Normal Values of Distal Radioulnar Joint Kinematics during a Dynamic Press Test

Abstract Background Measurement of in vivo distal radioulnar joint (DRUJ) pathomechanics during simple activities can represent the disability experienced by patients and may be useful in diagnostics of DRUJ instability. A first step is to describe the physiological normal limits for DRUJ kinematics in a reproducible and precise test setup, which was the aim of this study. Methods DRUJ kinematics were evaluated in 33 participants with dynamic radiostereometry (RSA) while performing a standardized press test examination. AutoRSA software was used for image analyses. Computed tomography (CT) forearm bone models were generated, and standardized anatomical axes were applied to estimate kinematic outcomes including, DRUJ translation, DRUJ position ratio, and changes in ulnar variance. Repeatability of dynamic RSA press test double examinations was evaluated to estimate the precision and intraclass correlation coefficient (ICC) test–retest agreement. Results The maximum force during the press test was 6.0 kg (95% confidence interval [CI]: 5.1–6.9), which resulted in 4.7 mm (95% CI: 4.2–5.1) DRUJ translation, DRUJ position ratio of 0.40 (95% CI: 0.33–0.44), and increase in ulnar variance of 1.1 mm (95% CI: 1.0–1.2). The mean maximum DRUJ translation leveled off after a 5 kg force application. The DRUJ translation ICC coefficient was 0.93 within a prediction interval of ± 0.53mm. Conclusions This clinical study demonstrates the normal values of DRUJ kinematics and reports excellent agreement and high precision of the press tests examination using an automated noninvasive dynamic RSA imaging method based on patient-specific CT bone models. The next step is the application of the method in patients with arthroscopic verified triangular fibrocartilage complex injuries. Level of Evidence This is a Level IV, case series study.

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Normal values of distal radioulnar translation assessed by three-dimensional C-arm scans: a cadaveric study

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193419826486 ◽

2019 ◽

Vol 44 (5) ◽

pp. 503-509 ◽

Cited By ~ 3

Author(s):

Benedict Swartman ◽

Laura Benner ◽

Stephan Grechenig ◽

Jochen Franke ◽

Paul A. Grützner ◽

...

Keyword(s):

Normal Values ◽

Intraclass Correlation ◽

Three Dimensional ◽

Distal Radioulnar Joint ◽

Cone Beam ◽

Ratio Method ◽

Reference Ranges ◽

Radioulnar Joint ◽

Observer Reliability ◽

Cone Beam Computer Tomography

We investigated whether mobile C-arm cone beam computer tomography (CBCT) could be used to measure radioulnar translation. The study was conducted on 31 Thiel-fixed intact cadaver arms. Three-dimensional scans of each wrist were carried out in pronation and supination. Four established measurement methods were used (radioulnar line, subluxation ratio, epicentre and radioulnar ratio methods) to measure radioulnar translation. The intraclass correlation coefficient for inter-observer and intra-observer reliability were excellent in three of four methods (>0.94). The reference ranges for physiological radioulnar translation were between −30% and 91% (radioulnar line method), −32% and 87% (subluxation ratio method), −40% and 23% (epicentre method), and 2% and 73% (radioulnar ratio method). Our results indicate that radioulnar translation in the distal radioulnar joint can be determined reliably using mobile C-arm CBCT. The normal values provide a basis for further experimental and clinical studies.

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Distal radioulnar joint stabilization with open foveal reinsertion versus tendon graft reconstruction: an experimental study using radiostereometry

Journal of Experimental Orthopaedics ◽

10.1186/s40634-021-00329-y ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Janni Kjærgaard Thillemann ◽

Sepp De Raedt ◽

Torben Bæk Hansen ◽

Bo Munk ◽

Maiken Stilling

Keyword(s):

