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

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.

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The Critical Size of Ulnar Styloid Fragment for the DRUJ Stability

Journal of Wrist Surgery ◽

10.1055/s-0041-1726309 ◽

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.

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

Journal of Wrist Surgery ◽

10.1055/s-0040-1719041 ◽

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.

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The Effect of Volarly Angulated Distal Radius Fractures on Forearm Rotation: In Vitro Biomechanical Study

Journal of Wrist Surgery ◽

10.1055/s-0035-1544221 ◽

2015 ◽

Vol 04 (S 01) ◽

Author(s):

Masao Nishiwaki ◽

Mark Welsh ◽

Louis Ferreira ◽

James Johnson ◽

Graham King ◽

...

Keyword(s):

Distal Radius ◽

Biomechanical Study ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Forearm Rotation

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Ulnar styloid fractures associated with distal radius fractures: Incidence and implications for distal radioulnar joint instability

The Journal Of Hand Surgery ◽

10.1053/jhsu.2002.36525 ◽

2002 ◽

Vol 27 (6) ◽

pp. 965-971 ◽

Cited By ~ 146

Author(s):

Megan M. May ◽

Jeffrey N. Lawton ◽

Philip E. Blazar

Keyword(s):

Distal Radius ◽

Joint Instability ◽

Distal Radioulnar Joint ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Ulnar Styloid ◽

Radioulnar Joint

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Radius distraction could contribute to long-term stability for treating distal radioulnar joint instability during volar plating of distal radius fracture: a retrospective case series study

10.21203/rs.3.rs-617556/v1 ◽

2021 ◽

Author(s):

Cheng-Yu Yin ◽

Hui-Kuang Huang ◽

Duretti Fufa ◽

Jung-Pan Wang

Keyword(s):

Surgical Technique ◽

Distal Radius Fracture ◽

Distal Radius ◽

Case Series ◽

Distal Radioulnar Joint ◽

Radius Fracture ◽

Radioulnar Joint ◽

Druj Instability

Abstract BackgroundThe surgical technique of radius distraction for stabilization of distal radioulnar joint (DRUJ) if intraoperative DRUJ instability was found after the fixation of distal radius fracture has been previously described, but this surgical technique lacks clinical and radiographic effect in minimal 3 years follow-up. We therefore evaluated the clinical outcome and radiographic results of radius distraction in minimal 3 years follow-up.MethodsWe reviewed the case series of distal radius fracture with concomitant DRUJ instability receiving radius distraction from the senior author over a 5-year period (January 1st, 2013 to June 30th, 2017) retrospectively, and the evaluation of clinical and radiographic outcomes was performed at clinic as long-term follow-up; a total 34 patients had been evaluated.ResultsAt minimal post-operative 36 months follow-up, all cases demonstrated acceptable wrist range of motion with stable DRUJs and low NRS of wrist pain (0.6, SD 0.7) and DASH score (mean 9.1, SD 6.2), and there were no cases suffering from nonunion of distal radius. The mean ulnar variance of injured wrist and uninjured wrist were − 1.2 mm and 0.2mm, respectively (SD 1.0 and 0.6) with significant statistical difference.ConclusionsRadius distraction during volar fixation of distal radius fracture should be consider if DRUJ instability was found by the radioulnar stress test intraoperatively, and the long-term DRUJ stability could be achieved by maintenance of normal-to-negative ulnar variance, with decreased wrist pain and satisfactory function outcome.Level of EvidenceTherapeutic Level IV

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

Hand Surgery ◽

10.1142/s0218810414720150 ◽

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.

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

Journal of International Medical Research ◽

10.1177/0300060519856157 ◽

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.

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Sonographic Findings in Adult Congenital Madelung Deformity: A Case Study

Journal of Diagnostic Medical Sonography ◽

10.1177/8756479319872151 ◽

2019 ◽

Vol 36 (1) ◽

pp. 65-71

Author(s):

Viviane Créteur ◽

Afarine Madani ◽

Stefano Bianchi

Keyword(s):

Distal Radius ◽

Imaging Technique ◽

Distal Radioulnar Joint ◽

Pronator Quadratus ◽

Correlative Imaging ◽

Madelung Deformity ◽

Cortical Defect ◽

Adult Congenital ◽

Rare Malformation

This case study describes six sonographic findings, with correlative imaging, in an adult patient with congenital Madelung deformity. Two are typical of congenital Madelung deformity: a thick volar hyperechoic band extending from the ulnar side of the distal radius toward the lunate-triquetrum area, the so-called Vickers ligament, adjacent to the radiotriquetral ligament, and a cortical defect on the ulnar and volar side of the distal radius. Other findings may be also observed, such as a narrowed distance between the Lister tubercle and the distal radioulnar joint, a dorsal subluxation of the ulnar head, an extensor tendons entrapment and pronator quadratus modifications. Although the diagnosis of congenital Madelung deformity is based usually on clinical examination, this rare malformation may remain undiscovered until adulthood. When sonography is used as the first imaging technique, the sonographic findings of congenital Madelung deformity can facilitate diagnosis and the appropriate radiographs.

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