Assessment of dorsal instability of the ulnar head in the distal radioulnar joint: comparison between normal wrist joints and cases of ruptured extensor tendons

2015 ◽  
Vol 26 (2) ◽  
pp. 161-166
Author(s):  
Kiyohito Naito ◽  
Yoichi Sugiyama ◽  
Kentaro Aritomi ◽  
Yasushi Nagahama ◽  
Yoshimasa Tomita ◽  
...  
Keyword(s):  
Distal Radioulnar Joint ◽  
Radioulnar Joint ◽  
Extensor Tendons ◽  
Ulnar Head ◽  
Wrist Joints

VAUGHAN JACKSON SYNDROME DUE TO DISTAL RADIOULNAR JOINT OSTEOARTHRITIS: A CASE REPORT

2021 ◽  
pp. 2150014
Author(s):  
Alaa A. Dawood ◽  
Hayder M. Mahmood
Keyword(s):  
Rheumatoid Arthritis ◽  
Case Report ◽  
Tendon Transfer ◽  
Distal Radioulnar Joint ◽  
Wrist Pain ◽  
Common Complication ◽  
Radioulnar Joint ◽  
Extensor Tendons ◽  
Ulnar Head

Spontaneous extensor tendons rupture (Vaughan Jackson syndrome) is a common complication of rheumatoid arthritis, but it is also reported sporadically with non-rheumatoid osteoarthritis of the distal radioulnar joint (DRUJ). We described a case of 45 years old female who lost her ability to extend the little, ring and middle fingers sequentially after months of wrist pain and limitation of movement due to osteoarthritis of DRUJ. The condition was treated surgically by tendon transfer and ulnar head excision. The patient did well after surgery.

Non-constrained implant arthroplasty for the distal radioulnar joint

2017 ◽  
Vol 42 (4) ◽  
pp. 415-421 ◽  
Author(s):  
B. D. Adams ◽  
J. L. Gaffey
Keyword(s):  
Surgical Techniques ◽  
Distal Radioulnar Joint ◽  
Implant Loosening ◽  
Short Term ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Radioulnar Joint ◽  
Ulnar Head ◽  
Strenuous Activity

A variety of surgical techniques are used to treat the arthritic distal radioulnar joint, which is influenced by aetiology and previous procedures. Four types of ulnar head arthroplasty exist: total ulnar head, partial ulnar head, unlinked total distal radioulnar joint, and linked distal radioulnar joint. Although long-term outcome studies are sparse, short-term clinical and biomechanical studies have shown encouraging results, leading to expanded indications. Based on our experience and a literature review, patients are advised that pain is improved but minor pain is common after strenuous activity. Ulnar neck resorption is common, however, implant loosening is rare. Sigmoid notch erosion is concerning, but appears to stabilize and not affect outcome. A partial ulnar head replacement that retains bony architecture and soft tissue restraints may have benefit over a total ulnar head in appropriate patients. If appropriate selection criteria are met, ulnar head replacement typically produces reliable results, with low revision.

scholarly journals The Optimal Suture Placement and Bone Tunnels for TFCC Repair: A Cadaveric Study

2018 ◽  
Vol 07 (05) ◽  
pp. 375-381 ◽  
Author(s):  
Peter Tang ◽  
Keiji Fujio ◽  
Robert Strauch ◽  
Melvin Rosenwasser ◽  
Taiichi Matsumoto
Keyword(s):  
Distal Radioulnar Joint ◽  
Radioulnar Joint ◽  
Ulnar Head ◽  
Transosseous Repair ◽  
Triangular Fibrocartilage ◽  
The Mean ◽  
Group 5 ◽  
Bone Tunnels ◽  
Isometric Point ◽  
Suture Placement

