The role of the distal radioulnar ligaments, interosseous membrane, and joint capsule in distal radioulnar joint stability

We describe an arthroscopic rein-type capsular suture that approximates the triangular fibrocartilage complex to the anatomical footprint, and report the results at a minimum 12 month follow-up. The procedure involves two 3-0 polydioxanone horizontal mattress sutures inserted 1.5 cm proximal to the 6-R and 6-U portals to obtain purchase on the dorsal and anterior radioulnar ligaments, respectively. The two sutures work as a rein to approximate the triangular fibrocartilage complex to the fovea. Ninety patients with Type IB triangular fibrocartilage complex injuries were included retrospectively. The 12-month postoperative Modified Mayo Wrist scores, Disabilities of Arm, Shoulder and Hand scores and visual analogue scale for pain showed significant improvements on preoperative values. Postoperative range of wrist motion, grip strength and ultrasound assessment of the distal radioulnar joint stability were comparable with the normal wrist. The patients had high satisfaction scores for surgery. There were minor complications of knot irritation. No revision surgery for distal radioulnar joint instability was required. It is an effective and technically simple procedure that provides a foveal footprint contact for the triangular fibrocartilage complex. Level of evidence: IV

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Clinical and Non-Clinical Aspects of Distal Radioulnar Joint Instability

The Open Orthopaedics Journal ◽

10.2174/1874325001206010204 ◽

2012 ◽

Vol 6 (1) ◽

pp. 204-210 ◽

Cited By ~ 31

Author(s):

MME Wijffels ◽

PRG Brink ◽

IB Schipper

Keyword(s):

Distal Radioulnar Joint ◽

Lateral View ◽

Joint Capsule ◽

Clinical Aspects ◽

Clinical Tests ◽

Radioulnar Joint ◽

Radiologic Evaluation ◽

Druj Instability ◽

Common Diagnosis ◽

Extensive Range

Untreated distal radioulnar joint (DRUJ) injuries can give rise to long lasting complaints. Although common, diagnosis and treatment of DRUJ injuries remains a challenge. The articulating anatomy of the distal radius and ulna, among others, enables an extensive range of forearm pronosupination movements. Stabilization of this joint is provided by both intrinsic and extrinsic stabilizers and the joint capsule. These structures transmit the load and prevent the DRUJ from luxation during movement. Several clinical tests have been suggested to determine static or dynamic DRUJ stability, but their predictive value is unclear. Radiologic evaluation of DRUJ instability begins with conventional radiographs in anterioposterior and true lateral view. If not conclusive, CT-scan seems to be the best additional modality to evaluate the osseous structures. MRI has proven to be more sensitive and specific for TFCC tears, potentially causing DRUJ instability. DRUJ instability may remain asymptomatic. Symptomatic DRUJ injuries treatment can be conservative or operative. Operative treatment should consist of restoration of osseous and ligamenteous anatomy. If not successful, salvage procedures can be performed to regain stability.

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The role of radiography and computerized tomography in the diagnosis of subluxation and dislocation of the distal radioulnar joint

Plastic & Reconstructive Surgery ◽

10.1097/00006534-198509000-00061 ◽

1985 ◽

Vol 76 (3) ◽

pp. 487

Author(s):

Mino D. E. ◽

Palmer A. K. ◽

Levinsohn E. M.

Keyword(s):

Computerized Tomography ◽

Distal Radioulnar Joint ◽

Radioulnar Joint

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Effect of decrease in radial inclination of distal radius fractures on distal radioulnar joint stability: a biomechanical study

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193418761266 ◽

2018 ◽

Vol 43 (9) ◽

pp. 967-973 ◽

Cited By ~ 2

Author(s):

Yuki Bessho ◽

Toshiyasu Nakamura ◽

Masao Nishiwaki ◽

Takeo Nagura ◽

Morio Matsumoto ◽

...

