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Huddleston HP, Kurtzman JS, Deegan L, Hayes W, Austin K, Carter J, Aibinder WR, Koehler SM. Negative Ulnar Variance Lessens DRUJ Instability After DRUJ Disruption: A Biomechanical Analysis. Hand (N Y) 2024; 19:448-455. [PMID: 36205307 PMCID: PMC11067838 DOI: 10.1177/15589447221124233] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND The purpose of this study was to perform a biomechanical investigation on the effect of ulnar variance (UV) on the stability of the distal radioulnar joint (DRUJ) prior to and after DRUJ sectioning. METHODS Ten cadaveric forearm specimens were included in the study and baseline UV was assessed radiographically. Radial motion relative to the ulna was evaluated using Intel real sense cameras and a custom developed program. The forearms were dissected, and a radial osteotomy was performed. Using a custom-made plate, radial stability was assessed with an UV of + 4, 0, and -4 mm by measuring the maximum and minimum radial position relative to the ulna during a simulated Shuck test. The volar radioulnar ligaments and triangular fibrocartilage complex (TFCC) were then sectioned, and testing was repeated at each UV state. RESULTS Sectioning significantly increased radial translation at neutral (P = .008), +4 mm UV (P = .008), and -4 mm UV (P = .018). There were no significant differences in translation between the 3 UV groups with the DRUJ intact (P = .124). The ulnar negative (-4 mm) state had significantly lower translation compared to the positive (+4 mm) (P < .001) and the neutral (0 mm) (P = .026) UV states. There were no significant differences between the positive and neutral UV groups with the DRUJ sectioned. CONCLUSIONS Fixating the radius in -4 mm of ulnar negativity significantly decreased radial translation after sectioning the volar radioulnar ligament and TFCC. Ulnar variance had no effect on stability with an intact DRUJ. STUDY TYPE Biomechanical Study.
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Affiliation(s)
| | - Joey S. Kurtzman
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Liam Deegan
- SUNY Downstate Medical Center, Brooklyn, USA
| | | | | | - John Carter
- SUNY Downstate Medical Center, Brooklyn, USA
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Hayward D, Kastner T, Harder J, Baum G, Cox C, MacKay BJ. Arthrex Mini Tightrope Fixation for Chronic Distal Radioulnar Joint Instability. Tech Hand Up Extrem Surg 2023; 27:243-248. [PMID: 37490566 PMCID: PMC10651277 DOI: 10.1097/bth.0000000000000446] [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] [Indexed: 07/27/2023]
Abstract
Chronic distal radioulnar joint (DRUJ) instability is a complex clinical condition that is difficult to treat. Currently, there is no gold standard treatment. We present a novel technique using Arthrex Mini Tightrope for DRUJ stabilization. In this case series, a 1.6 mm K-wire was passed transversely through the distal ulna and radius. The Mini Tightrope was inserted into the end of the K-wire and pulled through the bone tunnels. Appropriate tension was achieved to stabilize the joint according to individual laxity comparable to the contralateral side. Five patients (3 males and 2 females) comprised this pilot series, with a mean age of 27.1 years. All sustained a traumatic injury at an average of 12.4 months before surgery (range: 5 to 32 mo). In addition, 3 patients had central triangular fibrocartilage complex tears treated with arthroscopy at the time of Mini Tightrope placement. While one patient was lost to follow-up after 7 weeks postoperative due to incarceration, 4 patients demonstrated coronal and sagittal stability in the context of DRUJ motion and a satisfactory range of motion. The mean time for the return to work for the two patients who were laborers or normal activity postoperatively was 5.2 weeks (range: 1 to 16.4 wk). Unrestricted activity was generally allowed 8 weeks postoperatively but varied by patient. The same 4 patients underwent hardware removal at an average of 31 weeks (range: 15 to 44 wk). Although this is only a pilot series, this suggests that temporary Mini Tightrope stabilization of the DRUJ may be a viable solution while upholding the benefits of minimally invasive surgery.
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Affiliation(s)
- Dan Hayward
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX
| | - Tyler Kastner
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX
| | - Justin Harder
- Department of Orthopedic Hand Surgery, Texas Tech University Health Sciences Center, Lubbock, TX
| | - Gracie Baum
- Department of Orthopedic Hand Surgery, Texas Tech University Health Sciences Center, Lubbock, TX
| | - Cameron Cox
- Department of Orthopedic Hand Surgery, Texas Tech University Health Sciences Center, Lubbock, TX
| | - Brendan J. MacKay
- Department of Orthopedic Hand Surgery, Texas Tech University Health Sciences Center, Lubbock, TX
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Messina NA, Dowley KS, Raducha JE, Gil JA. Radial Sided Triangular Fibrocartilage Complex Tears: A Comprehensive Review. Hand (N Y) 2023; 18:1245-1252. [PMID: 35403459 PMCID: PMC10617482 DOI: 10.1177/15589447221084125] [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] [Indexed: 11/15/2022]
Abstract
When evaluating the available literature on the diagnosis and management of triangular fibrocartilage complex tears (TFCC), ulnar tears comprise the major focus of TFCC literature. Radial-sided (Class 1D) tears are seldom researched or discussed. The purpose of this study was to review the methods for identifying and treating radial-sided TFCC lesions, by examining the anatomy of the TFCC, the pathology of its radial portion, diagnostic techniques, and both surgical and nonoperative treatments. The avascular nature of the radial TFCC may influence its healing potential. Magnetic resonance arthrogram is the gold standard for non-invasively diagnosing a radial-sided tear. Non-operative management should be exhausted prior to surgical intervention, which commonly involves an inside-out repair involving radial trans-osseous sutures. Still, the literature is limited by patient sample size and therefore requires a greater population of class 1-D tears to confirm optimal diagnostic and treatment methods.
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Affiliation(s)
| | | | - Jeremy E. Raducha
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
- University Orthopedics, Providence, RI, USA
| | - Joseph A. Gil
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
- University Orthopedics, Providence, RI, USA
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Bakker D, Derksen BM, Kramer SB, Cleffken BI, Schep NWL. Concomitant ligament injuries can be left untreated during surgery of distal radial fractures. J Hand Surg Eur Vol 2023; 48:1068-1073. [PMID: 37226470 DOI: 10.1177/17531934231177424] [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] [Indexed: 05/26/2023]
Abstract
Instability of the distal radioulnar joint and scapholunate dissociation may cause pain, functional impairment and subsequent arthrosis. There is no consensus about whether these injuries should be treated acutely in patients undergoing surgery for distal radial fractures. We conducted a prospective cohort study to determine whether concomitant distal radioulnar joint instability or scapholunate dissociation negatively influence patient-related outcomes in these patients. The primary outcome was the patient-reported wrist/hand evaluation at 6 and 12 months after surgery. Out of 62 patients, 58% and 27% had intraoperative distal radioulnar joint instability and scapholunate dissociation, respectively. No significant differences were found in patient-reported scores at follow-up between patients with stable and unstable distal radioulnar joints, nor between patients with and without scapholunate dissociation. Sixty-three per cent of patients with an unstable distal radioulnar joint during surgery were stable on retesting after 6 months. Our study suggests that a wait-and-see policy in these patients therefore seems reasonable.Level of evidence: III.
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Affiliation(s)
- Daniel Bakker
- Department of Hand and Wrist Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - Bas M Derksen
- Department of Hand and Wrist Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - Simon B Kramer
- Department of Hand and Wrist Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - Berry I Cleffken
- Department of Hand and Wrist Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - Niels W L Schep
- Department of Hand and Wrist Surgery, Maasstad Hospital, Rotterdam, The Netherlands
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Jawahier PA, Rahimtoola ZO, Schep NWL. Stabilization of the Distal Radioulnar Joint Using the TightRope Implant: A Distal Oblique Bundle Augmentation. J Wrist Surg 2023; 12:453-459. [PMID: 37841350 PMCID: PMC10569831 DOI: 10.1055/s-0043-1764346] [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: 01/18/2022] [Accepted: 02/03/2023] [Indexed: 10/17/2023]
Abstract
Background Triangular fibrocartilage complex (TFCC) injury often results in distal radioulnar joint (DRUJ) instability. However, not all patients with a ruptured TFCC have an unstable DRUJ as in these patients a distal oblique bundle (DOB) may be present. We assumed that augmentation of the DOB leads to a more stable situation following reinsertion of the TFCC. We present the clinical results of a new surgical technique using the TightRope system as a DOB augmentation. Description of Technique All cases were treated under regional anesthesia with the TightRope implant for which a tunnel was drilled from the distal ulna through the radius along the path of the DOB. The TightRope was passed through the tunnel and secured with buttons on either side. X-rays were made during surgery to confirm correct positioning. Methods A retrospective study was performed analyzing 21 cases treated with a TightRope augmentation of the DOB. The primary outcome was measured using the patient-rated wrist evaluation (PRWE) score at least 12 months after surgery. Results Postoperatively, the DRUJ was stable in all patients. The median PRWE score was 16 for the injured side compared to zero for the uninjured side ( p -value: < 0.001). The median pronation and supination were not statistically significant when we compared the injured side to the uninjured side. The median grip strength was 31 kg for the injured side compared to 38 kg for the uninjured side ( p -value: 0.015). There were two minor postoperative complications (10%). Conclusion This technique is capable of restoring DRUJ stability with a short immobilization period resulting in good patient-related outcomes and a low complication rate.
