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At least 19 recordsLinked to original sources

PubMed2000

The role of the distal radioulnar ligaments, interosseous membrane, and joint capsule in distal radioulnar joint stability.

The individual contribution of the distal radioulnar ligaments to dorsal and palmar translational stability during forearm rotation remains controversial. Furthermore, the role of the distal radioulnar joint capsule as a restraint and contributor to stability has not been investigated. A biomechanical study was performed in 11 fresh cadaver specimens to simultaneously measure dorsal and palmar radioulnar ligament tension. Joint rotation and radial translation were measured after sequential excision of the disk, interosseous membrane, joint capsule, and radioulnar ligaments. Results confirmed that the dorsal ligament tightens during pronation while the palmar ligament becomes progressively lax; the converse occurred during supination. Translational stability remained intact at all positions throughout the sectioning sequence until one of the radioulnar ligaments was sectioned. The most significant increases in translation occurred after sectioning the dorsal radioulnar ligament in pronation and after sectioning the palmar radioulnar ligament in supination. Forearm rotation increased significantly after excising either hemicapsule.

Biomechanical Phenomena↗

PubMed1991

Radioulnar joint fusion for distal radioulnar joint instability.

Each one of this small group of patients illustrates a rare indication for the radioulnar joint fusion procedure in distal radioulnar joint instability. The case histories tell of a last ditch effort to salvage function in an extremity crippled by painful radioulnar instability after excision of the distal ulna. The fusions healed slowly and two required repeat surgery to achieve union. Today we would routinely add iliac bone graft to the fusion area to hasten healing. Rarely indicated, this is a salvage procedure that is done after failure of other procedures geared to preserve the rotation of the forearm. These patients all had successful salvage of their extremities for activities of daily living, but only one returned to his labor job. All were worker's compensation cases in physical jobs. Two patients had had prior radiocarpal fusions, making them even more restricted in function. This procedure should be kept in mind to be used in the rare cases of painful instability of the distal radioulnar joint when traditional motion-preserving procedures have failed.

Adult↗

PubMed2002

An anatomic reconstruction of the distal radioulnar ligaments for posttraumatic distal radioulnar joint instability.

Fourteen patients with posttraumatic distal radioulnar joint instability were treated with a reconstruction of the distal radioulnar ligaments. The technique is anatomically accurate, is reproducible, and requires less dissection than previously described techniques. Candidates for the procedure had joint instability and an irreparable triangular fibrocartilage complex. Ten patients had bidirectional instability. Two patients had a concurrent corrective osteotomy of the distal radius for a malunion. The procedure restored stability and relieved symptoms in 12 of 14 patients at 1 to 4 years' follow-up evaluation. One patient with a deficient sigmoid notch and one with ulnocarpal ligament injury did not achieve full stability. All patients attained near full pronation and supination. The procedure is an effective treatment for an unstable distal radioulnar joint when its articular surfaces are intact and the other wrist ligaments are functional, and it can be used in combination with a distal radius corrective osteotomy.

Adolescent↗

PubMed2001

The radioulnar ratio: a new method of quantifying distal radioulnar joint subluxation.

Computed tomography was used to image the distal radioulnar joint (DRUJ) for instability. Four methods were used to quantify subluxation of the DRUJ: the Mino criteria, the epicenter method, the congruency method, and a new method called the radioulnar ratio (RUR). Validity of the various methods was evaluated in clinical and laboratory situations. Rheumatoid patients with symptomatic DRUJ pathology had significantly more abnormal RUR values (100% vs 73% [epicenter method] and 88% [Mino criteria]). The RUR detected instability sooner in a progressive laboratory-induced instability model. The intraobserver and interobserver reliability of the RUR was high, with intraclass correlation coefficients of 0.89 and 0.87, respectively. The RUR demonstrated superior performance in the diagnosis of DRUJ subluxation.

Adult↗

PubMed1995

The stabilizing mechanism of the distal radioulnar joint during pronation and supination.

A biomechanical cadaver study was performed to determine the roles of the stabilizing structures of the distal radioulnar joint during pronation and supination. Subluxation and dislocation of the radius with respect to the ulna were evaluated in seven cadaver forearms placed in supination, pronation, and neutral forearm rotation. The amount of subluxation was measured with all structures intact, and after sectioning in various sequences the dorsal and palmar radioulnar ligaments, the distal portion of the interosseous membrane including the pronator quadratus, and the entire interosseous membrane. After sectioning two of any four structures, the distal radioulnar joint remained stable. When the interosseous membrane was disrupted first, the dorsal radioulnar ligament was found to be more important than the palmar radioulnar ligament in stabilizing the distal radioulnar joint in pronation, and conversely the palmar radioulnar ligament was more important than the dorsal radioulnar ligament in supination. Dislocation, and frequently diastasis, occurred only with sectioning of all four structures. This suggests that all four structures contribute to stability of the distal radioulnar joint.

