Novel Radiographic View to Evaluate the Articular Surface of the Sigmoid Notch and Prevent Intra-articular Screw Placement in Distal Radius Fractures

Abstract Background The objective of this study was to predict the function of the forearm rotation on the basis of the articular surface of the sigmoid notch from three-dimensional reconstruction images. Methods We retrospectively reviewed patients who underwent volar plate fixation for intra-articular distal radius fractures (DRFs) in our institution between January 2017 and July 2019. The 3D image of the sigmoid notch on the fractured distal radius was reconstructed and looked up from the ulnar view to determine the existence of gaps or steps. Patients with or without gaps/steps on the sigmoid notch were included in the case group or control group, respectively. The patients’ basic data and postoperative data were collected and compared. Results A total of 81 patients were included. There were 33 patients in the case group, and 48 patients in the control group. There was no significant difference between the two groups at baseline. The total range of motion (ROM) of rotation in the case group and control group was 130.3 ± 6.2° and 145.3 ± 6.7°, respectively (P < 0.001). The percentage of rotation ROM of contralateral limb in the case group and control group was 72.3 ± 3.1% and 80.7 ± 3.6%, respectively (P < 0.001). VAS during forearm rotation was 2.1 ± 0.7 in the case group, which is significantly higher than that in the control group (1.5 ± 0.5, P < 0.001). Conclusion This study proposed a new method to assess the articular surface of the sigmoid notch which is based on 3D reconstruction images. With the assistance of this method, we found that gaps or steps on the sigmoid notch not only limit forearm pronation rotation and supination rotation, but also cause apparent wrist pain during forearm rotation movement and poor wrist ability.

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The Effect of Distal Radius Fractures Involving Distal Radioulnar Articular Joint on Forearm Rotation

10.21203/rs.3.rs-76689/v1 ◽

2020 ◽

Author(s):

Lingde Kong ◽

Meng Fu ◽

Jian Lu ◽

Yanqing Zhou ◽

Zuzhuo Zhang ◽

...

Keyword(s):

Distal Radius ◽

Articular Surface ◽

Distal Radius Fractures ◽

Control Group ◽

Case Group ◽

Radius Fractures ◽

Forearm Rotation ◽

Sigmoid Notch ◽

Significant Difference ◽

And Control

Abstract Background: The objective of this study was to predict the function of forearm rotation on basis of articular surface of sigmoid notch from three-dimensional reconstruction images. Methods: We retrospectively reviewed patients who underwent volar plate fixation for intra-articular distal radius fractures (DRFs) in our institution between January 2017 and July 2019. The 3D image of sigmoid notch on fractured distal radius was reconstructed and looked up from ulnar view to determine the existence of gaps or steps. Patients with or without gaps/steps on sigmoid notch were included in case group or control group respectively. The patients’ basic data and postoperative data were collected and compared. Results: A total of 81 patients were included. There were 33 patients in case group, and 48 patients in control group. There was no significant difference between the two groups at baseline. Total range of motion (ROM) of rotation in case group and control group were 130.3±6.2 degrees and 145.3±6.7 degrees respectively (P<0.001). Percentage of rotation ROM of contralateral limb in case group and control group were 72.3±3.1% and 80.7±3.6% respectively (P<0.001). VAS during forearm rotation were 2.1±0.7 in case group, which is significantly higher than that in control group (1.5±0.5, P<0.001). Conclusion: This study proposed a new method to assess the articular surface of sigmoid notch which is based on 3D reconstruction images. With the assistance of this method, we found that gaps or steps on sigmoid notch not only limit forearm pronation rotation and supination rotation, but also cause apparent wrist pain during forearm rotation movement.