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Affiliation(s)
| | - Zulfi O. Rahimtoola
- Department of Orthopaedic Surgery, The Royal Berkshire Hospital, Berkshire, United Kingdom
| | - N. W. L. Schep
- Department of Hand and Wrist Surgery, Maasstad Hospital, Rotterdam, the Netherlands
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Yuine H, Mutsuzaki H, Yoshii Y, Shimizu Y, Ishida N, Yasuda T, Iwai K, Hotta K, Shiraishi H, Tachibana K. Evaluation of hand functions and distal radioulnar joint instability in elite wheelchair basketball athletes: a cross-sectional pilot study. BMC Sports Sci Med Rehabil 2023; 15:58. [PMID: 37061701 PMCID: PMC10105936 DOI: 10.1186/s13102-023-00658-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 03/24/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND Wrist injury affects wheelchair basketball players' performance; however, the relationship between distal radioulnar joint (DRUJ) instability and hand functions is unclear. This cross-sectional pilot study investigated DRUJ instability in elite female wheelchair basketball athletes using force-monitor ultrasonography. METHODS Nine elite female wheelchair basketball athletes (18 wrists) were included in the study. A triangular fibrocartilage complex (TFCC) injury was confirmed using magnetic resonance imaging (MRI). Hand functions were evaluated based on the range of motion (ROM) of wrist palmar flexion, dorsiflexion, radial deviation, and ulnar deviation; grip strength; arm circumference; forearm circumference; and DRUJ instability or pain using the ballottement test. The Mann-Whitney U test was used to compare parameters between the TFCC-injured and intact wrists. Radioulnar displacement was measured using force-monitor ultrasonography and pressure data, and the displacement-to-force ratio was used as an indicator of DRUJ instability. The correlation between the DRUJ displacement-to-force ratio and each hand function assessment was evaluated using Pearson correlation coefficient for the TFCC-injured and intact wrists. A generalized linear mixed model (GLMM) was used to estimate the relationship between hand functions and DRUJ instability. RESULTS TFCC injuries in seven wrists were confirmed using MRI findings (38.9%). The ulnar deviation ROM values of the TFCC-injured wrist (n = 7) and intact (n = 11) groups were 38.6 ± 8.0° and 48.6 ± 7.8°, respectively. The ulnar deviation ROM was significantly smaller in the TFCC-injured wrists (p = 0.02, r = - 0.54). In the TFCC-injured wrists, no correlation was observed between the displacement-to-force ratio and the hand function assessment. In contrast, the displacement-to-force ratio negatively correlated with grip strength, arm circumference, and forearm circumference in the intact wrists (Pearson correlation coefficient r = - 0.78, - 0.61, and - 0.74, respectively). The GLMM showed that the displacement-to-force ratio significantly affected grip strength, arm circumference, and forearm circumference in the intact group. CONCLUSIONS In intact wrists, correlations were observed between hand functions such as upper arm/forearm strength and DRUJ stability evaluated using ultrasound. Maintaining and strengthening grip strength, forearm circumference, and arm circumference are associated with DRUJ stability and may be related to TFCC injury prevention in wheelchair basketball athletes. TRIAL REGISTRATION The protocol was registered with the UMIN Clinical Trials Registry (UMIN000043343) [Date of first registration: 16/02/2021].
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Affiliation(s)
- Hiroshi Yuine
- Department of Occupational Therapy, School of Health Sciences, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Ami-Machi, Inashiki-Gun, Ibaraki, 300-0394, Japan.
| | - Hirotaka Mutsuzaki
- Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences, Ami, Ibaraki, 300-0394, Japan
| | - Yuichi Yoshii
- Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, Ami, Ibaraki, 300-0395, Japan
| | - Yukiyo Shimizu
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Natsuki Ishida
- Geriatric Health Services Facility Nadeshiko, Tsukuba, Ibaraki, 300-4245, Japan
| | - Taku Yasuda
- Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences, Ami, Ibaraki, 300-0394, Japan
| | - Koichi Iwai
- Center for Humanities and Sciences, Ibaraki Prefectural University of Health Sciences, Ami, Ibaraki, 300-0394, Japan
| | - Kazushi Hotta
- Department of Occupational Therapy, School of Health Sciences, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Ami-Machi, Inashiki-Gun, Ibaraki, 300-0394, Japan
| | - Hideki Shiraishi
- Department of Occupational Therapy, School of Health Sciences, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Ami-Machi, Inashiki-Gun, Ibaraki, 300-0394, Japan
| | - Kaori Tachibana
- Department of Physical Therapy, School of Health Sciences, Ibaraki Prefectural University of Health Sciences, Ami, Ibaraki, 300-0394, Japan
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Azhar S, Abdullah S, Soh E. WALANT technique for percutaneous pinning of distal radioulnar joint. J Hand Surg Eur Vol 2023; 48:279-281. [PMID: 36691295 DOI: 10.1177/17531934221148115] [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: 01/25/2023]
Affiliation(s)
- Shafiq Azhar
- Hand and Microsurgery Unit, Department of Orthopaedics and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Shalimar Abdullah
- Hand and Microsurgery Unit, Department of Orthopaedics and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Elaine Soh
- Hand and Microsurgery Unit, Department of Orthopaedics and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Zhang JY, Samineni AV, Sing DC, Rothman A, Stein AB. Higher-Than-Expected Rates of Distal Radioulnar Joint Fixation in Radial Shaft Fractures: Location of Fracture Matters. Hand (N Y) 2023; 18:328-334. [PMID: 33858223 PMCID: PMC10035106 DOI: 10.1177/15589447211006836] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate rates of distal radioulnar joint (DRUJ) fixation based on location of the radial shaft fracture and risk factors associated with postoperative complications following radial shaft open reduction internal fixation (ORIF). METHODS Adult patients who underwent isolated radial shaft ORIF from 2014 to 2018 were identified from American College of Surgeons National Surgical Quality Improvement Program database and stratified by fracture location and by the presence or absence of DRUJ fixation. Preoperative patient characteristics and postoperative complications were compared to determine risk factors associated with DRUJ fixation. RESULTS We identified 1517 patients who underwent isolated radial shaft ORIF, of which 396 (26.1%) underwent DRUJ fixation. Preoperative patient characteristics and postoperative complications were similar between cohorts. Distal radioulnar joint fixation was performed in 50 (30.7%) of 163 distal radial shaft fractures, 191 (21.8%) of 875 midshaft fractures, and 3 (13.0%) of 23 proximal shaft fractures (P = .025). Risk factors for patients readmitted include male sex (odds ratio [OR] = 12.76, P = .009) and older age (OR = 4.99, P = .035). Risk factors for patients with any postoperative complication include dependent functional status (OR = 6.78, P = .02), older age (50-69 vs <50) (OR = 2.73, P = .05), and American Society of Anesthesiologists (ASA) ≥3 (OR = 2.45, P = .047). CONCLUSIONS The rate of DRUJ fixation in radial shaft ORIF exceeded previously reported rates of concomitant DRUJ injury, especially among distal radial shaft fractures. More distally located radial shaft fractures are significantly associated with higher rates of DRUJ fixation. Male sex is a risk factor for readmission, whereas dependent functional status, older age, and ASA ≥3 are risk factors for postoperative complications.
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Cha SM, Shin HD, Kim YK, Lee KW. Ulnar shortening osteotomy for posttraumatic ulnar impaction syndrome in adolescent (younger than 18 years) - Based on the Cha & Shin assessment. Injury 2022; 53:4038-4047. [PMID: 36243581 DOI: 10.1016/j.injury.2022.10.004] [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: 08/23/2022] [Revised: 09/28/2022] [Accepted: 10/05/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE We performed ordinary ulnar shortening osteotomy (USO) in patients younger than 18 years old with secondary ulnar impaction syndrome (UIS) after traumatic events. Here, we report the clinical and radiologic outcomes with a review of the previous literature through a retrospective case series. METHODS Twenty-two adolescents treated by USOs from 2006 to 2018 were investigated. The amount of shortening was classified into three categories. The first category was for a still open physis on the medial half of the radius in those younger than 15. In this category, we osteotomized the ulna for the physis level to be left neutral or negative by 1-2 mm. The second category had no growth potency in the radius. If the patient was younger than 15, we considered only residual growth of the ulna, thus performing USO for the ordinary UV to be negative by 2-3 mm. For patients aged 15-18 years old, if growth potency was nearly absent in the ulna, we performed traditional USO with a neutral ulnar variance (UV). RESULTS Categories 1, 2, and 3 for the amount of USO were determined for 4, 4, and 14 patients, respectively. All USOs properly healed without substantial complications. The mean preoperative UV was 2.91 mm, and the final value decreased to 0.23 with statistical significance (p < 0.001). The range of wrist motion was improved after USO from 133.86° and 132.73° to 154.77° and 160.68° (all, p < 0.001 in flexion-extension and pronation-supination arcs, respectively). The preoperative VAS and MMWS scores also improved from 2.77 to 75.00 to 0.18 and 88.86, respectively, at the final follow-up (all, p < 0.001). CONCLUSIONS UIS in adolescent populations after trauma in their children/younger adolescents could be properly treated by USO. Even with an open physis at the ulna, neutral UVs could be achieved, and the clinical outcomes were satisfactory. However, long-term follow-up is still needed regarding TFCC and DRUJ status. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Soo Min Cha
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Hyun Dae Shin
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea.
