Ageing does not affect ulnar variance: an investigation in Taiwan

Association of ulnar variance with three-dimensional carpal alignment and demographics in asymptomatic volunteers

BACKGROUND

Several carpal pathologies are considered to be related to ulnar variance. Recently, computer-aided computed tomography (CT) analysis software was introduced to quantify three-dimensional (3D) carpal alignment with high accuracy and reliability.

PURPOSE

To determine the association of ulnar variance with 3D carpal alignment and demographics.

MATERIAL AND METHODS

A wrist of 121 asymptomatic volunteers (69 men, 52 women; mean age = 38 ± 10.4 years) was imaged in the neutral wrist position with cone-beam CT. Computer-aided CT analysis software (Bonelogic), based on segmentation and numerical modelling, was used to define ulnar variance and standardized 3D axes for all carpal bones. The association of ulnar variance with 3D carpal alignment, age of the volunteer, and side and dominance of the imaged wrist was assessed.

RESULTS

The mean ulnar variance was -1.6 ± 1.5 mm (range = -5.3 to 2.4 mm). The mean ulnar variance was -1.9 mm and -1.1 mm in men and women (P = 0.007), respectively. Of the imaged 121 wrists, 18 (15%) had positive and 103 (85%) negative ulnar variance. There was no association between ulnar variance and any of the radio- or intercarpal angle values in either the sagittal or coronal plane (ρ = -0.16…0.17, r = -0.13….0.12). The ulnar variance showed no association with side (P = 0.51) or dominance (P = 0.27) of the imaged wrist.

CONCLUSION

3D carpal alignment is not affected by ulnar variance. The association of ulnar variance with sex may in part explain the difference in reported prevalence of some carpal pathologies, such as ulnar impaction syndrome and Kienböck's disease.

The effect of ulnar variance on the pisotriquetral joint

BACKGROUND

Pisotriquetral joint (PTJ) disorders are an important cause of ulnar-sided wrist pain but are often underrecognized. Ulnar variance (UV) has been associated with several wrist pathologies.

PURPOSE

To determine the effect of UV on PTJ in patients with trauma.

MATERIAL AND METHODS

A total of 143 patients (77 men, 66 women; mean age=41.64 ± 18.07 years) were included. Patients with fractures, severe and high-energy trauma, arthritic conditions, avascular necrosis, congenital deformity, bone and soft-tissue tumors, suboptimal image quality, and incorrect joint position were excluded. UV and the amount of PTJ subluxation were evaluated using coronal and sagittal computed tomography images.

RESULTS

PTJ subluxation was divided into five grades. A statistically significant difference was found between the presence of PTJ subluxation and sex (P = 0.045). PTJ subluxation was more common in men (46.8%) than in women (30.3%). There was no significant difference between the presence of PTJ subluxation and age (P = 0.758). The patients were also divided into three groups as positive, neutral, and negative UV. A statistically significant relationship was found between the UV and presence of PTJ subluxation (P = 0.01). PTJ subluxation was significantly less in the neutral (none=51.1%, present=48.9%; P < 0.05) and negative (none=77.8%, present=22.2%; P < 0.05) groups.

CONCLUSION

PTJ subluxation was found to be less among the groups with neutral and negative UV in our study population. PTJ subluxation is more common in men while there is no relationship with age. UV and gender may be risk factors for PTJ subluxation by affecting force dynamics at the wrist joint.

Morphometric Analysis of Ulnar Variance and Its Demographic Dynamics Using High Resolution MRI: A Retrospective Study in Indian Population and Review of Literature

Background

Ulnar variance (UV) is the variation of the level of the distal articulating surface of the radius with respect to the distal articulating surface of the ulna. These variations either positive or negative can predispose to pathologies involving the wrist joint. The aim of this study was to measure the ulnar variance in a subset of Indian population using high-resolution MRI and compare our results with the existing literature.

Materials and Methods

Retrospective analysis of 100 normal wrist MRIs were done performed during November 2020 to November 2021 and the ulnar variance was calculated using the Method of Perpendiculars. All the MRI sequences were performed by an experienced radiologist with prior fixed protocol for the study. The measurements were done on the mid-coronal section based on the Method of Perpendiculars using Meddiff Rispacs software.

