scholarly journals Distal radioulnar joint instability with three different injury patterns assessed by three-dimensional C-arm scans: a cadaveric study

2019 ◽  
Vol 44 (10) ◽  
pp. 1072-1078
Author(s):  
Benedict Swartman ◽  
Laura Benner ◽  
Jochen Franke ◽  
Paul A. Grützner ◽  
Sven Y. Vetter ◽  
...  
Keyword(s):  
Joint Instability ◽  
Three Dimensional ◽  
Distal Radioulnar Joint ◽  
Ratio Method ◽  
Control Group ◽  
Injury Patterns ◽  
Radioulnar Joint ◽  
Sigmoid Notch ◽  
Triangular Fibrocartilage ◽  
Essex Lopresti

The aim of this study was to establish a radiographic method for detecting distal radioulnar joint instability intraoperatively. We created three successive instabilities in 12 intact Thiel-fixed upper limb specimens: lesion of the triangular fibrocartilage complex, Galeazzi injury and Essex–Lopresti injury. We made three-dimensional scans of the wrists in pronation and supination with a mobile C-arm. We used four validated measurement methods to quantify ulnar migration in the standard axial planes: the radioulnar line method, the subluxation ratio method, the epicentre method and the radioulnar ratio method. All types of instability showed significantly increased migration of the ulna compared with the control group. The subluxation ratio and the radioulnar ratio methods showed the highest sensitivity and specificity in detecting the instabilities. We conclude that these two methods are feasible for radiographically assessing distal radioulnar joint instability. Instability may be assumed if the migration of the ulna in the sigmoid notch is at least 45% of the length of the sigmoid notch, in which case wire transfixation of the distal radioulnar joint is advised.

scholarly journals The Effect of Dorsal Angulation on Distal Radioulnar Joint Arthrokinematics Measured Using Intercartilage Distance

2018 ◽  
Vol 08 (01) ◽  
pp. 010-017
Author(s):  
Emily Lalone ◽  
Masao Nishiwaki ◽  
Ryan Willing ◽  
James Johnson ◽  
Graham King ◽  
...  
Keyword(s):  
Distal Radius ◽  
Contact Area ◽  
Three Dimensional ◽  
Distal Radioulnar Joint ◽  
Radioulnar Joint ◽  
Motion Data ◽  
Contact Patterns ◽  
Dorsal Angulation ◽  
Triangular Fibrocartilage

Background The effects of dorsal angulation deformity on in vitro distal radioulnar joint (DRUJ) contact patterns are not well understood. Purpose The purpose of this study was to utilize intercartilage distance to examine the effects of forearm rotation angle, distal radius deformity, and triangular fibrocartilage complex (TFCC) sectioning on DRUJ contact area and centroid position. Methods An adjustable implant permitted the creation of simulated intact state and dorsal angulation deformities of 10, 20, and 30 degrees. Three-dimensional cartilage models of the distal radius and ulna were created using computed tomography data. Using optically tracked motion data, the relative position of the cartilage models was rendered and used to measure DRUJ cartilage contact mechanics. Results DRUJ contact area was highest between 10 and 30 degrees of supination. TFCC sectioning caused a significant decrease in contact area with a mean reduction of 11 ± 7 mm2 between the TFCC intact and sectioned conditions across all variables. The position of the contact centroid moved volarly and proximally with supination for all variables. Deformity had a significant effect on the location of the contact centroid along the volar–dorsal plane. Conclusion Contact area in the DRUJ was maximal between 10 and 30 degrees of supination during the conditions tested. There was a significant effect of simulated TFCC rupture on contact area in the DRUJ, with a mean contact reduction of 11 ± 7 mm2 after sectioning. Increasing dorsal angulation caused the contact centroid to move progressively more volar in the sigmoid notch.

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

2016 ◽  
Vol 41 (7) ◽  
pp. 732-738 ◽  
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.

scholarly journals Three-Dimensional Automated Assessment of the Distal Radioulnar Joint Morphology According to Sigmoid Notch Surface Orientation

2020 ◽  
Vol 45 (11) ◽  
pp. 1083.e1-1083.e11
Author(s):  
Simon Roner ◽  
Philipp Fürnstahl ◽  
Anne-Gita Scheibler ◽  
Reto Sutter ◽  
Ladislav Nagy ◽  
...  
Keyword(s):  
Three Dimensional ◽  
Distal Radioulnar Joint ◽  
Surface Orientation ◽  
Automated Assessment ◽  
Radioulnar Joint ◽  
Sigmoid Notch ◽  
Joint Morphology

A Two-Dimensional Kinematic Analysis of the Distal Radioulnar Joint

1996 ◽  
Vol 21 (6) ◽  
pp. 824-829 ◽  
Author(s):  
E. P. A. VAN DER HEIJDEN ◽  
B. HILLEN
Keyword(s):  
Healthy Volunteer ◽  
Ct Scan ◽  
Kinematic Analysis ◽  
Three Dimensional ◽  
Kinematic Chain ◽  
Distal Radioulnar Joint ◽  
Two Dimensional ◽  
Dorsal Part ◽  
Radioulnar Joint ◽  
Triangular Fibrocartilage

The triangular fibrocartilage and its function in the kinematics of pronation and supination in the distal radioulnar joint was studied. Measurements of the constituent parts of this joint in 11 cadavers showed that the palmar radioulnar ligament is at least 2 mm longer than the dorsal radioulnar ligament. Based on these measurements the movements of the joint were modelled in a two-dimensional kinematic chain. Predictions based on this chain could be confirmed by direct observation and videotaping dissections of joints of unfixed specimens and three-dimensional reconstructions of a CT scan of a healthy volunteer. It could be concluded that (a) the dorsal part is tight during pronation and the palmar part during supination and (b) considerable asymmetrical translations, (dorsal translation being the largest) occur because of the length differences of the ligaments.

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