| | - Yun Ki Kim
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Kun Woo Lee
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
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Azócar C, Corvalán G, Cobb P, Román J, Orellana P. Lesiones traumáticas crónicas del complejo fibrocartílago triangular: ¿Cómo enfrentarlas? REVISTA IBEROAMERICANA DE CIRUGÍA DE LA MANO 2022. [DOI: 10.1055/s-0042-1758190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
ResumenLas lesiones crónicas del complejo fibrocartílago triangular (CFCT) son una entidad que no ha sido descrita previamente como tal y no existe consenso en su manejo. La temporalidad de la lesión y su potencial de reparación son aspectos fundamentales a la hora de indicar un tratamiento. Proponemos un esquema de enfrentamiento a lesiones traumáticas crónicas del CFCT y describimos una técnica novedosa de reconstrucción con injerto de brachioradialis con asistencia artroscópica. Mostramos los resultados y el seguimiento de dos pacientes intervenidos con esta técnica.
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Affiliation(s)
- Camila Azócar
- Equipo de Mano y Microcirugía, Servicio de Traumatología y Ortopedia, Clínica Indisa, Santiago, Chile
| | - Gonzalo Corvalán
- Equipo de Mano y Microcirugía, Servicio de Traumatología y Ortopedia, Clínica Indisa, Santiago, Chile
| | - Peter Cobb
- Equipo de Mano y Microcirugía, Servicio de Traumatología y Ortopedia, Clínica Indisa, Santiago, Chile
| | - Javier Román
- Equipo de Mano y Microcirugía, Servicio de Traumatología y Ortopedia, Clínica Indisa, Santiago, Chile
| | - Pablo Orellana
- Equipo de Mano y Microcirugía, Servicio de Traumatología y Ortopedia, Clínica Indisa, Santiago, Chile
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Yuine H, Yoshii Y, Miyata K, Shiraishi H. Quantitative assessment of the course of distal radioulnar joint instability. HAND THERAPY 2022; 27:83-90. [PMID: 37905198 PMCID: PMC10588430 DOI: 10.1177/17589983221113872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 06/29/2022] [Indexed: 11/02/2023]
Abstract
Introduction There is a lack of methods to objectively evaluate improvement in distal radioulnar joint (DRUJ) instability through treatment. We used ultrasonography to assess DRUJ instability and calculated the minimal detectable change (MDC) in healthy individuals. MDC was used to evaluate post-treatment changes in a patient with triangular fibrocartilage complex (TFCC) injury. Methods DRUJ instability was evaluated using force-monitor ultrasonography in eight healthy male participants to determine MDC and in a man in his 60s who underwent surgery and rehabilitation for TFCC injury (Palmer classification: type 2C). In the patient, DRUJ instability was measured pre-operatively, 3 months postoperatively, and 1 year post-operatively. Self-reported hand and upper limb functional ability were also recorded. The transducer of the force-monitor ultrasonographic system was used to apply cyclic compressions to the wrists automatically and measure DRUJ displacements. The amount of displacement was calculated using the distance between the radius and ulna before and during cyclic compression to the wrists. The applied pressure was measured as the force to the wrist, and the displacement-to-force ratio was calculated. Results The 95% confidence MDC95 for radioulnar displacement, displacement force, and displacement-to-force ratio were 0.27-0.31 mm, 0.30-0.59 N, and 0.12-0.15 mm/N, respectively. The patient's post-operative decrease in displacement exceeded the MDC95. DRUJ stability, pain, and use of the affected hand in daily life improved. Discussion Force-monitor ultrasonography can quantitatively evaluate post-treatment improvement in DRUJ stability over time. MDC for DRUJ instability can assess recovery after treatment or rehabilitation and determine changes resulting from interventions.
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Affiliation(s)
- Hiroshi Yuine
- Department of Occupational Therapy, School of Health Sciences, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
| | - Yuichi Yoshii
- Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, Ibaraki, Japan
| | - Kazuhiro Miyata
- Department of Physical Therapy, School of Health Sciences, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
| | - Hideki Shiraishi
- Department of Occupational Therapy, School of Health Sciences, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
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Yuine H, Yoshii Y, Iwai K, Ishii T, Shiraishi H. Application of force-monitor ultrasonography to assess distal radioulnar joint instability in patients with triangular fibrocartilage complex injury. ULTRASOUND (LEEDS, ENGLAND) 2022; 30:219-227. [PMID: 35936965 PMCID: PMC9354175 DOI: 10.1177/1742271x211038351] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/22/2021] [Indexed: 08/03/2023]
Abstract
Introduction In this study, we evaluated the differences and measurement accuracy in the force-displacement relationship of the distal radioulnar joint (DRUJ) between patients with triangular fibrocartilage complex (TFCC) injury and healthy controls using force-monitor ultrasonography. Methods This study included 11 TFCC injury patients and 22 healthy controls. We evaluated differences in the force-displacement relationship of the DRUJ in these patients using force-monitor ultrasonography. Cyclic compression was applied to the dorsal surface of the ulnar head. Distance between the dorsal surface of the distal radius and ulnar head at the DRUJ level was measured in the initial and pressed-down positions. Changes in radioulnar displacement, applied force, and displacement-to-force ratio were measured. Furthermore, we compared the parameters between the affected and unaffected wrists and between TFCC injury patients and controls. Results The radioulnar displacement and displacement-to-force ratio were significantly larger in the affected wrists than in the unaffected wrists (P = 0.003 and P = 0.02). The affected/unaffected side ratio of radioulnar displacement and displacement-to-force ratio were significantly larger in the TFCC injury patients than in the controls (P = 0.003 and P = 0.02). The area under the curve was 0.82 for the affected/unaffected ratio of the radioulnar displacement. The optimal cutoff value indicated by the receiver-operating characteristic curve for the affected/unaffected ratio of the radioulnar displacement was 1.71; the sensitivity and specificity were 82% and 86%, respectively. Conclusions Assessing the DRUJ instability with force-monitor ultrasonography may help identify TFCC-injured wrists.
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Affiliation(s)
- Hiroshi Yuine
- Department of Occupational Therapy, Ibaraki Prefectural University of Health Sciences, School of Healthcare, Ibaraki Prefectural University of Health Sciences, Ami, Japan
- Department of Rehabilitation, Tokyo Medical University Ibaraki Medical Center, Tokyo Medical University Ibaraki Medical Center, Ami, Japan
| | - Yuichi Yoshii
- Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, Tokyo Medical University Ibaraki Medical Center, Ami, Japan
| | - Koichi Iwai
- Center for Humanities and Sciences, Ibaraki Prefectural University of Health Sciences, Ibaraki Prefectural University of Health Sciences, Ami, Japan
| | - Tomoo Ishii
- Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, Tokyo Medical University Ibaraki Medical Center, Ami, Japan
| | - Hideki Shiraishi
- Department of Occupational Therapy, Ibaraki Prefectural University of Health Sciences, School of Healthcare, Ibaraki Prefectural University of Health Sciences, Ami, Japan
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Mau M, Livingstone J, Lee G, Murray P. Optimizing the Orientation of a Suture Button to Stabilize the Distal Radioulnar Joint in a Sawbones Model. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2022; 4:355-359. [DOI: 10.1016/j.jhsg.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/27/2022] [Indexed: 10/15/2022] Open
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Chen ACY, Cheng YH, Chiu CH, Cheng CY, Chan YS. Functional Outcomes Are Similar After Arthroscopic Capsular Repair of Triangular Fibrocartilage Complex Tears Between Outside-In Technique and All-Inside Technique Using Pre-Tied Suture Device. Arthroscopy 2022; 38:1457-1462. [PMID: 34920003 DOI: 10.1016/j.arthro.2021.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 12/01/2021] [Accepted: 12/01/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare outcomes of arthroscopic triangular fibrocartilage complex capsular repair at 2-year follow-up between outside-in and all-inside techniques. METHODS In total, 58 consecutive patients (wrists) with a Palmer 1B triangular fibrocartilage complex tear without symptomatic distal radioulnar joint instability underwent arthroscopic suture repair from 2011 to 2019 including 31 patients via the outside-in technique (group A) and 27 via the all-inside technique using a pre-tied needle device (group B). Two-year follow-up included visual analog scale (VAS) pain score, motion range, grip strength, Mayo Modified Wrist Score (MMWS), the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, and complication rate. Correlation between functional result and patient satisfaction was analyzed. RESULTS Score changes in VAS, wrist flexion-tension, supination-pronation, grip strength, MMWS, and QuickDASH at 2-year follow-up were not significantly different between group A (3.4 ± 0.8, 18.4 ± 17.5, 12.9 ± 13.3, 30.7 ± 11.2, 26.6 ± 7.9 and 19.4 ± 9.9 and group B (3.4 ± 1.0, 18.5 ± 18.3, 15.6 ± 13.7, 30.8 ± 11.4, 28.1 ± 8.6, and 7.6 ± 7.2) with P values of .400, .489, .223, .486, .240, and .223 respectively. Surgical time averaged 105 minutes (78 to 136) in group A and 94 minutes (61-126) in group B with significant difference (P = .012). Patient satisfaction averaged 1.1 (0-3.5) in group A and 1.0 (range 0-3.0) in group B. Satisfaction score was more strongly correlated with QuickDASH (coefficients: 0.863 in group A and 0.918 in group B) than with MMWS (-0.693 in group A and -0.465), grip strength (-0.619 in group A and -0.417 in group B) and VAS score (0.607 in group A and 0.222 in group B). CONCLUSIONS Both techniques achieved comparable outcomes with shorter surgical time in all-inside repair using pre-tied needle device. Patient satisfaction was strongly correlated with QuickDASH score. LEVEL OF EVIDENCE Level III, retrospective therapeutic comparative investigation.
