The Critical Size of Ulnar Styloid Fragment for the DRUJ Stability

2021 ◽  
Author(s):  
Mauro Maniglio ◽  
Il Jung Park ◽  
Matthias Zumstein ◽  
Michael Kuenzler ◽  
Michelle H. McGarry ◽  
...  
Keyword(s):  
Critical Size ◽  
Fragment Size ◽  
Distal Radioulnar Joint ◽  
Forearm Rotation ◽  
Ulnar Styloid ◽  
Druj Instability ◽  
Ulnar Styloid Fracture ◽  
Fracture Size ◽  
Clinically Significant ◽  
Fracture Types

Abstract Background Ulnar styloid fractures can be associated with clinically significant instability of the distal radioulnar joint (DRUJ). However, the exact fragment size that results in DRUJ instability is unknown. Purpose The objective of this study was to determine the critical size of an ulnar styloid fracture that would result in a significant increase in DRUJ translation and forearm rotation. Methods Eight cadaveric specimens were used to investigate the effects of three different ulnar styloid fracture sizes on DRUJ instability: tip fracture, base fracture, and a fracture including the fovea. Forearm rotation and dorsopalmar DRUJ translation were measured after each sequential increase in fracture size. Results Relative to the uninjured state, a significant increase in forearm rotation and dorsopalmar translation was found for all three fractures. However, the fovea fracture showed a statistically significant increase in forearm rotation compared with all other fracture types and a statistically significant increase in total dorsopalmar translation compared with the tip fracture. Conclusion In this study, ulnar styloid fractures involving the fovea resulted in significantly greater DRUJ instability comparted to tip and base fractures alone. This study provides important biomechanical data regarding the critical size of ulnar styloid fractures that result in DRUJ instability and may aid in the surgical decision-making algorithm in these patients.

Relationship between Fracture of the Ulnar Styloid Process and DRUJ Instability: A Biomechanical Study

2020 ◽  
Author(s):  
Toshiyasu Nakamura ◽  
Owen J. Moy ◽  
Clayton A. Peimer
Keyword(s):  
Styloid Process ◽  
Distal Radioulnar Joint ◽  
Significant Loss ◽  
Biomechanical Study ◽  
Clinical Question ◽  
Ulnar Styloid ◽  
Horizontal Fracture ◽  
Druj Instability ◽  
Ulnar Styloid Fracture ◽  
Additional Section

Abstract Background There has been clinical question in the treatment of ulnar styloid fracture with distal radius fracture, surgical fixation of the styloid fragment, or ignorance of the fragment. We examined relationship between size of the ulnar styloid fracture and distal radioulnar joint (DRUJ) stability biomechanically to answer the above clinical question. Methods Changes in the dorsopalmar stiffness of the DRUJ after experimentally simulating in four types of ulnar styloid fractures were examined in cadavers. After tip, middle, base-horizontal, and base-oblique type of styloid fractures were made sequentially, changes in dorsopalmar DRUJ stiffness were measured using the MTS machine in the intact wrist, for each fracture, at 60 degrees pronation, neutral, and 60 degrees supination, respectively. Additional cutting of the radioulnar ligament (RUL) at the fovea was also simulated with the base-horizontal fracture. Results The tip and middle type fractures did not demonstrate significant loss of stiffness compared with the intact. The base-horizontal fracture demonstrated only significant loss of stiffness in the dorsal direction (radius palmar; ulnar dorsal) with forearm in neutral rotation. The base-oblique fracture demonstrated significant loss of dorsopalmar stiffness of the DRUJ. Additional section of the RUL with the base-horizontal fracture induced significant loss of stiffness of the DRUJ compared with the intact. Conclusions Because the RUL originates from the fovea as well as from the base of the ulnar styloid, these results suggest that DRUJ instability closely correlates with how much of the bony fragment includes the originating portions of the RUL. The findings further suggest that larger base-oblique and base-horizontal fragments with resultant DRUJ instability must be reattached, but that even base-horizontal fragment as well as tip and middle ulnar styloid fragment can be ignored when there is no instability.