Biomechanical Phenomena↗

PubMed1992

The distal radioulnar joint. Anatomic and functional considerations.

The distal radioulnar joint is functionally coupled with the proximal radioulnar joint, thus forming a mechanism for the longitudinal rotation of the hand. Distal radioulnar mobility is derived from the geometry of the joint, joint surfaces, and radioulnar connections. There is a structural and functional separation between the distal radioulnar and carpal joints, giving the possibility of pronation and supination in every position of the hand to the forearm. As for the stability of the joints involved, the ulnar articular disk plays an essential role. Being part of both distal radioulnar and carpal joints, the disk has very specific morphologic features that not only are individualized to the function of both joints but also stabilize the joints in their independent movements. Developmental data give the strong impression of an architectural scheme, of which the distal radioulnar joint is only a part. Traumatic lesions at the distal radioulnar joint and disturbances in normal distal radioulnar alignment have to be viewed, therefore, in a wider context.

Cartilage, Articular↗

PubMed2006

Contact area inside the distal radioulnar joint: effect of axial loading and position of the forearm.

BACKGROUND: A biomechanical study was performed to define the normal profiles of contact area inside the distal radioulnar joint and how these profiles change as a result of damage to the distal radioulnar ligaments. METHODS: Twelve cadaver arms were used and a custom-made jig was designed to allow axial loading of the hand. Tekscan sensor film was used to measure the contact area inside the joint. Measurements were taken with different loads and in different positions of the forearm. The same measurements were taken after dividing either the volar or dorsal distal radioulnar ligament. Finally the measurements were repeated after reconstruction of the divided ligament. FINDINGS: The contact area increases with axial loading of the hand and is greater in supination than pronation. Division of a single distal radioulnar ligament increases the contact area inside the distal radioulnar joint (123% of normal) and reconstruction of the divided distal radioulnar ligament restores the contact patterns towards the normal values (113% of normal). INTERPRETATION: The results show that axial loading of the hand and position of the forearm has a significant effect on the contact area inside the distal radioulnar joint. The study also shows that injury of the distal radioulnar ligament disturbs the normal profiles of contact.

Aged↗

PubMed2003

Displacement of the distal radioulnar joint of clinically symptom-free patients.

There are three methods for evaluation of dislocation of the distal radioulnar joint using computed tomography: the radioulnar line method, the epicenter method, and the congruity method. However, some patients who are clinically symptom-free have abnormal findings from computed tomography of the distal radioulnar joint according to the aforementioned criteria. In addition, these methods are qualitative, not quantitative definitions. Forty patients were included in this study. Computed tomography scans of the wrists were done. The variation of displacement of the distal radioulnar joint was measured. By the epicenter method, the 95% confidence interval (mean +/- 1.96 standard error) was from 0.0026 to 0.1114 in supination and from -0.1171 to 0.0446 in pronation. By the radioulnar line method, the 95% confidence interval was from 0.0026 to 0.0479 in supination and from -0.0065 to 0.0745 in pronation. By the modified radioulnar line method, the 95% confidence interval was from 0.1778 to 0.2752 in supination and from 0.0990 to 0.2310 in pronation. There was a wide range of the displacement of the distal radioulnar joint in patients with clinically normal wrists. The results can be regarded as reference points for normal variation of the distal radioulnar joint. This can help to differentiate the causes of internal derangement of the wrist.

Adult↗

PubMed1990

Effects of radioulnar instability on the radiocarpal joint: a biomechanical study.

Five fresh cadaver upper extremities were studied with use of a static positioning frame, pressure-sensitive film and a microcomputer-based videodigitizing system to assess the effect of increasing radioulnar instability on the load distribution within the proximal carpal joint. Three stages of radioulnar instability were studied: (1) an avulsion fracture at the base of the ulna styloid; (2) an avulsion fracture at the base of the ulna styloid plus disruption of the dorsal portion of the distal radioulnar joint capsule; and (3) an avulsion fracture at the base of the ulna styloid, disruption of the dorsal portion of the distal radioulnar joint capsule, and disruption of the radioulnar interosseous membrane. All stages of radioulnar instability demonstrated a decrease in the lunate contact area in positions with the forearm in supination. In stage 3 instability there was also less lunate contact area in positions with the forearm in neutral pronation/supination. In stage 3 instability the lunate high pressure area centroid was abnormally palmar in all positions and the scaphoid high pressure area centroid was abnormally palmar in positions with the forearm in pronation or supination.