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Affiliation(s)
- Alvin Chao-Yu Chen
- Bone and Joint Research Center, Department of Orthopedic Surgery and Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital-Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan, R.O.C..
| | - You-Hung Cheng
- Bone and Joint Research Center, Department of Orthopedic Surgery and Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital-Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan, R.O.C
| | - Chih-Hao Chiu
- Bone and Joint Research Center, Department of Orthopedic Surgery and Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital-Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan, R.O.C
| | - Chun-Ying Cheng
- Bone and Joint Research Center, Department of Orthopedic Surgery and Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital-Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan, R.O.C
| | - Yi-Sheng Chan
- Bone and Joint Research Center, Department of Orthopedic Surgery and Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital-Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan, R.O.C
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15
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Rodríguez-Merchán EC, Shojaie B, Kachooei AR. Distal Radioulnar Joint Instability: Diagnosis and Treatment. THE ARCHIVES OF BONE AND JOINT SURGERY 2022; 10:3-16. [PMID: 35291239 PMCID: PMC8889419 DOI: 10.22038/abjs.2021.57194.2833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/30/2021] [Indexed: 01/24/2023]
Abstract
Distal radioulnar joint (DRUJ) instability and triangular fibrocartilage complex (TFCC) tears are more usual than estimated and are frequently overlooked. Diagnosis is often clinical, which can be confirmed using computed tomography (CT) scan and magnetic resonance imaging (MRI). In doubtful cases, bilateral computed tomography in neutral forearm rotation, supination, and pronation should also be performed. Wrist arthroscopy can be diagnostic and therapeutic for ulnar-sided wrist pain. Two systematic reviews showed equivalent outcomes between open and arthroscopic repair of the TFCC. There is scant proof to advise one technique over the other in clinical practice. TFCC repair and reconstruction are contraindicated when there is a bony deformation of the radius or ulna or osteoarthritis of the DRUJ. With the advancement of implant arthroplasty, salvage procedures are less desirable. Constrained distal radioulnar arthroplasty is stable, and the longevity is encouraging.
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Affiliation(s)
- E. Carlos Rodríguez-Merchán
- Department of Orthopaedic Surgery, La Paz University Hospital, Madrid, Spain. ,Osteoarticular Surgery Research, Hospital La Paz Institute for Health Research – IdiPAZ (La Paz University Hospital – Autonomous University of Madrid), Madrid, Spain
| | - Babak Shojaie
- Department of Hand, Plastic and reconstructive Surgery,Göttingen University of medical Sciences,Klinikum Bremen Mitte,Bremen,Germany,Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir R. Kachooei
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, USA. ,Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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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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Yuine H, Yoshii Y, Iwai K, Ishii T, Shiraishi H. Assessment of distal radioulnar joint stability in healthy subjects: Changes with dominant hand, sex, and age. J Orthop Res 2021; 39:2028-2035. [PMID: 33002205 DOI: 10.1002/jor.24870] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/22/2020] [Accepted: 09/29/2020] [Indexed: 02/04/2023]
Abstract
This study aimed to elucidate the differences in distal radioulnar stability in dominant/nondominant hand, sex, and age. Bilateral wrists of 60 healthy subjects were evaluated using force-monitoring ultrasonography. This apparatus was developed to apply cyclic compression and measure applied force to displacement during an ultrasound exam. The transducer was placed on the dorsal side of the distal radioulnar joint, and the center of the ulnar head was displayed on the monitor. The distance between the dorsal surface of the distal radius and the ulnar head was measured at an initial and at a pressed-down position. The radioulnar displacement, applied force to displacement, and displacement-to-force ratio were evaluated. The results were compared between the dominant and nondominant hands, and between males and females, and among different age groups. There were no significant differences in the parameters between the dominant and nondominant hands. The applied force to displacement was significantly greater in the male group compared with the female group. There were significant effects for the different age groups in all parameters (displacement: F = 3.67, p = .008; applied-force: F = 3.08, p = .019; displacement-to-force ratio: F = 4.66, p = .002). Our results indicated that the stability of distal radioulnar joint differed depending on age and sex. Age and sex should be considered when assessing distal radioulnar joint stability.
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Affiliation(s)
- Hiroshi Yuine
- Department of Occupational Therapy, Ibaraki Prefectural University of Health Sciences, Ami, Ibaraki, Japan.,Department of Rehabilitation, Tokyo Medical University Ibaraki Medical Center, Ami, Ibaraki, Japan
| | - Yuichi Yoshii
- Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, Ami, Ibaraki, Japan
| | - Koichi Iwai
- Center for Humanities and Sciences, Ibaraki Prefectural University of Health Sciences, Ami, Ibaraki, Japan
| | - Tomoo Ishii
- Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, Ami, Ibaraki, Japan
| | - Hideki Shiraishi
- Department of Occupational Therapy, Ibaraki Prefectural University of Health Sciences, Ami, Ibaraki, Japan
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18
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Xiao AX, Graf AR, Dawes A, Daley C, Wagner ER, Gottschalk MB. Management of Acute Distal Radioulnar Joint Instability Following a Distal Radius Fracture: A Systematic Review and Meta-Analysis. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2021; 3:133-138. [PMID: 35415552 PMCID: PMC8991773 DOI: 10.1016/j.jhsg.2021.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 02/23/2021] [Indexed: 11/19/2022] Open
Abstract
Purpose We sought to review the clinical outcomes of conservative and operative treatment options for acute distal radioulnar joint (DRUJ) instability associated with distal radius fractures in adult patients. Methods A systematic search of PubMed, MEDLINE, and EMBASE for articles published between 1990 and 2020 involving DRUJ instability associated with distal radius fractures was performed. The primary outcomes analyzed included clinical grip strength; range of motion; the disability of the arm, shoulder and hand (DASH) score; and the modified Mayo wrist score (MMWS). Results Of the 531 articles identified in the literature search, 8 met our defined criteria and were included in the final analysis. The cumulative sample size was 258 patients at a mean follow-up of 11.1 months (range, 3–16.9 months). Treatment groups included cast immobilization in supination, K-wire stabilization, and triangular fibrocartilage complex (TFCC) repair. Statistical analysis revealed no difference across groups in active flexion-extension or DASH scores. A significant decrease in grip strength was found in patients who underwent TFCC repair compared with that in those who underwent both cast immobilization (P = .04) and K-wire stabilization (P = .02). Furthermore, we found a significant decrease in active pronation-supination between patients who underwent TFCC repair and those who underwent cast immobilization (P = .03). Patients who underwent TFCC repair were also found to exhibit decreased MMWS as compared with those who underwent K-wire stabilization (P = .05). Overall, persistent DRUJ instability was only found in 4 patients (1.5%), without a significant difference between treatment groups. Conclusions This study suggests functional advantages of certain treatment modalities over others, with the range of motion being highest in patients who underwent cast immobilization and grip strength being highest in patients who underwent K-wire stabilization. However, the mean DASH scores showed no difference across all groups, calling into question the clinical need to pursue operative treatment via K-wire stabilization or TFCC repair over conservative treatment via cast immobilization. This study will hopefully serve as a foundation for future prospective studies to help improve and standardize treatment algorithms in patients with DRUJ instability and distal radius fractures. Type of study/level of evidence: Therapeutic II.
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Affiliation(s)
| | - Alexander R. Graf
- Department of Orthopedic Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Alexander Dawes
- Department of Orthopedic Surgery, Emory University, Atlanta, GA
| | - Charles Daley
- Department of Orthopedic Surgery, Emory University, Atlanta, GA
| | - Eric R. Wagner
- Department of Orthopedic Surgery, Emory University, Atlanta, GA
| | - Michael B. Gottschalk
- Department of Orthopedic Surgery, Emory University, Atlanta, GA
- Corresponding author: Michael B. Gottschalk, MD, Department of Orthopedic Surgery, Emory University, 59 S Executive Park NW, Atlanta, GA 30329
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19
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Abstract
The distal radioulnar joint is inherently unstable, relying primarily on ligaments for stability. Disruption of the joint-stabilizing structures can occur in isolation or concomitantly with osseous trauma. Instability can result from dislocations, fractures, ligament injuries, or malunions. Untreated instability alters wrist and forearm kinematics, leading to pain, weakness, and possibly arthritis. In chronic instability, the native ligaments may not be reparable, necessitating a reconstructive procedure.