Background Transosseous repair of foveal detachment of the triangular fibrocartilage complex (TFCC) is effective for distal radioulnar joint stabilization. However, studies of the optimal foveal and TFCC suture positions are scant. Purpose The purpose of this study was to clarify the optimal TFCC suture position and bone tunnels for transosseous foveal repair. Materials and Methods Seven cadavers were utilized. The TFCC was incised at the foveal insertion and sutured at six locations (TFCCs 1–6) using inelastic sutures. Six osseous tunnels were created in the fovea (foveae 1–6). Fovea 2 is located at the center of the circle formed by the ulnar head overlooking the distal end of the ulna (theoretical center of rotation); fovea 5 is located 2 mm ulnar to fovea 2. TFCC 5 is at the ulnar apex of the TFCC disc; TFCC 4 is 2 mm dorsal to TFCC 5. TFCC 1 to 6 sutures were then placed through each of the six osseous tunnels, resulting in 36 combinations, which were individually tested. The forearm was placed in five positions between supination and pronation, and the degree of suture displacement was measured. The position with the least displacement indicated the isometric point of the TFCC and fovea. Results The mean distance of suture displacement was 2.4 ± 1.6 mm. Fovea 2, combined with any TFCC location, (0.7 ± 0.6 mm) and fovea group 5, combined with TFCC 4 location (0.8 ± 0.8) or with TFCC 5 location (0.9 ± 0.6) had statistically shorter suture displacements than any other fovea groups. Conclusion For TFCC transosseous repair, osseous tunnel position was more important than TFCC suture location.

Clinical, radiological and patient-rated outcome comparison between total and partial ulnar head implants

2021 ◽  
pp. 175319342110484
Author(s):  
Lea Estermann ◽  
Lisa Reissner ◽  
Andrea B. Rosskopf ◽  
Andreas Schweizer ◽  
Ladislav Nagy
Keyword(s):  
Grip Strength ◽  
Distal Radioulnar Joint ◽  
Joint Arthroplasty ◽  
Dash Score ◽  
Level Of Evidence ◽  
Radioulnar Joint ◽  
Ulnar Head ◽  
Outcome Comparison ◽  
Pain At Rest

This study aimed to analyse the clinical and radiological outcomes after ulnar head replacement and to compare partial and total ulnar head implants. Twenty-two patients with 23 implants were available with a mean follow-up time of 7 years (range 1.3 to 17) after distal radioulnar joint arthroplasty. At the final follow-up, patients had a low level of pain at rest and during effort, a median Disabilities of the Arm, Shoulder, and Hand (DASH) score of 12 and Patient-Rated Wrist Evaluation score of 12 with partial ulnar head implants, and scores of 20 and 22 in total ulnar head implants, respectively. While the range of motion in patients with partial ulnar head implants was slightly reduced in comparison with the preoperative condition and to the patients with total ulnar head implants, there was a tendency to a higher grip strength and rotational torque. Both types of prosthesis showed sigmoid notch resorptions and resorptions around the neck. We conclude that the results after partial ulnar head replacement do not significantly differ from the total ulnar head implants in many aspects. Level of evidence: III

MODIFIED MATCHED ULNAR RESECTION FOR ARTHROSIS OF DISTAL RADIOULNAR JOINT IN RHEUMATOID ARTHRITIS

Hand Surgery ◽  
2006 ◽  
Vol 11 (01n02) ◽  
pp. 15-19 ◽  
Author(s):  
K. N. Srikanth ◽  
S. A. Shahane ◽  
J. H. Stilwell
Keyword(s):  
Rheumatoid Arthritis ◽  
Retrospective Study ◽  
Pain Relief ◽  
Distal Radius ◽  
Distal Radioulnar Joint ◽  
Rheumatoid Patient ◽  
Radioulnar Joint ◽  
Ulnar Head

The pain of distal radioulnar arthrosis in rheumatoid patients is often due to disease largely confined to the radioulnar rather than the ulnocarpal articulation. This is a retrospective study of 14 patients (14 wrists) who underwent selective shaving of the radial articulation of the ulnar head leaving the ulnocarpal articulation intact. The ulnar head is reduced to the circumference of its shaft and a dorsal retinacular flap is interposed between it and the distal radius. Average age of the patients and follow-up were 63.5 years and 31 months, respectively. All patients had rheumatoid arthritis. Pain improved in 14 out of 15 wrists. Overall results were 67% good to excellent and 33% fair based on the modified Mayo's wrist score. This novel procedure for DRUJ arthrosis produces predictable pain relief in low demand rheumatoid patient.