Adult↗

PubMed2005

Does the orientation of the distal radioulnar joint influence the force in the joint and the tension in the interosseous membrane?

OBJECTIVE: To investigate the effect of change in the orientation of the distal radioulnar joint on the force in the joint and the strain in the interosseous membrane. DESIGN: Biomechanical study in fresh frozen cadavers. BACKGROUND: The articular surfaces of the distal radioulnar joint may be orientated in parallel with the long axis of the forearm (a Type I joint) or at an oblique angle opening distally to the ulnar side (a Type II joint). METHODS: Three cadaveric upper limbs were held on a custom built frame allowing measured rotation and axial loading across the wrist. Measurements of force in the distal radioulnar joint and strain in the interosseous membrane were taken and repeated after replacement of the distal radioulnar joint with prosthetic Type I and Type II joints. FINDINGS: The force in the joint and the strain in the interosseous membrane increased with increasing load across the wrist (P < 0.0001). The force in the Type I joint was reduced compared to the normal or Type II joint. This difference was greater with increasing load and was significant at 8 kg (P < 0.001). The strain in the interosseous membrane was maximal at neutral forearm rotation and decreased with increasing pronation and supination. INTERPRETATION: The force in the joint is greater with the Type II distal radioulnar joint. We believe this compressive force increases joint stability and this orientation of the articular surfaces should be considered in the design of a total distal radioulnar joint arthroplasty.

Cadaver↗

PubMedDate not supplied

Symptoms and radiographic findings in the proximal and distal ulnar stumps after the Sauvé-Kapandji procedure for treatment of chronic derangement of the distal radioulnar joint.

PURPOSE: We analyzed correlations between symptoms and radiographic findings with respect to the proximal and distal ulnar stumps after the Sauvé-Kapandji procedure for treating chronic derangement of the distal radioulnar joint. METHODS: A total of 26 patients were studied (13 men, 13 women) with a mean age of 46 years at examination. Clinical assessment included elicitation of postoperative symptoms related to the proximal and distal ulnar stumps. In the radiographic study the radioulnar distance in the neutral wrist position and the presence or absence of scalloping at the radius were determined from posteroanterior (PA) views. The total mobility distance of the proximal ulnar stump was measured on the PA and lateral views while the wrist moved from radial to ulnar deviation or from extension to flexion. RESULTS: Eleven patients complained of tenderness over the distal ulnar stump and 5 patients felt discomfort around the proximal ulnar stump during forearm rotation. The postoperative radioulnar distance in patients with tenderness was significantly smaller than in the group without tenderness. Scalloping at the radius was shown in 9 patients but it was not related to the radioulnar distance. The total mobility distance of the proximal ulnar stump on the PA view was significantly greater in patients with tenderness than in those without, and it also was significantly greater in patients with scalloping than in those without. The total mobility distance on the lateral view was significantly greater in the group with discomfort than in the group without discomfort. CONCLUSIONS: The radioulnar distance was related to tenderness over the distal ulnar stump but not to the scalloping. Tenderness and scalloping each were related to radioulnar instability of the proximal ulnar stump. Discomfort around the proximal ulnar stump was related to dorsovolar instability of the stump. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic, Level IV.

Adult↗

PubMed1995

Kinematics of the distal radioulnar joint in rheumatoid arthritis: an in vivo study using centrode analysis.

The kinematics of the distal radioulnar joint were examined using the method of centrode analysis in vivo. A group of normal subjects was studied along with a group of rheumatoid arthritis patients who had distal radioulnar joint involvement. Serial computed tomographic scans were obtained through the distal radioulnar joint of nine subjects (10 wrists) in varying degrees of pronation and supination. For normal subjects, the movement that occurs in a stable distal radioulnar joint is not erratic and the center of rotation lies within a well-defined area. When subjects with rheumatoid arthritis were analyzed, it was determined that early in the disease process bone erosions may occur in the sigmoid notch of the distal radius. When the joint contour in this region is maintained, the kinematics are not markedly altered. Erosion involving the dorsal border of the sigmoid notch of the radius is associated with subluxation of the distal radioulnar joint. The ulna becomes dorsally positioned relative to the radius, and significant alteration in the kinematics of the distal radioulnar joint occurs.