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Affiliation(s)
- Logan W Carr
- Department of Orthopedic Surgery, Baylor College of Medicine, 7200 Cambridge, Suite 10A, Houston, TX 77044, USA.
| | - Brian Adams
- Department of Orthopedic Surgery, Baylor College of Medicine, 7200 Cambridge, Suite 10A, Houston, TX 77044, USA
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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: 0.3] [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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Abstract
Distal radioulnar joint (DRUJ) instability is often an underestimated or missed lesion which may entail fatal consequences. The triangular fibrocartilage complex is a biomechanically very important stabilizer of the DRUJ and guarantees unrestricted range of motion of the forearm. To detect DRUJ instability a systematic examination is of uppermost importance. The contralateral healthy arm will be used for comparison during clinical examination. X-rays are required to exclude osseous lesions or deformities. Computed tomography of both wrists in neutral forearm rotation, supination, and pronation may be necessary to verify DRUJ instability in ambiguous situations. Following a systematic clinical examination wrist and DRUJ arthroscopy detects lesions definitely. Tears of the distal radioulnar ligaments which entail DRUJ instability should be repaired preferably anatomically. Ulnar-sided ligament ruptures which cause instability are detected more often than radial-sided ones. Osseous ligament avulsions are mostly refixated osteosynthetically. Ligamentous tears of the distal radioulnar ligaments may be reconstructed using anchor suture or transosseous refixation. Secondary procedures such as tendon transplants are necessary for anatomical reconstruction in cases of unrepairable ligament tears.
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22
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Sander AL, Sommer K, Kaiser AK, Marzi I, Frank J. Outcome of conservative treatment for triangular fibrocartilage complex lesions with stable distal radioulnar joint. Eur J Trauma Emerg Surg 2020; 47:1621-1625. [PMID: 32036393 PMCID: PMC8476392 DOI: 10.1007/s00068-020-01315-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 01/27/2020] [Indexed: 11/24/2022]
Abstract
Purpose Triangular fibrocartilage complex (TFCC) lesions have high clinical relevance. Although multiple studies have been done in the past, there is a lack of data after conservative treatment and controversy remains regarding management. The purpose of this study was to compare the outcome of symptomatic TFCC lesions after conservative treatment and arthroscopic debridement. Methods Between 2012 and 2017, 33 patients were included. 16 patients were treated conservatively and 17 patients with arthroscopic debridement. The average age was 41 years (range 18–63). The mean follow-up was 22.2 months (range 6–74). Evaluation included pain, range of motion (ROM), grip strength, Disabilities of the Arm, Shoulder, and Hand (DASH) score, Modified Mayo Wrist Score (MMWS), and Purdue Pegboard test. Results Pain averaged 0.1 (range 0–1) in the conservative group compared to 1.3 (range 0–6) in the arthroscopic group. The mean ROM was 99% for wrist extension, and 100% for flexion and pro-/supination in the conservative group, and 96% for extension and flexion, and 100% for pro-/supination in the arthoscopic group compared to the contralateral side. Grip strength was 88% (range 63–100) in the conservative group versus 89% (range 33–100) in the arthroscopic group. The conservative group reached a DASH score of 16.8 and MMWS of 94.3 compared to 22.1 and 87.2 in the arthroscopic group. The differences were not statistically significant. Conclusions Our study demonstrated similar results of conservative compared to arthroscopic treatment. Because conservative treatment was a sufficient and reliable option, we propose it as first-line treatment for TFCC lesions with stable distal radioulnar joint.
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Affiliation(s)
- Anna Lena Sander
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
| | - Katharina Sommer
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Antonia Katharina Kaiser
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Ingo Marzi
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Johannes Frank
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
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23
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Swartman B, Benner L, Franke J, Grützner PA, Vetter SY, Schnetzke M. Distal radioulnar joint instability with three different injury patterns assessed by three-dimensional C-arm scans: a cadaveric study. J Hand Surg Eur Vol 2019; 44:1072-1078. [PMID: 31475872 DOI: 10.1177/1753193419870378] [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] [Indexed: 02/03/2023]
Abstract
The aim of this study was to establish a radiographic method for detecting distal radioulnar joint instability intraoperatively. We created three successive instabilities in 12 intact Thiel-fixed upper limb specimens: lesion of the triangular fibrocartilage complex, Galeazzi injury and Essex-Lopresti injury. We made three-dimensional scans of the wrists in pronation and supination with a mobile C-arm. We used four validated measurement methods to quantify ulnar migration in the standard axial planes: the radioulnar line method, the subluxation ratio method, the epicentre method and the radioulnar ratio method. All types of instability showed significantly increased migration of the ulna compared with the control group. The subluxation ratio and the radioulnar ratio methods showed the highest sensitivity and specificity in detecting the instabilities. We conclude that these two methods are feasible for radiographically assessing distal radioulnar joint instability. Instability may be assumed if the migration of the ulna in the sigmoid notch is at least 45% of the length of the sigmoid notch, in which case wire transfixation of the distal radioulnar joint is advised.
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Affiliation(s)
- Benedict Swartman
- Department for Orthopedics and Orthopedic Trauma, Trauma Surgery Clinic at Heidelberg University, Ludwigshafen, Germany
| | - Laura Benner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Jochen Franke
- Department for Orthopedics and Orthopedic Trauma, Trauma Surgery Clinic at Heidelberg University, Ludwigshafen, Germany
| | - Paul A Grützner
- Department for Orthopedics and Orthopedic Trauma, Trauma Surgery Clinic at Heidelberg University, Ludwigshafen, Germany
| | - Sven Y Vetter
- Department for Orthopedics and Orthopedic Trauma, Trauma Surgery Clinic at Heidelberg University, Ludwigshafen, Germany
| | - Marc Schnetzke
- Department for Orthopedics and Orthopedic Trauma, Trauma Surgery Clinic at Heidelberg University, Ludwigshafen, Germany
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24
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Yuine H, Yoshii Y, Tung WL, Ishii T, Shiraishi H. Reliability of Quantitative Assessment of Distal Radioulnar Joint Stability With Force-Monitor Ultrasonography. J Orthop Res 2019; 37:2053-2060. [PMID: 31062374 DOI: 10.1002/jor.24331] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 04/23/2019] [Indexed: 02/04/2023]
Abstract
The purpose of this study was to evaluate the reliability of ultrasound assessment of the displacement-force relationships for distal radioulnar joint (DRUJ) stability. Non-dominant wrists of 10 healthy male subjects were evaluated by force-monitor ultrasonography. This apparatus was developed to apply cyclic compression to the wrist with pre-determined transducer displacement conditions in the range of 0.1-3.0 mm. The subject's wrist was placed on the table with the forearm in the pronated position. The transducer was placed on the dorsal surface of the distal radius and ulna, perpendicular to the long axis of the forearm. The center of the ulnar head was at the DRUJ level. The distance between the dorsal surface of the distal radius and the ulnar head was measured at an initial and a pressed-down position. Changes in radioulnar displacement, force to the wrist and the displacement/force ratio were evaluated. The measurements were performed independently by two raters. The intra-class correlation coefficients (ICCs) for the radioulnar displacement were 0.76, 0.68, and 0.93, in the 1.0, 2.0, and 3.0 mm transducer displacement conditions, respectively. The ICCs for the force to the wrist were 0.18, 0.67, and 0.34, in different transducer displacement conditions, respectively. The ICCs for the displacement/force ratios were 0.68, 0.67, and 0.97, in different transducer displacement conditions, respectively. The highest ICC for the radioulnar displacement and the displacement/force ratio was observed in the 3.0 mm displacement condition. This assessment of displacement-force relationships may be useful to quantify DRUJ stability. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2053-2060, 2019.
