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

2020 ◽  
Vol 45 (9) ◽  
pp. 909-915 ◽  
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

Arthroscopic thermal stabilization for distal radioulnar joint instability: 3 to 19 years follow-up

2020 ◽  
Vol 45 (9) ◽  
pp. 916-922
Author(s):  
Elizabeth A. Helsper ◽  
Lisa M. Frantz ◽  
Jessica M. Adams ◽  
Harry A. Morris ◽  
Bernard F. Hearon
Keyword(s):  
Joint Instability ◽  
Stress Test ◽  
Thermal Stabilization ◽  
Distal Radioulnar Joint ◽  
Thermal Shrinkage ◽  
Joint Stability ◽  
Early Failure ◽  
Level Of Evidence ◽  
Radioulnar Joint

This retrospective study investigated the clinical outcomes of patients treated for chronic distal radioulnar joint instability with arthroscopic thermal annealing of the superficial radioulnar ligaments, ulnar palmar wrist ligaments, and dorsoulnar wrist capsule using a radiofrequency probe. Sixty patients (62 wrists) were treated over an 18-year period. At mean follow-up of 10 years (range 3 to 19), 30 of 33 patients were satisfied with their surgical outcomes. There were statistically significant improvements in ulnar-sided wrist pain on a visual analogue scale and in distal radioulnar joint stability on the dorsopalmar stress test after surgery compared with preoperative status. The modified Mayo Wrist Score and Quick Disabilities of the Arm, Shoulder, and Hand score of the patients were favourable. Early failure occurred in 11 of 62 wrists. Nine of these 11 wrists needed a secondary procedure. We conclude that arthroscopic thermal shrinkage is effective for the majority of the patients with mild to moderate chronic distal radioulnar joint instability in long-term follow-up. Secondary open ligament reconstruction is an option in the case of early failure. Level of evidence: IV

The rein-type arthroscopic capsular suture for triangular fibrocartilage complex foveal tears: midterm results for 90 patients

2021 ◽  
pp. 175319342110241
Author(s):  
I-Ning Lo ◽  
Kuan-Jung Chen ◽  
Tung-Fu Huang ◽  
Yi-Chao Huang
Keyword(s):  
Simple Procedure ◽  
Distal Radioulnar Joint ◽  
Triangular Fibrocartilage Complex ◽  
Joint Stability ◽  
Level Of Evidence ◽  
Radioulnar Joint ◽  
High Satisfaction ◽  
Ultrasound Assessment ◽  
Triangular Fibrocartilage

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

In-vivo three-dimensional measurement of distal radioulnar joint translation in normal and clinically unstable populations

2016 ◽  
Vol 41 (5) ◽  
pp. 521-526 ◽  
Author(s):  
G. T. Pickering ◽  
H. Nagata ◽  
G. E. B. Giddins
Keyword(s):  
Joint Instability ◽  
Distal Radioulnar Joint ◽  
Joint Stability ◽  
Forearm Rotation ◽  
Level Of Evidence ◽  
Ulnar Deviation ◽  
Radioulnar Joint ◽  
Normal Ranges ◽  
Clinical Instability

Assessment of distal radioulnar joint instability is clinically difficult and subjective. The distal radioulnar joint is postulated to ‘tighten’ in ulnar/radial deviation and pronation/supination. Using a rig, we measured mean distal radioulnar joint translation in neutral forearm rotation and neutral wrist radial and ulnar deviation, as well as extremes of wrist radial and ulnar deviation and forearm rotation. We tested the rig on ten cadaver forearms to validate the measurements we made. We tested 50 normal adults and 50 patients with clinical distal radioulnar joint instability. Distal radioulnar joint stability in men and women and on contralateral sides were comparable. Distal radioulnar joint translation decreased significantly with wrist radial and ulnar deviation and forearm pronation and supination, matching clinical practice and further validating the rig. The data in normal patients is comparable with previous computed tomography-based studies. Translation in all positions was statistically increased within the clinical instability group and did not cross-over with the normal ranges. Distal radioulnar joint translation is a physically measurable phenomenon. Our device appears to be a valid test of distal radioulnar joint translation, establishing normal data in vivo. Level of Evidence: III

scholarly journals Modification of the use of the extensor retinaculum for reducible distal radioulnar joint instability: technique and results

2017 ◽  
Vol 42 (8) ◽  
pp. 839-845 ◽  
Author(s):  
A. Filius ◽  
J. M. Zuidam ◽  
J. B. Jaquet ◽  
H. P. Slijper ◽  
J. H. Coert
Keyword(s):  
Grip Strength ◽  
Analogue Scale ◽  
Joint Instability ◽  
Simple Technique ◽  
Surgical Techniques ◽  
Distal Radioulnar Joint ◽  
Anatomic Reconstruction ◽  
Extensor Retinaculum ◽  
Level Of Evidence ◽  
Radioulnar Joint

Different surgical techniques have been described for chronic distal radioulnar joint instability: they are often complicated, quite invasive and may not be recommended for bidirectional instability. We describe a procedure using a radial-based extensor retinaculum strip and a capsular plication. This is a simple technique and less invasive than ‘anatomic’ radioulnar ligament reconstructions. We report the results of 38 patients (38 wrists) who we treated. After a minimum of 8 months we quantified the outcomes of the patients objectively by assessing ranges of motion, grip strength and clinical assessment of stability, and subjectively using questionnaires. Overall, 36 out of 38 patients were stable after surgery. The operated forearm and wrist had approximately 3° less range of motion in all planes and 3 kgf less grip strength compared with the unoperated side. The median Mayo modified wrist score was 90; the median visual analogue scale score was 2. This surgical technique appears to successfully treat patients with chronic reducible distal radioulnar joint instability. Anatomic reconstruction of both radioulnar ligaments is not always necessary. Level of evidence: IV

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.