Results

The average age of the participants was 42 years, with Male to female ratio of 0.9:1. 47 MRIs were of the left wrist, while 53 MRIs were of the right wrist. The mean UV was - 0.7 mm (SD-0.175), ranging from - 4.5 mm to 3.5 mm. There was a significant relationship between ulnar-variance and age, as ulnar-variance increases with the age (p value = 0.039). There was no statistically significant correlation of ulnar-variance with gender distribution and handedness.

Conclusions

This study utilized high-resolution MRI for measuring ulnar-variance in a subset of Indian population and disclosed that the ulnar-variance affirms a positive correlation with age, while no specific pattern between the ulnar-variance and gender or handedness could be established.

Graphical abstract

Importance of measurement methods and demographic characteristics in evaluating ulnar variance: A retrospective comparative study

OBJECTIVE

This study aimed to compare 2 methods of ulnar variance (UV) measurement (the perpendicular method and the circular method) and to determine whether UV changed based on the demographic characteristics (sex and age).

METHODS

UV was measured on bilateral wrist radiographs of 124 patients (62 men, 62 women; mean age=48.5 years; range=18-79 years) who had no history of trauma, congenital wrist anomaly, previous wrist surgery, and wrist osteoarthritis by a single radiologist with 4 years of experience. All measurements were made on standardized radiographic images using 2 methods: the perpendicular method and the circular method. All the patients were then divided into groups based on sex and age, and the study population was determined by selecting a similar number of patients for each sex and age group.

RESULTS

The mean UV of the right and left wrists was measured as 0.33 (range=-4.3 to 5.7) mm by the perpendicular method and as 0.034 (range=-5 to 5.7) mm by the circular method. A significant difference was determined between the 2 measurement methods (p<0.001). There was a statistically significant difference between sex and UV values in the left wrist measurements by both methods (p<0.05). A significant correlation was found between the UV and age in both right and left side measurements, indicating a statistically significant difference between the methods (p<0.001).

CONCLUSION

The results of our study demonstrated significant differences in the UV measurement between the 2 methods. Furthermore, UV measurement may change based on age and sex. These differences should be considered in the treatment planning of patients with wrist disorders.

LEVEL OF EVIDENCE

Level IV, Therapeutic Study.

Morphology at the Distal Radioulnar Joint: Identifying the Prevalence of Reverse Obliquity

Background  Recent advances in the understanding of ulnar-sided wrist pathologies such as ulnar abutment syndrome (UAS) have brought increased attention to the anatomy of the distal radioulnar joint (DRUJ). Previous work established three anatomical variants of the sigmoid notch (parallel, oblique, and reverse oblique). The reverse oblique DRUJ poses theoretical risk of increased contact forces following ulnar shortening osteotomy, a common method of treating UAS. Purpose  As prevalence of reverse oblique morphology has been under-reported, this study aims to better define the prevalence of reverse oblique morphology in the adult population. Methods  Institutional Review Board-approved review of 1,000 radiographs over a 2-year period was performed. Demographic data and radiographic measurements were recorded (ulnar variance, notch inclination, and presence of arthritis). Correlation tests, a test of proportions, a t -test, and linear and logic regression tests were used to examine associations between ulnar variance, sigmoid inclination, sex, age, and presence of arthritis. Results  One thousand radiographs were analyzed revealing prevalence rates of: parallel-68%, oblique-26%, and reverse oblique-6%. Females were significantly more likely to have reverse inclination. No significant correlation was noted for morphology by age. Ulna positive variance was negatively correlated with reverse inclination. DRUJ arthritis was noted in 14% of patients. Higher sigmoid inclination was associated with higher odds of presence of arthritis, adjusting for sex and age. Higher incidence of arthritis was noted among patients with the oblique (20.8%) or reverse oblique (24.6%) compared with parallel (10.5%) morphology. Conclusion  This series of 1,000 radiographs demonstrates a 6% overall prevalence of reverse obliquity. This large dataset allows for better quantification of the prevalence of DRUJ morphologies and determination of correlations that have clinical implications for patients with ulnar-sided wrist pathology. Level of Evidence  This is a Level IV study.