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Affiliation(s)
- Hiroshi Yuine
- Department of Rehabilitation, Tokyo Medical University Ibaraki Medical Center, Ami, Ibaraki, Japan.,Department of Health Sciences, Graduate School of Health Sciences, Ibaraki Prefectural University of Health Sciences, Ami, Ibaraki, Japan
| | - Yuichi Yoshii
- Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, Ami, Ibaraki, Japan
| | - Wen-Lin Tung
- Department of Occupational Therapy, Ibaraki Prefectural University of Health Sciences, Ami, Ibaraki, Japan
| | - Tomoo Ishii
- Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, Ami, Ibaraki, Japan
| | - Hideki Shiraishi
- Department of Occupational Therapy, Ibaraki Prefectural University of Health Sciences, Ami, Ibaraki, Japan
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25
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Swartman B, Benner L, Grechenig S, Franke J, Grützner PA, Schnetzke M. Normal values of distal radioulnar translation assessed by three-dimensional C-arm scans: a cadaveric study. J Hand Surg Eur Vol 2019; 44:503-509. [PMID: 30727815 DOI: 10.1177/1753193419826486] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We investigated whether mobile C-arm cone beam computer tomography (CBCT) could be used to measure radioulnar translation. The study was conducted on 31 Thiel-fixed intact cadaver arms. Three-dimensional scans of each wrist were carried out in pronation and supination. Four established measurement methods were used (radioulnar line, subluxation ratio, epicentre and radioulnar ratio methods) to measure radioulnar translation. The intraclass correlation coefficient for inter-observer and intra-observer reliability were excellent in three of four methods (>0.94). The reference ranges for physiological radioulnar translation were between -30% and 91% (radioulnar line method), -32% and 87% (subluxation ratio method), -40% and 23% (epicentre method), and 2% and 73% (radioulnar ratio method). Our results indicate that radioulnar translation in the distal radioulnar joint can be determined reliably using mobile C-arm CBCT. The normal values provide a basis for further experimental and clinical studies.
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Affiliation(s)
- Benedict Swartman
- 1 BG-Klinik Ludwigshafen, Department for Orthopedics and Orthopedic Trauma, Trauma Surgery Clinic at Heidelberg University, Ludwigshafen, Germany
| | - Laura Benner
- 2 Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Stephan Grechenig
- 3 University Hospital Regensburg, Department for Trauma Surgery, Regensburg, Germany
| | - Jochen Franke
- 1 BG-Klinik Ludwigshafen, Department for Orthopedics and Orthopedic Trauma, Trauma Surgery Clinic at Heidelberg University, Ludwigshafen, Germany
| | - Paul A Grützner
- 1 BG-Klinik Ludwigshafen, Department for Orthopedics and Orthopedic Trauma, Trauma Surgery Clinic at Heidelberg University, Ludwigshafen, Germany
| | - Marc Schnetzke
- 1 BG-Klinik Ludwigshafen, Department for Orthopedics and Orthopedic Trauma, Trauma Surgery Clinic at Heidelberg University, Ludwigshafen, Germany
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Cheema AN, Dardas AZ, Hast MW, Gray BL. The effects of incremental ulnar styloid osteotomies on distal radioulnar joint stability: a biomechanical cadaveric study. J Hand Surg Eur Vol 2019; 44:510-516. [PMID: 30871405 DOI: 10.1177/1753193419834858] [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] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to systematically quantify distal radioulnar joint stability with a cadaveric model, using radiographic and joint contact force measurements. Six fresh-frozen cadavers underwent sequential ulnar styloid osteotomies. Posteroanterior and lateral stress radiographs were obtained and joint contact forces and areas were measured. Posteroanterior radiographs showed a significant increase in the distal radioulnar joint gap after osteotomy of the base of the ulnar styloid. Contact force and contact area measurements were not significantly different. We conclude that fractures that involve the ulnar styloid base should be considered for operative fixation when carrying out open reduction and internal fixation of fractures of the distal radius.
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Affiliation(s)
- Adnan N Cheema
- 1 Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Agnes Z Dardas
- 1 Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael W Hast
- 2 University of Pennsylvania, Biedermann Lab for Orthopaedic Research, Philadelphia, PA, USA
| | - Benjamin L Gray
- 1 Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
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Gulati A, Wadhwa V, Ashikyan O, Cerezal L, Chhabra A. Current perspectives in conventional and advanced imaging of the distal radioulnar joint dysfunction: review for the musculoskeletal radiologist. Skeletal Radiol 2019; 48:331-348. [PMID: 30171275 DOI: 10.1007/s00256-018-3042-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 07/27/2018] [Accepted: 08/01/2018] [Indexed: 02/02/2023]
Abstract
Distal radioulnar joint (DRUJ) dysfunction is a common cause of ulnar sided wrist pain. Physical examination yields only subtle clues towards the underlying etiology. Thus, imaging is commonly obtained towards an improved characterization of DRUJ pathology, especially multimodality imaging, which is frequently resorted to arrive at an accurate diagnosis. With increasing use of advanced MRI and CT techniques, DRUJ imaging has become an important part of a musculoskeletal radiologist's practice. This article discusses the normal anatomy and biomechanics of the DRUJ, illustrates common clinical abnormalities, and provides a comprehensive overview of the imaging evaluation with an insight into the role of advanced cross-sectional modalities in this domain.
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Affiliation(s)
| | - Vibhor Wadhwa
- Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - Luis Cerezal
- Radiology, Diagnóstico Médico Cantabria, Santander, Spain
| | - Avneesh Chhabra
- Radiology, UT Southwestern Medical Center, Dallas, TX, USA. .,Orthopaedic Surgery, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9178, USA. .,Johns Hopkins University, Baltimore, MD, USA.
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Abstract
BACKGROUND Fractures of the radial shaft with disruption of the distal radial ulnar joint (DRUJ) or Galeazzi fractures are treated with reduction of the radius followed by stability assessment of the DRUJ. In rare instances, the reduction of the DRUJ is blocked by interposed structures requiring open reduction of this joint. The purpose of this study is to review all cases of irreducible Galeazzi fracture-dislocations reported in the literature to offer guidelines in the diagnosis and management of this rare injury. METHODS A search of the MEDLINE database, OVID database, and PubMed database was employed using the terms "Galeazzi" and "fracture." Of the 124 articles the search produced, a total of 12 articles and 17 cases of irreducible Galeazzi fracture-dislocations were found. RESULTS The age range was 16 to 64 years (mean = 25 years). A high-energy mechanism of injury was the root cause in all cases. More than half of the irreducible DRUJ dislocations were not identified intraoperatively. In a dorsally dislocated DRUJ, a block to reduction in most cases (92.3%) was secondary to entrapment of one or more extensor tendons including the extensor carpi ulnaris, extensor digiti minimi, and extensor digitorum communis, with the remaining cases blocked by fracture fragments. Irreducible volar dislocations due to entrapment of the ulnar head occurred in 17.6% of cases with no tendon entrapment noted. CONCLUSIONS In the presence of a Galeazzi fracture, a reduced/stable DRUJ needs to be critically assessed as more than half of irreducible DRUJs in a Galeazzi fracture-dislocation were missed either pre- or intraoperatively.
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Affiliation(s)
- Nicholas J. Yohe
- Maimonides Medical Center, Brooklyn, NY, USA,Nicholas J. Yohe, Department of Orthopaedic Surgery, Maimonides Medical Center, 927 49th Street, Brooklyn, NY 11219, USA.
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Kinematic Analysis of the Distal Radioulnar Joint in Asymptomatic Wrists Using 4-Dimensional Computed Tomography-Motion Pattern and Interreader Reliability. J Comput Assist Tomogr 2019; 43:392-398. [PMID: 30762658 DOI: 10.1097/rct.0000000000000839] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to determine the normal measurement values and interobserver performance of the distal radioulnar joint during wrist pronation-supination using 4-dimensional computed tomography (CT). METHODS Four-dimensional CT examinations were performed on the asymptomatic contralateral wrists of 10 patients with unilateral chronic wrist pain. Measurements were conducted using the modified radioulnar (mRU) line and epicenter (Epi) methods. Volar subluxation of the ulnar head was demonstrated with negative values. Wilcoxon rank sum test was used to determine the measurement changes. Interobserver agreements were assessed using interclass correlation coefficients. RESULTS In pronation, mRU line measurements (median, 0.09; interquartile range, 0-0.15) were significantly larger than in supination (median, -0.1; interquartile range, -0.18 to 0; P = 0.008).The Epi measurements were not significantly different in pronation (median, 0.03; interquartile range, 0.01-0.07) and supination (median, 0.06; interquartile range, 0.01-0.1; P = 0.799). There was an excellent inter-observer agreement between the two readers using mRU and Epi methods in pronation (0.982, 0.898), midpoint (0.994, 0.827) and supination (0.989, 0.972) positions, respectively. CONCLUSIONS Using 4-dimensional CT examination, distal radioulnar joint kinematics in asymptomatic wrists demonstrate excellent interobserver agreements with increased volar ulnar subluxation with supination as detected using mRU, but not the Epi method.