Distal radioulnar joint stability measured with radiostereometry during the piano key test

2020 ◽  
Vol 45 (9) ◽  
pp. 923-930 ◽  
Author(s):  
Janni Kjærgaard Thillemann ◽  
Sepp De Raedt ◽  
Peter Bo Jørgensen ◽  
Lone Rømer ◽  
Torben Bæk Hansen ◽  
...  
Keyword(s):  
Interobserver Reliability ◽  
Distal Radioulnar Joint ◽  
Cadaver Study ◽  
Triangular Fibrocartilage Complex ◽  
Joint Stability ◽  
Human Donor ◽  
Radioulnar Joint ◽  
Ulnar Head ◽  
Custom Made ◽  
Triangular Fibrocartilage

Distal radioulnar joint instability is difficult to grade by clinical examination and interobserver reliability is low. This study used a new and precise radiostereometry method for measurement of distal radioulnar joint translation. Eight human donor arms were positioned in a custom-made fixture and a standardized piano key test was done with pressure on the ulnar head. Examination was done before and after dividing the styloid and foveal insertions of the triangular fibrocartilage complex. In the intact wrists, the piano key test induced a mean 1.36 mm translation of the ulnar head, which increased statistically significantly to 1.96 mm after a lesion of the styloid ligament insertion and to 2.3 mm after combined lesions of the styloid and foveal ligament insertions. This experimental cadaver study demonstrates a radiological method for precise quantification of distal radioulnar joint stability after different grades of triangular fibrocartilage complex injury.

Ulnar Stump Stabilization Using the Flexor Carpi Ulnaris Tendon for the Rheumatoid Wrist

2019 ◽  
Vol 24 (04) ◽  
pp. 447-451 ◽  
Author(s):  
Asami Abe ◽  
Hajime IshikawaKim
Keyword(s):  
Computed Tomography ◽  
Tendon Rupture ◽  
Extensor Tendon ◽  
Distal Radioulnar Joint ◽  
Forearm Rotation ◽  
Radioulnar Joint ◽  
Ulnar Head ◽  
Ulnar Head Resection ◽  
Flexor Carpi Ulnaris ◽  
Grip Power

Background: The objective of this retrospective study was to evaluate the outcomes of ulnar stump stabilization after ulna head resection using the FCU tendon by investigating the rate of postoperative extensor tendon rupture and click on forearm rotation. Methods: Wrist synovectomy (distal radioulnar joint (DRUJ), radiocarpal and midcarpal joints) and ulnar head resection combined with ulnar stump stabilizing procedure were performed in 58 wrists of 53 patients with RA in our hospital. Before operation, the dorsal subluxation ratio (DSR) of the ulnar head was measured with a multi-slice computed tomography (CT) images. The stabilization of ulnar stump after head resection was performed by the value of the DSR or the instability before the operation. Results: There was neither extensor tendon rupture nor click on forearm rotation in all the patients. Smooth forearm rotation was achieved by ulnar head resection and stabilizing procedure for the ulnar stump. The active range of forearm supination and pronation increased significantly from 68° ± 23° (mean ± SD) to 80° ± 10°, and from 69° ± 17° to 74° ± 13°. The grip power increased from 117 ± 62 mmHg to 185 ± 55 mmHg. In the assessment using 3DCT, the preoperative DSR of 54% improved to 8% on the whole (n = 58). In the wrists with extensor tendon rupture (n = 36), the preoperative DSR of 58% improved to 12%. In the wrists without tendon rupture (n = 22), the preoperative DSR of 46% improved to 2%. Conclusions: The operative technique of ulnar stump stabilization using the FCU tendon was one of the suitable procedure to prevent complications after ulnar head resection.

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