Should We Repair the Pronator Quadratus in a Distal Radius Fracture with an Ulnar Styloid Base Fracture? A Biomechanical Study

2021 ◽  
Author(s):  
Mauro Maniglio ◽  
Victor Truong ◽  
Matthias Zumstein ◽  
Lilianna Bolliger ◽  
Michelle H. McGarry ◽  
...  
Keyword(s):  
Distal Radius ◽  
Distal Radioulnar Joint ◽  
Biomechanical Study ◽  
Forearm Rotation ◽  
Ulnar Styloid ◽  
Pronator Quadratus ◽  
Volar Approach ◽  
Druj Instability ◽  
Cadaveric Model

Abstract Background Merits of repairing the pronator quadratus (PQ) to restore distal radioulnar joint (DRUJ) stability after a volar approach remain controversial. Distal radius fractures are often associated with ulnar styloid fractures (USF). When involving the fovea, this USF can lead to a DRUJ instability. The PQ repair may be key in reducing this DRUJ instability. Methods This study aims to assess the biomechanical role of PQ repair in a cadaveric model of USF. In 17 forearm specimens, a USF including the fovea was executed. Positional changes of the DRUJ in forearm rotation and dorso-palmar (DP) translation were measured with variable loads (0, 2.5, and 5N) applied to the PQ origin. Results Forearm rotation and DP-translation decreased significantly with PQ loading of 5N, changing on average by 5 degrees and 0.6 mm, respectively. Conclusion We found a significant decrease in forearm rotation and DP-translation comparing a fully loaded PQ to an unloaded PQ in our cadaveric model.

TRAUMATIC VOLAR DISLOCATION OF THE DISTAL ULNA WITH A FRACTURE OF THE ULNAR STYLOID

Hand Surgery ◽  
2012 ◽  
Vol 17 (03) ◽  
pp. 383-386 ◽  
Author(s):  
Motoki Sonohata ◽  
Hiroko Mine ◽  
Toshiyuki Tsuruta ◽  
Masaaki Mawatari
Keyword(s):  
Functional Disability ◽  
Case Reports ◽  
Forearm Fracture ◽  
Distal Radioulnar Joint ◽  
Emergency Medical Technicians ◽  
Ulnar Styloid ◽  
Distal Ulna ◽  
Ulnar Styloid Fracture ◽  
Type Of Injury

Isolated volar dislocation of the distal ulna without forearm fracture is very rare; however, this injury is incorrectly diagnosed in approximately 50% of cases. This injury can lead to a significant functional disability if left untreated. This report presents a case of isolated volar dislocation of the distal ulna with an ulnar styloid fracture. The dislocation was subsequently reduced, the styloid was surgically repaired, and the patient was satisfied at the last follow-up. The importance of a proper clinical examination and an accurate radiographic position of the wrist are stressed. Furthermore, clinical evaluation of the distal radioular joint after reduction is important in achieving good results. There are various strategies for the treatment of distal radioulnar joint after reduction, including conservative treatment or surgical treatment. We believe that surgical exploration could have been carried out at an earlier stage had such a lesion been suspected. Additional case reports of other instances of successful treatment are needed to educate orthopaedic surgeons and emergency medical technicians on the nature of this type of injury.

SAUVÉ-KAPANDJI PROCEDURE IN A PATIENT WITH WRIST DISARTICULATION: CASE REPORT

Hand Surgery ◽  
2014 ◽  
Vol 19 (02) ◽  
pp. 227-229
Author(s):  
Hyun Sik Gong ◽  
Myung Ki Chung ◽  
Goo Hyun Baek
Keyword(s):  
Case Report ◽  
Distal Radioulnar Joint ◽  
Forearm Rotation ◽  
Ulnar Styloid ◽  
Chronic Instability ◽  
Radioulnar Joint ◽  
Post Traumatic

The advantage of preserving the distal radioulnar joint in wrist disarticulation is that full forearm rotation is possible if the joint is intact, which improves the capability of the amputee. The Sauvé-Kapandji procedure has been performed to treat rheumatoid or post-traumatic chronic instability and/or arthritis of the distal radioulnar joint. We report a patient with wrist disarticulation that presented to us with limited supination of the wrist due to an injured distal radioulnar joint. We performed the Sauvé-Kapandji procedure, and the patient could regain functional supination of the forearm without losing the ulnar styloid flare that improved prosthetic suspension. This case suggests that the Sauvé-Kapandji procedure can be performed to maintain the advantage of wrist disarticulation even when the initial trauma involves an irreparable injury of the distal radioulnar joint.

scholarly journals Prevalence of triangular fibrocartilage complex injuries in patients with distal radius fractures: a 3.0T magnetic resonance imaging study

2019 ◽  
Vol 47 (8) ◽  
pp. 3648-3655
Author(s):  
Bingshan Yan ◽  
Zhaoning Xu ◽  
Yanchao Chen ◽  
Wangping Yin
Keyword(s):  
Distal Radius ◽  
Distal Radioulnar Joint ◽  
Distal Radius Fractures ◽  
Resonance Imaging ◽  
Radius Fractures ◽  
Ulnar Styloid ◽  
Radioulnar Joint ◽  
Ulnar Styloid Fracture ◽  
Triangular Fibrocartilage ◽  
3.0T Mri