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Ding BTK, Pillay K, Sechachalam S. Radial shaft fracture obliquity as a predictor of distal radioulnar joint instability. J Hand Surg Eur Vol 2018; 43:732-738. [PMID: 29466912 DOI: 10.1177/1753193418756591] [Citation(s) in RCA: 6] [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
UNLABELLED We assessed whether radial shaft fracture obliquity measurements on radiographs could predict intra-operative distal radioulnar joint instability. We also clinically validated previously described predictors of distal radioulnar joint instability, which included a fracture line within 7.5 cm of the lunate fossa, radial shortening >5 mm, and ulna styloid fracture. We retrospectively analysed the radiographs of all surgically managed patients in our unit with radial shaft fractures from 2006 through 2016. The degree of obliquity was analysed on the basis of the maximum fracture-line angle in either the coronal or the sagittal plane. A radial shaft fracture obliquity >30° is predictive of distal radioulnar joint instability ( P = 0.001). Radial fracture shaft obliquity >30° was the most sensitive radiological parameter (76%) for predicting distal radioulnar joint instability. Oblique radial shaft fractures appear to be associated with increased incidence of distal radioulnar joint instability. This radiologic parameter may be used together with established parameters in predicting distal radioulnar joint instability for surgical treatment. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Benjamin T K Ding
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Kaamini Pillay
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore
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Kootstra TJM, van Doesburg MH, Schuurman AH. Functional Effects of the Adams Procedure: A Retrospective Intervention Study. J Wrist Surg 2018; 7:331-335. [PMID: 30174991 PMCID: PMC6117174 DOI: 10.1055/s-0038-1660812] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 05/10/2018] [Indexed: 10/14/2022]
Abstract
Background Injury to the distal radioulnar joint (DRUJ) causes swelling and ulnar-sided wrist pain. The Adams procedure stabilizes the DRUJ and shows promising short-term results. Purpose We studied the long-term functional outcome in patients who underwent the Adams procedure. We also tested the null hypothesis that there would be no difference in range of motion (ROM) and grip strength between the operated wrist compared to the unaffected side. Patients and Methods We identified 74 consecutive patients that were operated from March 2005 to February 2014. Twenty-three patients responded to our invitation and underwent clinical follow-up. Three patients had a re-do of the Adams procedure after presenting with postoperative DRUJ instability, one was excluded due to additional wrist surgery not related to the initial procedure. Wrist functionality in the remaining 22 patients was examined by measuring ROM in all planes and grip strength of the operated and non-operated hand. Functional outcome was measured by asking patients to complete the Disabilities of the Arm, Shoulder, and Hand (DASH) outcome measure and the Patient-Rated Wrist and Hand Evaluation (PRWHE). Results After a mean follow-up time of 5.0 years (standard deviation [SD] 2.0), we found that supination, pronation, and grip strength were significantly decreased in the operated wrist. Postoperative DASH and PRWHE-scores averaged 13.1 (SD 18.6) and 20.3 (SD 15.1), respectively. Conclusion The Adams procedure affects, but largely restores pronation and supination, and clinical examination, DASH, and PRWHE scores indicate that the Adams procedure leaves patients with upper extremity functionality comparable to a healthy population. Level of Evidence Level IV.
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Affiliation(s)
- Thomas J. M. Kootstra
- Department of Plastic Surgery, Universitair Medisch Centrum Utrecht, Universiteit Utrecht, Utrecht, The Netherlands
| | - Margriet H. van Doesburg
- Department of Plastic Surgery, Universitair Medisch Centrum Utrecht, Universiteit Utrecht, Utrecht, The Netherlands
| | - Arnold H. Schuurman
- Department of Plastic Surgery, Universitair Medisch Centrum Utrecht, Universiteit Utrecht, Utrecht, The Netherlands
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Zheng M, Lin X, Xu S, Liu H, Liu J, Huang Z. [Combined ulnar shortening osteotomy and elastic suspended fixation in treatment of ulnar impaction syndrome]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:993-996. [PMID: 30238724 DOI: 10.7507/1002-1892.201802058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the effectiveness of ulnar shortening osteotomy combined with elastic suspension fixation for ulnar impaction syndrome caused by relatively long ulna. Methods Between October 2015 and August 2016, 3 cases of ulnar impaction syndrome were treated. One patient was male and 2 patients were females. The age was 32, 29, and 59 years, respectively. One patient was dislocation and impaction of distal radioulnar joint for more than 1 year after internal fixation due to ulnar and radial open fractures. Other patients had no trauma and surgery, but long-term manual history. The visual analogue scale (VAS) scores were 7, 5, and 5, respectively. Cooney wrist function scores were rated as poor. Preoperative X-ray measurements of the ulnar variance was 12.7, 9.0, and 8.7 mm, respectively. The ulna was transversely osteotomy and fixed with plate and screws. The distal radioulnar joint was elastic suspension fixed with mini plate. Results Postoperative X-ray film showed that the matching of the distal radioulnar joint had no significant difference compared with the contralateral side. All the incisions healed by first intention without complication such as neurovascular injury, infection, and dislocation of the distal radioulnar joint. The patients were followed up 27, 17, and 23 months, respectively. At last follow-up, X-ray film showed that all osteotomy segments achieved bony union without internal fixation failure. The VAS scores were 2, 0, and 1, respectively, and the Cooney wrist function scores were rated as excellent. Conclusion The ulnar shortening osteotomy combined with elastic suspension fixation can correct the ulna variation, avoid the instability of the distal radioulnar joint caused by the extensive dissection of the tissue around the ulnar, and avoid stiffness of the joints caused by rigid fixation. It is an ideal treatment for ulna impaction syndrome.
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Affiliation(s)
- Muxin Zheng
- The Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China
| | - Xiaodong Lin
- The Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China
| | - Shuchai Xu
- The 4th Department of Orthopeadics, Guangdong Provincial Traditional Chinese Medical Hospital Affiliated to Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 520105, P.R.China
| | - Hongliang Liu
- The 4th Department of Orthopeadics, Guangdong Provincial Traditional Chinese Medical Hospital Affiliated to Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 520105,
| | - Jian Liu
- The Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China
| | - Zexin Huang
- The 4th Department of Orthopeadics, Guangdong Provincial Traditional Chinese Medical Hospital Affiliated to Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 520105, P.R.China
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Response to "Letter Regarding 'Outcomes of Isolated Radial Osteotomy for Volar Distal Radioulnar Joint Instability Following Radial Malunion in Children'". J Hand Surg Am 2018; 43:e9-e10. [PMID: 29976392 DOI: 10.1016/j.jhsa.2018.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 05/04/2018] [Indexed: 02/02/2023]
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Oppermann J, Burkhart KJ, Löw S, Müller LP. [The proximal radioulnar joint in consideration of the distal radioulnar joint]. DER ORTHOPADE 2018; 47:663-669. [PMID: 29947876 DOI: 10.1007/s00132-018-3590-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The movement of the forearm follows a complex interplay of three main components: the proximal and distal radioulnar joint and the interosseous membrane. Injuries to one or even all components have a huge impact on the integrity of this system. The Essex-Lopresti lesion presented a high challenge in clinical diagnostics as well as therapy. Reconstructions of the length and stability are essential for a satisfactory postoperative outcome. If a reconstruction of the radial head by osteosynthesis is not possible, a radial head prosthesis should be implanted in the case of longitudinal instability - avoiding overlapping and/or oversizing. The reconstruction of the interosseous membrane should be considered, as well as the assessment of the distal radioulnar joint and/or the triangular fibrocartilage complex. Various reconstruction options are available in this regard.
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Affiliation(s)
- J Oppermann
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universität zu Köln, Kerpener Straße 62, 50937, Köln, Deutschland.
- Cologne Center for Musculoskeletal Biomechanics, Medical Faculty, University of Cologne, Köln, Deutschland.
| | | | - S Löw
- Praxis für Handchirurgie und Unfallchirurgie, Bad Mergentheim, Deutschland
| | - L P Müller
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universität zu Köln, Kerpener Straße 62, 50937, Köln, Deutschland
- Cologne Center for Musculoskeletal Biomechanics, Medical Faculty, University of Cologne, Köln, Deutschland
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Atılgan N, Pekince O, Kaçıra BK. Kırık olmadan Akut izole distal radioulnar eklem çıkığı cerrahi tedavisi: Nadir görülen pediatrik olgu sunumu. DICLE MEDICAL JOURNAL 2017. [DOI: 10.5798/dicletip.319785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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van Leerdam RH, Wijffels MME, Reijnierse M, Stomp W, Krijnen P, Schipper IB. The value of computed tomography in detecting distal radioulnar joint instability after a distal radius fracture. J Hand Surg Eur Vol 2017; 42:501-506. [PMID: 28058967 DOI: 10.1177/1753193416682682] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED This study evaluated the value of computed tomography scans for the diagnosis of distal radioulnar joint instability. A total of 46 patients, conservatively treated for a unilateral distal radius fracture, were evaluated. Clinical instability was tested using the stress test and clunk test. A computed tomography scan of both wrists was performed in pronation and supination. Two independent observers reviewed the computed tomography scans using: the radioulnar line, subluxation ratio, epicentre and radioulnar ratio methods. Radiological distal radioulnar joint instability was assessed by comparing the measurements of the injured wrist with those of the contralateral uninjured wrists. A total of 22 patients had clinical instability of whom 12 suffered from pain in the injured wrist. Distal radioulnar joint instability was diagnosed on computed tomography in 29 patients. Reliability analysis between clinical and radiological evaluations showed at best moderate, but generally poor agreement. The diagnostic ability of computed tomography for identifying distal radioulnar joint instability seems limited. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- R H van Leerdam
- 1 Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - M M E Wijffels
- 1 Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - M Reijnierse
- 2 Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - W Stomp
- 2 Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - P Krijnen
- 1 Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - I B Schipper
- 1 Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
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Subtle radiographic findings of acute, isolated distal radioulnar joint dislocation. Skeletal Radiol 2016; 45:1243-7. [PMID: 27229875 DOI: 10.1007/s00256-016-2411-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 04/23/2016] [Accepted: 05/16/2016] [Indexed: 02/02/2023]
Abstract
Distal radioulnar dislocations typically occur in association with fractures of the distal radius and/or ulna. Rare isolated dislocations or subluxations are more difficult to diagnose and are initially missed in up to 50 % of cases. We present two cases of missed isolated volar rotatory dislocation of the distal radioulnar joint. Subtle, overlooked radiographic findings of abnormal radioulnar alignment and ulnar styloid projection are highlighted. The supplemental role of cross-sectional imaging is reviewed. Adequate clinical information, appropriate radiographic technique, and high index of suspicion are necessary for the accurate and timely diagnosis of this rare injury pattern.