Experimental Study ◽

Surgical Techniques ◽

Distal Radioulnar Joint ◽

Tendon Graft ◽

Imaging Method ◽

Radioulnar Joint ◽

Clinical Recommendation ◽

Surgical Methods ◽

Custom Made ◽

Stabilizing Effect

Abstract Purpose Symptomatic instability of the distal radioulnar joint (DRUJ) caused by lesion of the Triangular Fibrocartilage Complex (TFCC) can be treated with a number of surgical techniques. Clinical examination of DRUJ translation is subjective and limited by inter-observer variability. The aim of this study was to compare the stabilizing effect on DRUJ translation with two different surgical methods using the Piano-key test and a new precise low-dose, non-invasive radiostereometric imaging method (AutoRSA). Methods In a randomized experimental study we evaluated the DRUJ translation in ten human cadaver arms (8 males, mean age 78 years) after cutting the proximal and distal TFCC insertions, and after open surgical TFCC reinsertion (n = 5) or TFCC reconstruction using a palmaris longus tendon graft ad modum Adams (n = 5). The cadaver arms were mounted in a custom-made fixture for a standardized Piano-key test. Radiostereometric images were recorded and AutoRSA software was used for image analyses. Standardised anatomical axes and coordinate systems of the forearm computer tomography bone models were applied to estimate DRUJ translation after TFCC lesions and after surgical repair. Results The DRUJ translation after cutting the proximal and distal TFCC insertions was 2.48 mm (95% CI 1.61; 3.36). Foveal TFCC reinsertion reduced DRUJ translation by 1.78 mm (95% CI 0.82; 2.74, p = 0.007), while TFCC reconstruction reduced DRUJ translation by 1.01 mm (95% CI -1.58; 3.60, p = 0.17). Conclusion In conclusion, foveal TFCC reinsertion significantly decreased DRUJ translation while the stabilizing effect of Adams TFCC reconstruction was heterogeneous. This supports the clinical recommendation of TFCC reinsertion in patients suffering from symptomatic DRUJ instability due to acute fovea TFCC lesions.

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TREATMENTS OF OSTEOARTHRITIS OF THE DISTAL RADIOULNAR JOINT: LONG-TERM RESULTS OF THREE PROCEDURES

Hand Surgery ◽

10.1142/s0218810405002942 ◽

2005 ◽

Vol 10 (02n03) ◽

pp. 243-248 ◽

Cited By ~ 38

Author(s):

Akio Minami ◽

Norimasa Iwasaki ◽

Jun-ichi Ishikawa ◽

Naoki Suenaga ◽

Kazunori Yasuda ◽

...

Keyword(s):

Grip Strength ◽

Statistical Significance ◽

Distal Radioulnar Joint ◽

Triangular Fibrocartilage Complex ◽

Ulnar Variance ◽

Long Term Results ◽

Interposition Arthroplasty ◽

Secondary Osteoarthritis ◽

Radioulnar Joint ◽

Triangular Fibrocartilage

Sixty-one wrists in 61 patients with osteoarthritis of the distal radioulnar joint treated by three consecutive procedures (20 Darrach, 25 Sauvé-Kapandji and 16 hemiresection-interposition arthroplastic procedures) were retrospectively evaluated. We preferred to perform Darrach's procedure in even the early stages of osteoarthritis of the distal radioulnar joint prior to introduction of Sauvé-Kapandji and hemirestion-interposition arthroplastic procedures. Subsequently the hemirestion-interposition arthroplasty was indicated when the triangular fibrocartilage cartilage was intact or could be reconstructed and the Sauvé-Kapandji when the triangular fibrocartilage complex could not be reconstructed or there was positive ulnar variance of more than 5 mm even though the triangular fibrocartilage complex was functional. Patient's age at operation averaged 59.8 years. There were 36 men and 25 women. There were 38 primary and 23 secondary osteoarthritis cases. Post-operative pain, range of motion, grip strength, return to work status; and radiographic results were evaluated. At the five- to 14-year (average, ten years) follow-up evaluation, relief of pain from Darrach procedure was inferior to the Sauvé-Kapandji procedure and hemiresection-interposition arthroplasty although this was not statistically significant. After both the Sauvé-Kapandji procedure and hemiresection-inteposition arthroplasty, post-operative improvements in flexion and extension of the wrist had statistical significance. Post-operative improvements in pronation and supination of the forearm showed statistical significances after all procedures. Improvements of post-operative grip strength and return to an original job in the Sauvé-Kapandji procedure and hemiresection-interposition arthroplasty were statistically superior to those with a Darrach's procedure. There were many post-operative complications following the Darrach's procedure. Darrach's procedure is better indicated for severe osteoarthritic changes of the distal radioulnar joint in elderly patients. We believe the operative indications between the Sauvé-Kapandji procedure and hemiresection-interposition arthroplasty are best determined prior to surgery by the existence and status of the triangular fibrocartilage complex and the amount of the positive ulnar variance.