Objective This study was performed to determine the prevalence of triangular fibrocartilage complex (TFCC) injuries as shown by 3.0T magnetic resonance imaging (MRI) in patients with distal radius fractures. Methods In total, 57 patients with distal radius fractures underwent 3.0T MRI examinations to observe the incidence of TFCC injuries after manual reduction and cast fixation. The fracture type was categorized by the AO classification, and the TFCC injury pattern was evaluated using the Palmer classification. The correlation between the location of the TFCC injury and the distal radius fracture pattern, distal radioulnar joint instability, or ulnar styloid fracture was analyzed. Results Fifty-five TFCC injuries were diagnosed. There was no significant relationship between the TFCC injury pattern and the type of distal radius fracture, distal radioulnar joint instability, or ulnar styloid fracture. Conclusions This study revealed a high prevalence of TFCC injuries in patients with distal radius fractures. The 3.0T MRI examination helps to assess TFCC injuries in patients with distal radius fractures. Clinical Trial Registration ChiCTR1800017101.

Ulnar Styloid Malunion with Dislocation of the Distal Radioulnar Joint

1998 ◽  
Vol 23 (2) ◽  
pp. 173-175 ◽  
Author(s):  
R. NAKAMURA ◽  
E. HORII ◽  
T. IMAEDA ◽  
E. NAKAO ◽  
K. SHIONOYA ◽  
...  
Keyword(s):  
Corrective Osteotomy ◽  
Distal Radioulnar Joint ◽  
Ulnar Styloid ◽  
Joint Dislocation ◽  
Radioulnar Joint ◽  
Ulnar Styloid Fracture ◽  
Wrist Function

Four patients with dorsal dislocation of the distal radioulnar joint and ulnar styloid malunion had corrective osteotomy of the ulnar styloid. Dislocation of the distal radioulnar joint was reduced in three of four patients. Subluxation persisted in the remaining patient. Wrist function improved in all patients. These results support the contention that a displaced ulnar styloid fracture with distal radioulnar joint dislocation should be reduced and internally fixed. Corrective osteotomy is recommended for malunion of the ulnar styloid associated with dislocation of the distal radioulnar joint.

scholarly journals DRUJ instability after distal radius fracture: A comparison between cases with and without ulnar styloid fracture

2011 ◽  
Vol 9 (8) ◽  
pp. 648-651 ◽  
Author(s):  
Gholam Hossein Kazemian ◽  
Hooman Bakhshi ◽  
Matt Lilley ◽  
Mohammad Emami Tehrani Moghaddam ◽  
Mohammad M. Omidian ◽  
...  
Keyword(s):  
Distal Radius Fracture ◽  
Distal Radius ◽  
Radius Fracture ◽  
Ulnar Styloid ◽  
Druj Instability ◽  
Ulnar Styloid Fracture

Relationship between the ulnar styloid fracture and druj instability

2003 ◽  
Vol 28 ◽  
pp. 48 ◽  
Author(s):  
Toshiyasu Nakamura ◽  
Owen J. Moy ◽  
Clayton A. Peimer
Keyword(s):  
Ulnar Styloid ◽  
Druj Instability ◽  
Ulnar Styloid Fracture

Ulnar Styloid Fracture with Distal Radioulnar Joint Subluxation/Dislocation

Hand Surgery ◽  
1997 ◽  
Vol 02 (02) ◽  
pp. 141-147
Author(s):  
Ryogo Nakamura ◽  
Emiko Horii ◽  
Toshihiko Imaeda ◽  
Etsuhiro Nakao ◽  
Hitoshi Kato
Keyword(s):  
Computed Tomography ◽  
Distal Radioulnar Joint ◽  
Ulnar Styloid ◽  
Radioulnar Joint ◽  
Ulnar Styloid Fracture ◽  
Distal Radioulnar Joint Subluxation

In 55 patients with ulnar styloid fractures, the site and displacement of the fracture was examined in relation to distal radioulnar joint subluxation/dislocation by computed tomography (CT). Distal radioulnar joint subluxation/dislocation confirmed with CT in 18 of 55 patients, irrespective of the site of the ulnar styloid fracture. In 21 patients with nondisplaced styloid fractures, only 3 fractures were associated with distal radioulnar joint subluxation/dislocation. In 34 patients where the styloid fracture was displaced for 3 mm or more, 15 fractures were associated with a distal radioulnar joint subluxation/dislocation. Therefore, ulnar styloid displacement of 3 mm or more suggests the need for further examination of the distal radioulnar joint.

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