Adult↗

PubMed1994

Distal radius fracture and the distal radioulnar joint--anatomical considerations.

The ulna represents the non-rotating, stable and weightbearing part of the forearm around which the radius rotates in pronation and supination. The distal radioulnar joint is the distal half of an articulation, the proximal half of which is the proximal radioulnar joint. In spite of the distance between the two, the distal and proximal radioulnar joints together form a bi-condylar joint, the "forearm joint", with the axis of rotation running from the centre of the radial head out distally into the interosseous space towards the centre of the ulnar head. The end of the radius together with the hand and what is held in the hand will rest against the stable, immobile ulnar head, which acts as the keystone of the wrist. Mobility and stability of the distal radioulnar joint is accomplished by the combined action between fully congruent articulating surfaces and intact radioulnar ligaments. Following a distal radius fracture, the semilunar notch of the radius will no longer be congruent to the ulnar head due to the displacement of the distal fracture fragment of the radius into either dorsal angulation, radial angulation, or both. The stabilizing ligaments will tear. Any posttraumatic disabling dysfunction of the distal radioulnar joint should accordingly be treated by a corrective osteotomy of the radius at the fracture site in order to achieve full congruity between the semilunar notch and the ulnar head. Resection of the ulnar head deprives the wrist its keystone and should therefore be avoided.

Biomechanical Phenomena↗

PubMed2004

[Salvage operations and their differential indication for the distal radioulnar joint].

The most common cause of an arthritically damaged distal radioulnar joint is a malunion of a distal radius fracture. Therapeutically, ulnar head resection, hemiresection-interposition-technique, Kapandji-Sauvé procedure and implantation of an ulnar head prosthesis have been described. None of these procedures is able to restore the complete function of the joint. Therefore, anatomical reconstruction of the joint in acute or secondary correction osteotomy for malunited fractures of the distal radius should be performed to avoid the development of the arthrosis. Numerous clinical studies have demonstrated a similar reduction of the clinical symptoms for all procedures. Therefore, classification of the different procedures has to consider the number of complications. Biomechanically, partial resection of the distal ulna will destabilize the distal radioulnar context and clinically may lead to painful radioulnar and/or dorsopalmar instability of the distal ulnar stump. Biomechanically and clinically, this complication, next to secondary extensor tendon ruptures, has to be expected far more often following complete resection of the ulnar head than in the alternative procedures. We do not see any remaining indication for complete resection of the ulnar head. Clinical results and the occurrence of painful instability of the distal ulnar stump have been reported almost identically for the hemiresection-interposition technique and the Kapandji Sauvé procedure. Therefore, both procedures appear to be equally suitable for the treatment of painful arthrosis of the distal radioulnar joint. In patients with a preexisting instability of the distal radioulnar joint, or a major deformity of the radius or the ulna, we prefer to perform the hemiresection-interposition-technique. In these conditions we consider the remaining contact of the triangular fibrocartilage complex with the distal end of the ulna a biomechanical advantage to reduce the risk of secondary instability. Biomechanically as well as clinically, replacement of the ulnar head using a prosthesis has been shown to either avoid or solve the problem of instability. We therefore consider ulnar head replacement the treatment of choice in secondary painful instability following resection procedures at the distal end of the ulna. Primary ulnar head replacement should be considered in special indications until long-term follow-up results are available.

Arthroplasty↗

PubMed2005

Comparison of distal radioulnar joint reconstructions using an active joint motion simulator.

PURPOSE: Distal radioulnar joint (DRUJ) instability can result in pain and functional disability. Numerous DRUJ reconstructive options have been described with minimal biomechanical analysis. The purpose of this study was to evaluate the ability of 4 well-described DRUJ reconstructions to restore joint kinematics using a dynamic, motion-controlled simulator. METHODS: Eleven cadaveric upper extremities had computer-controlled simulated active forearm rotation. Joint kinematics were quantified by using an electromagnetic tracking system. We compared the passive and simulated active kinematics of the intact, unstable, and reconstructed DRUJ (capsular repair, 2 described radioulnar ligament reconstructions, and a radioulnar tethering procedure). RESULTS: All reconstructions improved significantly the kinematics of the unstable DRUJ. The capsule repair restored simulated active joint kinematics closest to the intact DRUJ. CONCLUSIONS: All 4 reconstructions improved DRUJ stability significantly. The capsule repair most closely matched intact DRUJ kinematics and the radioulnar ligament reconstructions were found to be superior to a radioulnar tethering procedure.

