] [Accepted: 03/09/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Triangular fibrocartilage complex (TFCC) injuries are categorized most commonly by the Palmer and the Atzei and Luchetti classifications. Combined tears are reported less frequently, and the classification of these tears is unclear. In this study, we present a series of patients with combined central disc and foveal TFCC tears that do not fit into either of these classifications. METHODS Seventeen patients from 2 institutions presented with a combined central and foveal TFCC tear, confirmed by wrist arthroscopy between September 2017 and December 2020. Patient demographics, injury mechanism, associated injuries, clinical findings, magnetic resonance imaging results, surgeon description of tears, and treatment rendered were evaluated. RESULTS Patients were predominantly female (76%). Mean age was 40 years with a bimodal age distribution (7/17 patients <35 and 10/17 >45 years). Eleven patients (65%) sustained the injury from a fall. All had some degree of distal radioulnar joint (DRUJ) instability on clinical examination and almost half (8/17) had a history of a distal radius or ulnar styloid fracture during the initial injury. The foveal tear was confirmed by direct visual assessment and a positive hook test result; a suction test result commonly was positive as well. All patients underwent debridement of the central tear, and 16 of 17 underwent foveal TFCC repair with 1 having an irreparable tear. CONCLUSIONS We present a series of patients with combined central disc and foveal TFCC tears, a pattern that does not fit current classification schemes. All patients exhibited some degree of instability of the DRUJ and almost half had a history of distal radius or ulnar styloid fracture. Identification of a central tear of the TFCC, together with even subtle DRUJ instability, should lead to consideration of a coexistent foveal tear. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic IV.
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Affiliation(s)
- Shobhit Minhas
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO
| | - Sanjeev Kakar
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN
| | - Lindley Bevelle Wall
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO
| | - Charles Alan Goldfarb
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO.
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Abstract
ABSTRACT In this dynamic protocol, ultrasound evaluation of the wrist and hand is described using various maneuvers for relevant conditions. Scanning videos are coupled with real-time patient examination videos. The authors believe that this practical guide - prepared by the international consensus of several experts - will help musculoskeletal physicians perform a better and uniform/standard examination approach.
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Panagopoulos A, Solou K, Tatani I, Kouzelis A, Kokkalis Z. A Case of Bilateral Galeazzi Fracture-Dislocations. Cureus 2021; 13:e17491. [PMID: 34603873 PMCID: PMC8476194 DOI: 10.7759/cureus.17491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2021] [Indexed: 11/05/2022] Open
Abstract
Bilateral Galeazzi fracture-dislocations are extremely rare injuries and only a few case reports have been described so far in the literature. Herein, we report the case of a 31-year-old bicyclist who sustained bilateral Galeazzi fracture-dislocations after a collision with a car. Both radial shaft fractures were simple (AO type 22-A2.3), at the same level (Type I: <7.5 cm from the joint line), and without severe comminution having their apex located dorsally. Internal fixation was accomplished in both fractures with an 8-hole, 3.5-mm locking plate; the stability of the distal radioulnar joint (DRUJ) was assessed with several intraoperative tests and found to be stable so that no additional stabilization was necessary. Postoperatively, the forearms were immobilized in a long forearm cast for four weeks. At the last follow-up evaluation, six years postoperatively, the patient was pain-free, had a full range of motion with a total Mayo wrist score of 95 in both wrists. Bilateral Galeazzi fracture-dislocations are rare injuries requiring proper radial fracture management and thorough assessment of DRUJ stability.
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Affiliation(s)
| | | | - Irini Tatani
- Orthopaedic Department, University of Patras, Patras, GRC
| | | | - Zinon Kokkalis
- Orthopaedic Department, University of Patras, Patras, GRC
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Moradi A, Binava R, Hedjazi A, Eslami Hasanabadi S, Taher Chaharjouy N, Ebrahimzadeh MH. Biomechanical evaluation of intraosseous distal radioulnar joint prosthesis: A prosthesis designed based on Sauvé-Kapandji procedure. Orthop Traumatol Surg Res 2021; 107:102975. [PMID: 34087499 DOI: 10.1016/j.otsr.2021.102975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 10/31/2020] [Accepted: 12/09/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION To avoid the DRUJ surgical procedures disadvantages, a new intraosseous distal radioulnar prosthesis designed on Sauvé-Kapandji procedure has been introduced. Stability of the prosthesis and biomechanics are to be evaluated in this article. MATERIALS AND METHODS On a cadaveric study, during placement of the prosthesis, biometry of the bones, prosthesis stability (in axial and lateral tractions, wrist pronation and supination, and squeeze test), wrist range of motion before and after implantation, and radiographic evaluation were done on 16 cadavers. RESULTS Range of motion of the wrist joint before and after the insertion of the prosthesis, had no significant difference in all six directions. Stability of the prosthesis, when rotational pronation force was exerted, was greater than when rotational supination force was exerted. The prosthesis showed significant stability against longitudinal traction forces in a way that no prosthesis dislocation was observed up to 150N forces. Stability of the prosthesis was investigated when lateral force was applied to different wrist positions. The most stable position of the prosthesis was in the case of lateral traction forces in supination where no case of dislocation was observed. CONCLUSIONS The intraosseous distal radioulnar prosthesis demonstrated stable structure with no effect on wrist range of motion. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Ali Moradi
- Orthopedic Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Reza Binava
- Orthopedic Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Arya Hedjazi
- Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
| | | | - Negar Taher Chaharjouy
- Orthopedic Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
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Abstract
This article reviews the anatomy and mechanics of pronation and supination (axial rotation) of the forearm through the distal radioulnar joint (DRUJ), and the proximal radioulnar joint (PRUJ). Injuries to the bones and/or ligaments of the forearm, wrist, or elbow can result in instability, pain, and limited rotation. Acute dislocations of the DRUJ commonly occur along with a fracture to the distal radius, radial metadiaphysis, or radial head. These injuries are all caused by high-energy trauma. Outcomes are predicated on anatomic reduction and restoration of stability to the DRUJ and PRUJ with or without ligamentous repair or reconstruction.
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Affiliation(s)
- Louis H Poppler
- Department of Plastic & Reconstructive Surgery, St. Luke's Health System, Boise, ID, USA
| | - Steven L Moran
- Department of Plastic & Reconstructive Surgery, Mayo Clinic, Rochester, MN, USA; Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
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