Ulnar variance according to gender and side during aging: An analysis of 600 wrists

BACKGROUND

Ulnar variance, or the difference in height between the joint surfaces of the distal radius and ulna, may play a role in several diseases of the wrist.

HYPOTHESIS

This study was to conduct a detailed analysis of ulnar variance in a wider case series by dividing the patients' radiographs into groups according to age, gender, and side.

MATERIALS AND METHODS

Twenty groups were created in order to investigate the change of ulnar variance according to age, gender, and side. Each group was planned to have 30 wrists. Wrist radiographs were scanned retrospectively, and ulnar variance was measured using the method of perpendiculars. Patients with any arthritic conditions, avascular necrosis, congenital deformities, bone and soft tissue tumors, and previous fractures or surgeries, and those radiographs, which were not at the exact anteroposterior position, and with insufficient technique were not included the study.

RESULTS

Six hundrends wrists (300 males [150 right, and 150 left wrists], and 300 females [150 right, and 150 left wrists]) were included in this study. There was a significant difference between the males (median: 0.4, minimum: -3.8, maximum: 5.1) and females (median: 0.85, minimum: -4.8, maximum: 5.7), regardless of the age and side (p=0.043). In the right wrists only (regardless of age), there was also a significant difference between the males (median: 0, minimum: -3.8, maximum: 5.1) and females (median: 0.8, minimum: -3.9, maximum: 5.7) (p=0.025). No statistically significant differences were found within the males and females with regard to aging, or between the sides in the same sex in any decade. In addition, there were no significant differences between the same sides in the males and females in any decade.

DISCUSSION

Although this study has one of the larger series in the literature, further studies should be done in different populations and ethnicities to obtain more accurate results, and to understand the relationship between ulnar variance and specific wrist disorders.

LEVEL OF EVIDENCE

Level III.

Does ulnar variance change with age and what is the influence of training and biological characteristics in this change? A short-term longitudinal study in Portuguese artistic gymnasts

OBJECTIVE

To analyze the variability and longitudinal stress-related changes in ulnar variance (UV) in a group of immature artistic gymnasts. The relationship between UV and a group of biological and training variables was also investigated.

DESIGN

Prospective cohort study.

SETTING

Portuguese Federation of Gymnastics.

PARTICIPANTS

Twenty-five Portuguese skeletally immature gymnasts competing nationally.

ASSESSMENT OF RISK FACTORS

Skeletal age (Tanner-Whitehouse 3 method), stature, body mass and body mass index (BMI) (Seca stadiometer), fat-free mass and percentage of body fat mass (Tanita BC 418), handgrip strength (Takei dynamometer), and training data (interview).

MAIN OUTCOME MEASURES

To determine UV stress-related changes over time, left UV was obtained using Hafner procedure. Ulnar variance values and biological characteristics were tested twice (at baseline and after 18 months of training).

RESULTS

Analysis of covariance analysis presented a significant interaction between age and time effect in UV at baseline. Each category of UV reacted differently to the interaction between age and training time. Significant relationships between UV and biological and training variables (chronological and skeletal age, body mass, BMI, handgrip strength, hour per week, and years of training) were evident in at least one of the moments of data collection.

CONCLUSIONS

The gymnasts showed significant longitudinal UV changes toward less negative UV over the training period. Nevertheless, we could not find a significant correlation between UV and the majority of the researched variables. Thus, although UV has been broadly studied, this phenomenon is complex because it depends on different intrinsic and extrinsic factors that are difficult to control, making necessary additional research on this topic.

CLINICAL RELEVANCE

The gymnast's wrist has been associated with a high incidence of painful symptomatology and injuries, leading to the formulation of several hypotheses related to the UV ethiology. Knowledge about the possible intrinsic or extrinsic factors related to UV changes and/or different UV categories (negative, neutral, and positive), as well as their consequent specific injuries in gymnasts' wrists may contribute to a primary prevention or reduction in the occurrence, recurrence and severity of pain, functional disability, or injuries in radius-ulnocarpal joint, thereby improving gymnasts' performance.