Keyword(s):

Distal Radius ◽

Joint Stiffness ◽

Distal Radioulnar Joint ◽

Biomechanical Study ◽

Joint Stability ◽

Radius Fractures ◽

Radioulnar Joint ◽

Radial Inclination ◽

Fresh Frozen ◽

The Relationship

We investigated the relationship between the radial inclination of the distal radius and distal radioulnar joint stability. Six fresh-frozen upper extremities were used. Radial inclination was decreased by 10° and 20° and increased by 10° from the original radial inclination. Distal radioulnar joint stiffness was assessed with an intact radioulnar ligament and after partial and then complete sectioning of the radioulnar ligament. Radial angulation deformities significantly increased distal radioulnar joint stiffness when the radioulnar ligament is totally or partially attached to the ulnar fovea. After complete sectioning of the radioulnar ligament, distal radioulnar joint stiffness decreased significantly; additional radial angulation deformity slightly increased distal radioulnar joint stiffness, but the distal radioulnar joint never recovered to the original stiffness. Based on the results, radial angulation deformities of the distal radius should be corrected within 10° when the radioulnar ligament is intact, to reduce the risk of symptomatic distal radioulnar joint instability.

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Outcomes after anatomic reconstruction of the radioulnar ligaments for distal radioulnar joint instability

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193420942668 ◽

2020 ◽

Vol 45 (9) ◽

pp. 909-915 ◽

Cited By ~ 1

Author(s):

Lisa M. Frantz ◽

Elizabeth A. Helsper ◽

Harry A. Morris ◽

Bernard F. Hearon

Keyword(s):

Joint Instability ◽

Stress Test ◽

Distal Radioulnar Joint ◽

Tendon Graft ◽

Anatomic Reconstruction ◽

Joint Stability ◽

Level Of Evidence ◽

Radioulnar Joint ◽

High Satisfaction ◽

Graft Rupture

This retrospective study investigated the clinical outcomes of patients treated for chronic distal radioulnar joint instability with open anatomic reconstruction of the palmar and dorsal radioulnar ligaments. After the midpoint of a tendon graft is anchored at the ulnar fovea, the two graft limbs traverse the distal radioulnar joint. One limb is woven into the palmar wrist capsule and the other is secured to the dorsal wrist capsule and retinaculum to stabilize the joint. Of 30 patients (31 wrists) treated with this technique, 19 were followed longitudinally for a mean of 10 years (range 3–21). In this long-term cohort, there were statistically significant improvements in ulnar-sided wrist pain on the visual analogue scale and in distal radioulnar joint stability on the dorsopalmar stress test. The modified Mayo Wrist Scores were classified as three excellent, 12 good, three fair and one poor. Of the 30 patients studied, failure occurred in four patients, two from graft rupture and two from distal radioulnar joint arthrosis. We conclude that anatomic reconstruction of the palmar and dorsal radioulnar ligaments is an effective treatment for distal radioulnar joint instability and is associated with high satisfaction and durable outcomes. Level of evidence: IV

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Reconstruction of the Distal Oblique Bundle of the Interosseous Membrane with Extensor Carpi Radialis Hemitendon: A New Minimally-Invasive Technique

Revista Iberoamericana de Cirugía de la Mano ◽

10.1055/s-0040-1719013 ◽

2020 ◽

Vol 48 (02) ◽

pp. 138-142

Author(s):

Francisco Martínez-Martínez ◽

Alberto Giménez-Ros ◽

Vicente J. León-Muñoz ◽

Fernando Santonja-Medina

Keyword(s):

Minimally Invasive ◽

Therapeutic Option ◽

Distal Radioulnar Joint ◽

Minimally Invasive Technique ◽

Interosseous Membrane ◽

Invasive Technique ◽

Radioulnar Joint ◽

Triangular Fibrocartilage ◽

Extensor Carpi Radialis ◽

Stabilizing Element

AbstractThe main stabilizing element of the distal radioulnar joint (DRUJ) is the triangular fibrocartilage complex (TFCC). Secondary stabilizers include the distal oblique band (DOB), which is inconsistently found. When TFCC repair has failed or cannot be performed, DOB reconstruction is a therapeutic option. Even though distal radioulnar ligamentoplasty remains the technique of choice, recent papers show similar outcomes from both methods. We present two cases of successful DOB repair with the extensor carpi radialis longus (ECRL) hemitendon.

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