In Vivo Contact Mechanics of the Distal Radioulnar Joint of the Normal Wrist Compared to Scapholunate Injury and Surgical Repair

2011 ◽  
Author(s):  
Mathew S. Varre ◽  
Sang-Pil Lee ◽  
Terence E. McIff ◽  
E. Bruce Toby ◽  
Kenneth J. Fischer
Keyword(s):  
Contact Mechanics ◽  
Distal Radioulnar Joint ◽  
The Body ◽  
Ulnar Variance ◽  
Joint Mechanics ◽  
Force Transmission ◽  
Scapholunate Dissociation ◽  
Secondary Osteoarthritis ◽  
Radioulnar Joint

The distal radioulnar joint (DRUJ) is a joint of the wrist which allows forearm rotation and force transmission in the upper limb while preserving stability independent of flexion and extension of the forearm and wrist. The DRUJ is a frequently injured joint in the body. Conditions affecting the joint could be positive ulnar variance (Ulnar Impaction Syndrome) or negative ulnar variance (ulnar impingement), which may be congenital or may result from a poorly reduced distal radius fracture or both bone forearm fracture. The DRUJ is also adversely affected by other injuries near the joint. In fact, a significant correlation has been found between negative ulnar variance and scapholunate dissociation [1, 2, 3]. While this could be a predisposing factor, the associate also leads to the question of whether or not scapholunate dissociation may cause changes in the radioulnar joint mechanics. Altered joint mechanics are highly associated with onset of secondary osteoarthritis. An understanding of in vivo distal radioulnar joint contact mechanics in the normal and pathological wrist could help physicians make better clinical recommendations and improve treatment for the primary injury and avoid DRUJ pathology. Successful treatment may possibly reduce risk of or prevent the onset of osteoarthritis.

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

Hand Surgery ◽  
2005 ◽  
Vol 10 (02n03) ◽  
pp. 243-248 ◽  
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.

Comparison of Normal Capitate Mid-Carpal Joint Mechanics With the Effects of Scapholunate Dissociation Injury

2011 ◽  
Author(s):  
Madhan Sai Kallem ◽  
Sang-Pil Lee ◽  
Terence E. McIff ◽  
E. Bruce Toby ◽  
Kenneth J. Fischer
Keyword(s):  
Contact Mechanics ◽  
Surgical Techniques ◽  
Ligament Injury ◽  
Joint Mechanics ◽  
Scapholunate Dissociation ◽  
Carpal Collapse ◽  
Contact Patterns ◽  
Carpal Joint ◽  
Slac Wrist

The wrist is one of the most complicated multibody joints in the human body. It can be subject to many injuries. Scapholunate (SL) dissociation is a relatively common injury that is particularly difficult to diagnose and treat. Without treatment, SL dissociation is known to progress to scapholunate advance collapse (SLAC wrist) and associated osteoarthritis (OA) [1]. Traumatic arthropathy of the wrist due to scapholunate dissociation has a definitive pattern from onset to severe bone and joint degeneration. The altered radiocarpal and SL mechanics with SL dissociation may be accompanied by a secondary carpal collapse between the capitate and lunate [2]. The initial SL disruption causes apparent changes in joint kinematics and contact patterns. Thus, understanding normal and abnormal in vivo contact mechanics as a result of SL ligament injury may lead to more effective treatments that may even prevent the onset of OA. In addition, in vivo contact mechanics data after surgical treatment may help determine the effectiveness of various surgical techniques which are used to correct SL injury.

scholarly journals Effects of distal radius malunion on distal radioulnar joint mechanics—an in vivo study

2007 ◽  
Vol 25 (4) ◽  
pp. 547-555 ◽  
Author(s):  
Joseph J. Crisco ◽  
Douglas C. Moore ◽  
G. Elisabeta Marai ◽  
David H. Laidlaw ◽  
Edward Akelman ◽  
...  
Keyword(s):  
Distal Radius ◽  
Distal Radioulnar Joint ◽  
In Vivo Study ◽  
Joint Mechanics ◽  
Radioulnar Joint ◽  
Distal Radius Malunion ◽  
Radius Malunion

In vivo measurement of distal radioulnar translation following distal radius fracture

2021 ◽  
pp. 175319342110166
Author(s):  
Grey E. B. Giddins ◽  
Greg T. Pickering
Keyword(s):  
Distal Radius Fracture ◽  
Distal Radius ◽  
Distal Radioulnar Joint ◽  
Wrist Fracture ◽  
Radius Fracture ◽  
Normal Range ◽  
Radioulnar Joint ◽  
In Vivo Measurement ◽  
Objectively Measured

The incidence of distal radioulnar joint instability following a distal radius fracture is estimated around one in three based upon clinical examination. Using a validated rig, we objectively measured distal radioulnar joint translation in vivo following distal radius fracture. Dorsopalmar translation of the distal radioulnar joint was measured in 50 adults with previous distal radius fractures. Measurements were compared with the uninjured wrist and against a database of previous measurements within healthy and clinically lax populations. Translation at the distal radioulnar joint was greater in injured wrists at 12.2 mm (range 10–15, SD 1.2) than the uninjured wrists at 6.4 (range 4–9, SD 0.8) ( p < 0.001) and was always outside the established normal range. There was no statistically significant link between translation and the severity of the injury. Instability appears almost inevitable following a distal radius (wrist) fracture, albeit subclinical in the vast majority.

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

2021 ◽  
Author(s):  
Janni Kjærgaard Thillemann ◽  
Sepp De Raedt ◽  
Emil Toft Petersen ◽  
Katriina Bøcker Puhakka ◽  
Torben Bæk Hansen ◽  
...  
Keyword(s):  
Normal Values ◽  
Intraclass Correlation ◽  
Case Series ◽  
Distal Radioulnar Joint ◽  
Ulnar Variance ◽  
Patient Specific ◽  
Imaging Method ◽  
Radioulnar Joint ◽  
Case Series Study ◽  
The Press

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.

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

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>

Three-dimensional in vivo kinematics of the distal radioulnar joint in malunited distal radius fractures

2002 ◽  
Vol 27 (2) ◽  
pp. 233-242 ◽  
Author(s):  
Douglas C. Moore ◽  
Kathleen A. Hogan ◽  
Joseph J. Crisco ◽  
Edward Akelman ◽  
Manuel F. DaSilva ◽  
...  
Keyword(s):  
Distal Radius ◽  
Three Dimensional ◽  
Distal Radioulnar Joint ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Radioulnar Joint ◽  
In Vivo Kinematics

scholarly journals Morphological Associations between the Distal Radioulnar Joint and the Lunate

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.

Sign in / Sign up

Export Citation Format

Share Document