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Patients with triangular fibrocartilage complex injuries and distal radioulnar joint instability have reduced rotational torque in the forearm

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193415622342 ◽

2016 ◽

Vol 41 (7) ◽

pp. 732-738 ◽

Cited By ~ 11

Author(s):

J. K. Andersson ◽

P. Axelsson ◽

J. Strömberg ◽

J. Karlsson ◽

J. Fridén

Keyword(s):

Joint Instability ◽

Clinical Signs ◽

Case Series ◽

Distal Radioulnar Joint ◽

Triangular Fibrocartilage Complex ◽

Wrist Arthroscopy ◽

Level Of Evidence ◽

Independent Observer ◽

Radioulnar Joint ◽

Triangular Fibrocartilage

A total of 20 patients scheduled for wrist arthroscopy, all with clinical signs of rupture to the triangular fibrocartilage complex and distal radioulnar joint instability, were tested pre-operatively by an independent observer for strength of forearm rotation. During surgery, the intra-articular pathology was documented by photography and also subsequently individually analysed by another independent hand surgeon. Arthroscopy revealed a type 1-B injury to the triangular fibrocartilage complex in 18 of 20 patients. Inter-rater reliability between the operating surgeon and the independent reviewer showed absolute agreement in all but one patient (95%) in terms of the injury to the triangular fibrocartilage complex and its classification. The average pre-operative torque strength was 71% of the strength of the non-injured contralateral side in pronation and supination. Distal radioulnar joint instability with an arthroscopically verified injury to the triangular fibrocartilage complex is associated with a significant loss of both pronation and supination torque. Level of evidence: Case series, Level IV.

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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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Radius-ulna shaft fracture with distal radioulnar joint instability in a case of ipsilateral malunited colles fracture: a case report

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20211635 ◽

2021 ◽

Vol 7 (3) ◽

pp. 695

Author(s):

Neetin P. Mahajan ◽

Prasanna Kumar G. S. ◽

Kishor Jadhav ◽

Kartik Pande ◽

Tushar Patil

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

Shaft Fracture ◽

Distal Radioulnar Joint ◽

Fracture Site ◽

Ulnar Variance ◽

Radioulnar Joint ◽

Druj Instability ◽

Colles Fracture ◽

K Wires

<p class="abstract">Malunion of the distal end of radius is a known consequence of the conservative management. The functional impairment depends on the severity of the deformity and it can be associated with distal radioulnar joint (DRUJ) instability. Subsequent radius ulna fracture in an elderly osteoporotic patient is a challenging task to manage. A 60 year old female patient came with radius ulna shaft fracture with DRUJ instability with ipsilateral malunited distal radius fracture. We managed with open reduction and internal fixation using 3.5 mm locking compression plate (LCP) with ulnar shortening and K wires for DRUJ. At one year, follow-up, patient is having good clinical and radiological outcome without any complications. Radius ulna shaft fracture in cases of malunited colles fracture with positive ulnar variance with DRUJ instability can be managed well with open reduction and internal fixation of radius-ulna shaft which provides stable fixation, ulnar shortening at the fracture site to maintain the neutral/negative ulnar variance and DRUJ fixation using K wires. Use of multiple vicryl sutures to tie the plate to the bone gives additional stability in osteoporotic bones till the fracture unites and prevents implant failure. Combination of the above mentioned procedures helps in getting good functional outcome in elderly osteoporotic patients.</p>

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Anatomic Reconstruction of the Triangular Fibrocartilage Complex for the Treatment of Chronic Instability of the Distal Radioulnar Joint. A Systematic Review

Revista Iberoamericana de Cirugía de la Mano ◽

10.1055/s-0041-1736570 ◽

2021 ◽

Vol 49 (02) ◽

pp. e97-e104

Author(s):

Ignacio Miranda ◽

Francisco J. Lucas ◽

Vicente Carratalá ◽

Joan Ferràs-Tarragó ◽

Francisco J. Miranda

Keyword(s):

Systematic Review ◽

Surgical Techniques ◽

Case Series ◽

Distal Radioulnar Joint ◽

Triangular Fibrocartilage Complex ◽

Anatomic Reconstruction ◽

Wrist Arthroscopy ◽

Radioulnar Joint ◽

Druj Instability ◽

Triangular Fibrocartilage

Abstract Introduction Peripheral injuries of the triangular fibrocartilage complex (TFCC) can produce pain and instability of the distal radioulnar joint (DRUJ). There are several techniques for the reconstruction of the TFCC. The aim of the present paper was to summarize the tendon plasties of the DRUJ ligaments for the anatomic reconstruction of TFCC, to analyze the surgical techniques, and to evaluate their outcomes. Methods In order to perform a systematic review, we searched in the literature the terms DRUJ instability OR chronic distal radioulnar joint instability OR distal radioulnar tendon plasty. Results In total, 11 articles with level of evidence IV (case series) were retrieved. Most studies achieved good results, with recovery of wrist stability, improvement of the pain, and increase in grip strength in the functionality tests. In the historical evolution of the published series, wrist surgeons tried to perform a more anatomical plasty, with a more stable fixation and less invasive techniques. Conclusion The Adams procedure continues to be a valid and reproducible technique for the treatment of chronic DRUJ instability. If wrist arthroscopy and implants are available and surgeons have been technically trained, the authors recommend an arthroscopy-assisted technique, or, if possible, an all-arthroscopic TFCC reconstruction with implant fixation of the plasty in its anatomical points of insertion. Comparative studies between open and arthroscopic TFCC reconstruction techniques are needed.