Adult↗

PubMed2005

Dynamic effects of joint-leveling procedure on pressure at the distal radioulnar joint.

PURPOSE: Wrist joint-leveling procedures for decompression of the radiocarpal and ulnocarpal joints are accompanied by the risk for subsequent disorders of the adjacent distal radioulnar joint (DRUJ). This study evaluated the dynamic change of the pressure pattern at the DRUJ after joint-leveling procedures. METHODS: Thirteen fresh-frozen adult cadaveric upper extremities were used. A segment of the radius was excised at its midshaft to allow lengthening and shortening via a mini external fixator attachment. Dynamic pressure sensors were inserted into the DRUJ and the ulnocarpal joint. Axial loads were applied to the extensor carpi radialis brevis, extensor carpi radialis longus, extensor carpi ulnaris, flexor carpi radialis, and flexor carpi ulnaris for a total of 89 N with or without 30 N of radioulnar loading. The dynamic pressure distribution for full range of forearm rotation was recorded from 6 mm of radial shortening to 6 mm of radial lengthening in increments of 1 mm. RESULTS: The peak pressures at the DRUJ before the joint-leveling procedures averaged 3.3 MPa without radioulnar loading and 5.0 MPa with radioulnar loading. The peak pressures with axial and radioulnar loading increased 85% at 6 mm of lengthening and only 8% at 6 mm of shortening. The peak pressures at the DRUJ for radial lengthening of 4 mm or more were significantly greater than that of the original length. Pressure at the ulnocarpal joint increased in proportion to the amount of radial shortening and decreased with radial lengthening. CONCLUSIONS: Radial lengthening but not radial shortening significantly increases the peak pressure at the DRUJ.

Adult↗

PubMed1985

Distal radioulnar involvement in trauma of the wrist.

The distal radioulnar joint is the weakest point of the rotational column of the wrist. This joint is a functional part of the radiocarpal joint, united to it by an elastic tightening system, and perfectly controlled by the ulnaris (especially the extensor carpi) tendons. Our anatomic study allowed to define the mechanisms of the lesions and the methods for their correction. The key to success seems to be a functionally dynamic extensor carpi ulnaris and its dorsal position in supination. Our clinical study shows that all injuries to the distal radioulnar joint associated with trauma of the wrist or of the forearm are a factor of severity and they may be responsible for the high rate of complications. Therefore, in Galeazzi's fracture-dislocation, a specific method of stabilization may need to be associated with the radius osteosynthesis. In the absence of degenerative changes, chronic instability of the distal radioulnar joint can benefit from ligament stabilization. Results so far have been very encouraging, as far as young patients are concerned. Complex injuries remain a major obstacle, in which ligamentous and bone lesions must be distinguished by confronting clinical observation with paraclinical investigations. Computerized tomography seems to be of limited value, although this method of investigation is still in its prospective stages. Concerning management, shortening of the ulna with dorsal repositioning of the extensor carpi ulnaris allows to decompress the carpo-ulnar compartment, to stretch the tendinous and ligamentous structures, and, if need, to restore radioulnar congruity. Better knowledge of this pathology will allow to categorize radioulnar tears associated with wrist injuries. Under emergency conditions, surgical or non operative management must be adapted, allowing healing to occur with perfect restoration of the distal epiphysis of the radius. By doing so good functional results may be guaranteed.

Fracture Fixation, Internal↗

PubMed1996

Distal radioulnar joint injuries associated with fractures of the distal radius.

The most common cause of residual wrist disability after fractures of the distal radius is the distal radioulnar joint. The 3 basic conditions that produce radioulnar pain and limitation of forearm rotation are instability, joint incongruency, and ulnocarpal abutment. The last 2 entities initiate irreversible cartilage damage that eventually leads to degenerative joint disease. Early recognition and management in the acute stage aim at the anatomic reconstruction of the distal radioulnar joint including bone, joint surfaces, and ligaments in an effort to reduce the incidence of painful sequelae and functional deficit. This article provides a description and the treatment options of the distal radioulnar joint lesions that occur in association with fractures of the distal radius, and the results obtained with open and arthroscopic techniques. Both acute and chronic disorders are analyzed, and a prognostic and treatment oriented classification is presented Furthermore, the pathoanatomy and management of chronic distal radioulnar joint derangement after fracture of the distal radius are reviewed briefly.

Adult↗