Effect of volar angulation of extra-articular distal radius fractures on distal radioulnar joint stability: a biomechanical study

2015 ◽  
Vol 40 (8) ◽  
pp. 775-782 ◽  
Author(s):  
Y. Bessho ◽  
T. Nakamura ◽  
T. Nagura ◽  
M. Nishiwaki ◽  
K. Sato ◽  
...  
Keyword(s):  
Distal Radius ◽  
Joint Stiffness ◽  
Distal Radioulnar Joint ◽  
Biomechanical Study ◽  
Joint Stability ◽  
Level Of Evidence ◽  
Radioulnar Joint ◽  
Dorsal Angulation ◽  
Triangular Fibrocartilage ◽  
The Relationship

The relationship between increased volar tilt of the distal radius and distal radioulnar joint stability was examined. Distal radioulnar joint stiffness was recorded at 10° intervals from 10° dorsal angulation to 20° of volar angulation from the anatomical position of the radius. Tests were performed with the intact radioulnar ligament and repeated after partial and then complete sectioning of the radioulnar ligament at the ulnar fovea. With the intact radioulnar ligament, distal radioulnar joint stiffness increased significantly at 10° and 20° of volar angulation. Partial sectioning of the radioulnar ligament resulted in an approximate 10% decrease of distal radioulnar joint stiffness compared with the intact state, but distal radioulnar joint stiffness still increased significantly with greater volar tilt. Complete sectioning of the radioulnar ligament significantly decreased distal radioulnar joint stiffness, and increasing the volar tilt did not result in increased distal radioulnar joint stiffness. These results suggest that volar angulation deformities of the distal radius should be corrected to 10° of volar tilt when the triangular fibrocartilage complex is intact. Level of Evidence: N/A

Radioulnar Ratio in Detection of Distal Radioulnar Joint Instability Associated With Acute Distal Radius Fractures

2010 ◽  
Vol 35 (9) ◽  
pp. 730-734 ◽  
Author(s):  
J.H. Scheer ◽  
S. Hammerby ◽  
L.E. Adolfsson
Keyword(s):  
Computed Tomography ◽  
Prospective Study ◽  
Distal Radius ◽  
Joint Instability ◽  
Stress Test ◽  
Distal Radioulnar Joint ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Radioulnar Joint ◽  
Triangular Fibrocartilage

Lesions of the triangular fibrocartilage complex (TFCC) are commonly associated with distal radius fractures and may adversely affect the functional outcome. This prospective study evaluated computed tomography, using the radioulnar ratio (RUR), to detect laxity of the distal radioulnar joint in 48 consecutive patients with acute distal radius fractures and compared the results with a radioulnar stress test. We found the clinical stress test to be reliable in chronic cases, but the RUR method of questionable value in both acute and chronic cases.

scholarly journals A Novel Technique to Assess Distal Radioulnar Joint Stability Using Increasing Torque

2018 ◽  
Vol 08 (04) ◽  
pp. 327-334 ◽  
Author(s):  
Klara Nilsson ◽  
Peter Hallberg ◽  
Erik Tesselaar ◽  
Simon Farnebo
Keyword(s):  
Reference Values ◽  
Distal Radioulnar Joint ◽  
Radiographic Evaluation ◽  
Dominant Hand ◽  
Joint Stability ◽  
Level Of Evidence ◽  
4D Ct ◽  
Radioulnar Joint ◽  
Level Ii ◽  
Dc Servomotor

Background Previous studies on computed tomography (CT) in patients with a suspected triangular fibrocartilage complex (TFCC) injury have not been successful in assessing distal radioulnar joint (DRUJ) laxity. The aim of this study was to develop a novel servomotor-driven device for the assessment of DRUJ by applying increasing torque to the DRUJ in pronation and supination. Methods A custom-built device was designed to function during four-dimensional (4D) CT of the wrist. A torque meter, positioned between the incoming hand holder, and a direct current (DC) servomotor were used for angular positioning and for applying rotational force to the patient's arm. A total of 110 healthy participants were recruited to gather reference values for the range of motion (ROM), maximum torque in neutral and supinated/pronated position, and the ability to withstand an increasing, device-generated torque in these positions. The device was also used during 4D DRUJ CT in five patients with suspected TFCC injuries. Results A gender- and age-relevant reference chart for ROM and torque was created. Men showed a tendency (ns) toward having a larger ROM and increasing strength with increasing age, whereas women showed the opposite. Also, the dominant hand showed a tendency toward having a larger ROM and being stronger than the nondominant hand (ns). A smaller cohort of patients (n = 5) with suspected TFCC injuries showed a significantly decreased ability to withstand increasing torque in both supination (2.1 ± 0.3 vs. 3.1 ± 0.2 s; p < 0.005) and pronation (2.3 ± 0.5 vs. 3.1 ± 0.4 s; p < 0.0005) and also showed a clear laxity on real-time 4D CT image sequences. Decreased strength at all positions was also found (average 74% decrease compared to noninjured side). Conclusion Reference values for torque strength and ability to withstand increasing torque can be used clinically in the assessment of patients with symptoms that could represent ligamentous injuries to the TFCC. The ability to use the device during CT enables radiographic evaluation of instability during increasing torque. Level of Evidence This is a Level II study.

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