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Evaluation of Kienböck's Disease Treated by Camembert Osteotomy at Seven Years

Journal of Wrist Surgery ◽

10.1055/s-0039-1683931 ◽

2019 ◽

Vol 08 (03) ◽

pp. 226-233 ◽

Cited By ~ 4

Author(s):

Emmanuel J. Camus ◽

Luc Van Overstraeten

Keyword(s):

Case Series ◽

Ulnar Variance ◽

Wedge Osteotomy ◽

Kienböck’S Disease ◽

Kienböck's Disease ◽

Ulnar Shortening Osteotomy ◽

Case Series Study ◽

Shortening Osteotomy ◽

Functional Scores ◽

Kienbock’S Disease

AbstractIn Kienböck's disease, radius shortening osteotomy is the most common treatment. The Camembert procedure is a wedge osteotomy that shortens only the radius facing the lunate. Its aim is to offload the lunate by redirecting the compression stress of the grip forces toward the scaphoid. The purpose of this study was to determine if the Camembert osteotomy is effective in improving clinical symptoms and limits lunate collapse. The series include 10 patients who underwent a Camembert osteotomy for Kienböck's disease between 2002 and 2012 (one bilaterally). They are six men and four women, aged 40.6 years. Five patients had an additional ulnar shortening osteotomy if ulnar variance was neutral or positive. The mean follow-up is 7 years. Preoperatively, range of motion, grip strength, pain, and functional scores were poor. All osteotomies healed within 3 months. Extension, ulnar deviation, grip, functional scores improved significantly. In 10 cases, there were improvement in the T1 and T2 signals on the magnetic resonance imaging (MRI). There was no lunate collapse. This series shows good results with no worsening of the lunate shape. There was no ulnocarpal impingement. The Camembert osteotomy proposes to offload the lunate and redirect strains toward the scaphoid. The supposed interest is to protect the lunate from collapse. In this small series, the Camembert osteotomy improved function in patients with early stage Kienböck's disease. MRI aspects improve in most cases and no patients collapsed. Camembert can be used in combination with a Sennwald's ulnar shortening when ulnar variance is neutral or positive. Authors propose this procedure for Lichtman's stages 1–2–3A if there are no cartilage or ligament lesions. This is a Level IV, case series study.

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Morphological Associations between the Distal Radioulnar Joint and the Lunate

Journal of Wrist Surgery ◽

10.1055/s-0037-1607327 ◽

2017 ◽

Vol 07 (02) ◽

pp. 148-155

Author(s):

Jean-Yves Beaulieu ◽

Flavien Mauler

Keyword(s):

Emergency Department ◽

Distal Radioulnar Joint ◽

Ulnar Variance ◽

Mean Values ◽

Lunate Bone ◽

Future Studies ◽

Morphological Variations ◽

Radioulnar Joint ◽

The Mean

Background Variations in morphology of the carpal bones have been described. Their implication in wrist disease and specific kinematic features has been recognized, and a better knowledge of these variations is essential. Questions/Purpose To radiographically determine any association between the morphological variations of the distal radioulnar joint (DRUJ) and the lunate bone. Materials and Methods Radiographs of 100 wrists of patients presenting to the emergency department with wrist pain and referred to our outpatient clinic were retrospectively reviewed for DRUJ inclination, ulnar variance, and radiocarpal and midcarpal morphology of the lunate. Results There were 51 females and 49 males, mean age 51.2 years (range: 21–94). There was a statistically significant association between the DRUJ inclination and the morphology of the radiocarpal side of the lunate (p < 0.001). The mean values of ulnar variance changed according to DRUJ inclination and the radiocarpal side of the lunate (p < 0.001) but not according to the midcarpal side of the lunate. There was no significant association between the morphology of the DRUJ and the midcarpal side of the lunate or between the midcarpal and the radiocarpal morphology of the lunate. Conclusion This study demonstrated a statistically significant association at the radiocarpal level between the DRUJ inclination, ulnar variance, and the morphology of the lunate. No association was found with the morphology of the midcarpal side of the lunate. Accordingly, a classification of these carpal associations is proposed, highlighting seven main wrist configurations. Clinical Relevance These associations can guide future studies of wrist kinematics.

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