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A three-dimensional analysis of the sigmoid notch

Orthopedic Reviews ◽

10.4081/or.2011.e17 ◽

2011 ◽

Vol 3 (2) ◽

pp. 17 ◽

Cited By ~ 5

Author(s):

Evan D. Collins ◽

Faranak Vossoughi

Keyword(s):

Distal Radius ◽

Articular Surface ◽

Three Dimensional ◽

Distal Radioulnar Joint ◽

Distal Radius Fractures ◽

Radius Of Curvature ◽

Radius Fractures ◽

Sigmoid Notch ◽

Radiocarpal Joint ◽

Dimensional Reconstruction

Fractures of the distal radius are among the most common injuries of the upper extremity, though treatment has traditionally focused on restoration of the radiocarpal joint and late sequelae may persist. X-ray imaging underestimates sigmoid notch involvement following distal radius fractures. No classification system exists for disruption patterns of the sigmoid notch of the radius associated with distal radius fractures. This study quantifies the anatomy of the sigmoid notch and identifies the landmarks of the articular surface and proximal boundaries of the distal radioulnar joint (DRUJ) capsule. Computed tomography scans of freshly frozen cadaveric hands were used - followed by dissection, and three-dimensional reconstruction of the distal radius and sigmoid notch. The sigmoid notch surface was divided into two surfaces and measured. The Anterior Posterior (AP) and Proximal Distal (PD) widths of the articulating surface were reviewed, along with the radius of curvature, version angle and depth. The study showed that the sigmoid notch is flatter than previously believed - and only the distal 69% of its surface is covered by cartilage. On average, it has about nine degrees of retroversion, and its average inclination is almost parallel to the anatomical axis of the radius. Clinical implications exist for evaluation of the DRUJ involvement in distal radius fractures or degenerative diseases and for future development and evaluation of hemiarthroplasty replacement of the distal radius.

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Fragment-specific fixation for complex intra-articular fractures of the distal radius: results of a prospective single-centre trial

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193412439677 ◽

2012 ◽

Vol 37 (8) ◽

pp. 765-771 ◽

Cited By ~ 16

Author(s):

A. S. Gavaskar ◽

S. Muthukumar ◽

N. Chowdary

Keyword(s):

Distal Radius ◽

Articular Surface ◽

Distal Radius Fractures ◽

First Year ◽

Functional Evaluation ◽

Radius Fractures ◽

Articular Fractures ◽

Functional Scores ◽

Radial Length ◽

Specific Fixation

The goal was to evaluate the efficacy of 2.4 mm column-specific plating for intra-articular distal radius fractures. In total, 105 patients with AO type C distal radius fractures were operated on using the locking distal radius system, Synthes. Follow-up assessments including clinical (wrist and forearm range of motion, grip strength), radiological (articular step, radial length and inclination, volar tilt, and ulnar variance), and functional scores (Disabilities of the Arm, Shoulder, and Hand; Patient Rated Wrist Evaluation) were made at regular intervals until 1 year. Union was obtained in all patients. Articular surface was anatomically reconstructed in 74 patients (70.5%). Clinical and functional evaluation showed significant continuous improvements over the first year. C1 fractures had a better chance of anatomical reduction compared with C2 and C3 fractures. Fracture type, quality of reduction, and presence of degenerative changes did not show a significant effect on functional outcome scores. Column-specific fixation of the distal radius can achieve satisfactory results in complex intra-articular fractures.

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Intra-articular distal radius fractures in elderly patients: a randomized prospective study of casting versus volar plating

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193417727139 ◽

2017 ◽

Vol 43 (2) ◽

pp. 142-147 ◽

Cited By ~ 27

Author(s):

Daniel Martinez-Mendez ◽

Alejandro Lizaur-Utrilla ◽

Joaquin de-Juan-Herrero

Keyword(s):

Conservative Treatment ◽

Elderly Patients ◽

Distal Radius ◽

Articular Surface ◽

Distal Radius Fractures ◽

Volar Plating ◽

Radius Fractures ◽

Level Of Evidence ◽

Loss Of Reduction

We compared outcomes in elderly patients with intra-articular distal radius fractures treated by closed reduction and plaster immobilization or open reduction and internal fixation with a volar plate. Ninety-seven patients older than 60 years were randomly allocated to conservative (47 patients) or surgical (50 patients) treatment. Over a 2-year period, we assessed patient-rated wrist evaluation score, DASH (disability arm, shoulder and hand) questionnaire, pain, wrist range of motion, grip strength, and radiological parameters. The functional outcomes and quality of life were significantly better after volar plating fixation compared with conservative treatment. We found that restoration of the articular surface, radial inclination, and ulnar variance affected the outcomes, but the articular step-off did not. Twenty-five per cent of the patients with conservative treatment had secondary loss of reduction. We conclude that surgical plating leads to better outcomes than conservative treatment for elderly patients with intra-articular distal radius fractures. Level of evidence: I

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