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Abstract
Distal radioulnar joint (DRUJ) instability is a common clinical condition but a frequently missed diagnosis. Both surgical and nonsurgical treatments are possible for chronic cases of DRUJ instability. Nonsurgical treatment can be considered as the primary therapy in less active patients, while surgery should be considered to recover bone and ligament injuries if nonsurgical treatment fails to restore forearm stability and function. The appropriate choice of treatment depends on the individual patient and specific derangement of the DRUJ.
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Affiliation(s)
- Ali R Mirghasemi
- Department of Orthopaedic Surgery, Sina Hospital, School of Medicine, University of Tehran, Tehran, Iran
| | - Daniel J Lee
- Department of Orthopaedic Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Narges Rahimi
- Department of Physical Medicine and Rehabilitation, Aja University of Medical Science, Tehran, Iran
| | | | - John C Elfar
- Department of Orthopaedic Surgery, University of Rochester Medical Center, Rochester, NY, USA
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Spies C, Prommersberger K, Langer M, Müller L, Hahn P, Unglaub F. Instabilität des distalen Radioulnargelenks. Unfallchirurg 2015; 118:701-17. [DOI: 10.1007/s00113-015-0044-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
Background Chronic, dynamic bidirectional instability in the distal radioulnar joint (DRUJ) is diagnosed clinically, based on the patient's complaints and the finding of abnormal laxity in the vicinity of the distal ulna. In cases where malunion is ruled out or treated and there are no signs of osteoarthritis, stabilization of the DRUJ may offer relief. To this end, several different techniques have been investigated over the past 90 years. Materials and Methods In this article we outline the procedure for a new technique using a tendon graft to reinforce the distal edge of the interosseous membrane. Description of Technique A percutaneous technique is used to harvest the palmaris longus tendon and to create a tunnel, just proximal to the sigmoid notch, through the ulna and radius in an oblique direction. By overdrilling the radial cortex, the knotted tendon can be pulled through the radius and ulna and the knot blocked at the second radial cortex, creating a strong connection between the radius and ulna at the site of the distal oblique bundle (DOB). The tendon is fixed in the ulna with a small interference screw in full supination, preventing subluxation of the ulna out of the sigmoid notch during rotation. Results Fourteen patients were treated with this novel technique between 2011 and October 2013. The QuickDASH score at 25 months postoperatively (range 16-38 months) showed an improvement of 32 points. Similarly, an improvement of 33 points (67-34 months) was found on the PRWHE. Only one recurrence of chronic, dynamic bidirectional instability in the DRUJ was observed. Conclusion This simple percutaneous tenodesis technique between radius and ulna at the position of the distal edge of the interosseous membrane shows promise in terms of both restoring stability and relieving complaints related to chronic subluxation in the DRUJ.
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Affiliation(s)
- Peter R. G. Brink
- Department of Traumatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Pascal F. W. Hannemann
- Department of Traumatology, Maastricht University Medical Center, Maastricht, The Netherlands
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Midterm functional outcome after dorsal capsular imbrication for posttraumatic instability of the distal radioulnar joint. Arch Orthop Trauma Surg 2014; 134:1633-9. [PMID: 25288029 DOI: 10.1007/s00402-014-2092-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Indexed: 02/09/2023]
Abstract
INTRODUCTION The dorsal capsular imbrication of the distal radioulnar joint (DRUJ) which was performed because of posttraumatic dorsal instability showed promising functional results after the first postoperative years. Therefore, we hypothesized that patients after capsular imbrication are characterized by good subjective and functional outcome measurements after a midterm period. MATERIALS AND METHODS Eleven patients (range 21-50 years of age; median 35 years of age) were examined after capsular imbrication of the DRUJ because of posttraumatic instability with a mean follow-up time of 72 months (range 46-114 months; median 66 months). Examination parameters included the determination of range of motion (ROM), grip strength, pain and functional outcome scores (modified Mayo wrist score (MMWS); Disabilities of the Arm, Shoulder and Hand questionnaire (DASH score)). RESULTS A mean DASH score of 6.7 (range 0-22.5) and mean MMWS of 91.8 (range 75-100) were measured. Grip strength reached 96.7 % of the contralateral hand. Range of motion reached at least 93.1 % of the contralateral hand. Eight of 11 patients regarded functional outcome and pain reduction as excellent. Six of 11 patients did not recognize a diagnosed instability of DRUJ as such. Ulnar-sided wrist pain was the apparent symptom in these cases. CONCLUSIONS Capsular imbrication of the DRUJ is a reliable and sufficient treatment option in case of posttraumatic dorsal instability. Since DRUJ instability is seldom recognized by the patients as such, a standardised diagnostic algorithm is mandatory to guarantee reliability and efficacy for identifying DRUJ instability.
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The role of imaging in diagnosing diseases of the distal radioulnar joint, triangular fibrocartilage complex, and distal ulna. AJR Am J Roentgenol 2014; 203:146-53. [PMID: 24951208 DOI: 10.2214/ajr.13.11573] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this article is to review the anatomy, biomechanics, and multimodality imaging findings of common and uncommon distal radioulnar joint (DRUJ), triangular fibrocartilage complex, and distal ulna abnormalities. CONCLUSION The DRUJ is a common site for acute and chronic injuries and is frequently imaged to evaluate chronic wrist pain, forearm dysfunction, and traumatic forearm injury. Given the complex anatomy of the wrist, the radiologist plays a vital role in the diagnosis of wrist pain and dysfunction.
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Tomlinson JE, Manfredi JM. Evaluation of application of a carpal brace as a treatment for carpal ligament instability in dogs: 14 cases (2008–2011). J Am Vet Med Assoc 2014; 244:438-43. [DOI: 10.2460/javma.244.4.438] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Untreated distal radioulnar joint (DRUJ) instability can lead to arthritis of the DRUJ. To date, however, the clinical determination of DRUJ instability still represents a challenge. We developed a new clinical test to determine its stability. This works by directly observing the ulnar head's dynamic behavior during active pro-supination or testing the DRUJ's static stability at different grades of rotation. With the test results, the examiner gains a better understanding of the ulna head's behavior during rotational movements and how that compares to that of the uninjured side.
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45
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Tarallo L, Adani R, Catani F. Closed reduction of acute volar dislocation of the distal radioulnar joint. J Hand Surg Eur Vol 2013; 38:572-4. [PMID: 23315624 DOI: 10.1177/1753193412474400] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- L. Tarallo
- Department of Orthopaedic Surgery,University of Modena and Reggio Emila, Modena Hand Surgery Department, Azienda Ospedaliera Universitaria Verona, Verona, Italy
| | - R. Adani
- Department of Orthopaedic Surgery,University of Modena and Reggio Emila, Modena Hand Surgery Department, Azienda Ospedaliera Universitaria Verona, Verona, Italy
| | - F. Catani
- Department of Orthopaedic Surgery,University of Modena and Reggio Emila, Modena Hand Surgery Department, Azienda Ospedaliera Universitaria Verona, Verona, Italy
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46
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Tang C, Fung B, Chan R, Fok M. THE BEAUTY OF STABILITY: DISTAL RADIOULNAR JOINT STABILITY IN ARTHROSCOPIC TRIANGULAR FIBROCARTILAGE COMPLEX REPAIR. ACTA ACUST UNITED AC 2013; 18:21-6. [DOI: 10.1142/s0218810413500044] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The triangular fibrocartilage complex (TFCC) has an important role in the stability of the distal radioulnar joint (DRUJ) stability. We designed a new method of TFCC tear repair that has satisfactory post-operative DRUJ stability. From May 2004 to August 2010, 14 patients who underwent this operation were reviewed. The average post-operative follow-up period was 8.2 months; 66.7% of the patients with TFCC tear in sigmoid notch had clinical DRUJ instability, while only 50% of tear in fovea and 16.7% of tear in base of ulnar styloid had clinical DRUJ instability. Transosseous suture via inside-outside technique was used for repair. At the final follow-up, all 14 patients have soft end point with < 5 mm translations of the DRUJ shown by the stress test. Based on this small sample with satisfactory outcome assessed by the Mayo modified wrist score and DRUJ stability, we recommend TFCC tear in sigmoid notch, which has a higher chance of DRUJ instability, to be repaired by transosseous suture.
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Affiliation(s)
- Chris Tang
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong
| | - Boris Fung
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong
| | - Rebecca Chan
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong
| | - Margaret Fok
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong
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