Correlation between distal radioulnar joint effusion and the integrity of triangular fibrocartilage in healthy young adults / 中华全科医师杂志

Objective:To study the relationship between distal radioulnar joint (DRUJ) effusion and the integrity of triangular fibrcarotilage (TFC) in asymptomatic young adults.Methods:Thirty two asymptomatic young adults, 22 males and 10 females with a mean age of 25 year(20-30) were recruited in the study between September 2014 and October 2019. All subjects had no wrist pain, no wrist deformity or wrist mass, and had no history of wrist trauma or surgery. The DRUJ effusion was definedasfluid-like high signal intensityon fatsuppression proton density-weighted MRI.The presence of distal radioulnar joint effusion, the shape of the effusion, and the presence of triangular fibrocartilage abnormalities were documented.Results:Among 32 subjects, 25(78.1%, 15 males and 10 females) presented with distal radioulnar joint effusion on wrist MR images, including linear/tubular in 21 cases(84.0%) and saccular in 4 cases(16.0%).Twenty cases (62.5%) had distal radioulnar joint effusion while the TFC was intact, among whom, the effusion was confined to the proximal side of distal radioulnar jointin 17 cases, and reached the lower surface of TFC in 3 cases. In 5 cases (15.6%) with TFC tear, the effusion reached the lower surface of TFC in 4 cases. There were neutral, positive and negative variations of the ulna in 23, 6 and 3 cases, respectively, among whomthe distal radioulnar effusion was presented in 17, 5, 3 cases, and TFC tear in 1, 4 and 0 cases, respectively.The presence of distal radioulnar effusion was not significantly correlated with genders( P=0.069) or types of ulna variance( P=0.702). Conclusion:The distal radioulnar joint effusion maybe resent in asymptomatic young adults, and it maybe complicated with TFC tear.

Study progressing on the effect of bone structural abnormalities on the distal radioulnar joint stability / 中国骨伤

The distal radioulnar joint is not only the main load-bearing joint in the wrist, but also the pivot of the rotation of the forearm. It is one of the most important and unique joints in the body. Maintaining the stability of the distal radioulnar joint is very important for our daily life. The tissue to stabilize the distal radioulnar joint includes bone structures and soft tissue structures. Although the contribution of soft tissue structures to its stability is far exceeding that of bone structures, the influence of abnormal bone structure on the distal radioulnar joint cannot be ignored. By reviewing the relevant literatures, this article divides the bone structural abnormalities into congenital and acquired bone structural abnormalities. The effects of congenital and acquiredbone structural abnormalities on the distal radioulnar joint stability are analysized and collated in this article, and its clinical symptoms, clinical grading, clinical treatments are also summerized. The problems of distal radioulnar joint instability in clinical practicing and its future researching directions are briefly described in order to provide some suggestions for future clinical applications.

Analysis of Results of Arthroscopic Repair of Triangular Fibrocartilage Complex (TFCC) Injury.

Background: Triangular fibrocartilage complex (TFCC) tears are a major source of ulnar-sided wrist pain and may result in patient disability, ranging from activities of daily living to high-level athletics. The purpose of this study is to evaluate the long-term clinical outcomes in patients affected by TFCC lesion and in association with or without distal radio ulnar joint (DRUJ) instability after arthroscopic repair. Methods: Younger patients (50 years of age or younger), presented with mechanical symptoms at least 6 weeks of failed conservative treatment, a positive, fovea! tenderness test, were included in the study. Patients were excluded if they had ulnar impaction syndrome, arthritis of wrist joint or other wrist pathology on arthroscopic examination. Final results were evaluated after 1 year. Results: Forty-nine wrists in 48 patients had arthroscopy for a possibly repairable peripheral TFCC tear during the study period. Thirty four wrists in 34 patients remained after exclusions. The Mayo score from pre-operative value 46.9±10.4 was increased to 91.7±5.0 postoperatively. At final follow-up, 2 patients had fovea! tenderness, and no patients had a piano-key sign or caput ulna. Conclusion: Arthroscopic repair for traumatic TFCC fovea! tear can restore stability to the DRUJ and provide satisfactory subjective and objective results without serious complications after more than 12 months' follow-up.

Traumatic Triangular Fibrocartilage Complex Injuries and Instability of the Distal Radioulnar Joint / 대한정형외과학회잡지

Traumatic triangular fibrocartilage complex (TFCC) injuries require multidisciplinary approach and plan. Trauma to TFCC can lead to instability of the distal radioulnar joint (DRUJ). Injury to TFCC is classified as a stable type that does not cause unstable lesions for DRUJ or unstable type that can cause instability of DRUJ. According to the location and severity of the injury, arthroscopic debridement or arthroscopic repair may be considered. In the ulnar side avulsion of TFCC, which could cause DRUJ instability, arthroscopic examination should be performed to identify an accurate location of the damaged structures, followed by arthroscopic debridement and repair. In the event of TFCC and DRUJ injuries with ulnar positive variance, arthroscopic TFCC repair or ulnar shortening osteotomy after arthroscopic debridement could be considered to solve the instability and ulnar side pain. However, if peripheral TFCC tear with ulnar impaction syndrome and DRUJ instability, it combined operation of ulnar shortening osteotomy and TFCC foveal fixation could be considered. An accurate classification of TFCC and DRUJ injuries is necessary. It is important to resolve and prevent recurrence of ulnar wrist pain caused by instability.

Distal Radioulnar Joint Arthritis / 대한정형외과학회잡지

The distal radioulnar joint (DRUJ) is a complex structure that enables sufficient, painless forearm rotation and provides weight-bearing capabilities of the upper extremity. Arthritis of DRUJ is multifactorial; the most common causes are trauma, congenital anomalies, as well as degenerative and inflammatory diseases. Congenital etiologies, as well as degenerative and inflammatory causes of arthritis are more common in women. Conventionally, initial management of symptomatic DRUJ arthritis is nonsurgical; surgery is generally reserved for patients with refractory pain. Moreover, advanced arthritis arising from trauma can be prevented by early interventions in the form of corrective osteotomy for malunited distal radius and distal ulna fractures, repair/reconstruction of the triangular fibrocartilage complex, and ulnar shortening osteotomy. Although the outcomes are typically positive following excision of the distal ulna in definitive arthritis, postoperative complications, such as instability and impingement of the residual distal ulna stump, can be serious. Procedures managing unstable residual ulna include soft tissue stabilization techniques and DRUJ implant arthroplasty.

Effects of Malunited Fractured Distal End of Radius on the Morphometric Parameters of Distal Radioulnar Joint in Old Age Group.

Background: Fifteen per cent of all upper limb fractures occur in distal end of the radius. Occurrence of such fracture has increased in last 50 years. Normal values of four radiographic distal radius parameters are commonly used for accurately evaluating malunions i.e., a radial length of 11to 12 mm, a radial inclination of 22º to 23º, an ulnar variance of ±1mm and a palmar inclination of approximately 11º to12º. Our clinical practice is based on western figure due to the absence of the local database. Methods: Study was carried out on seventeen elderly (>50yr) females. Invariably the patients have a unilateral radial fracture belonging to universal classification type-Π. Results: Data of normal and malunited distal radius for each parameter were compared. In old age mean differences showed by radial length, radial inclination, ulnar variance and palmar tilt were 2.47 mm, 9.36º, 1.85 mm and 5.59º respectively. Conclusion: Most of our patients with radial shortening and increased dorsal tilt have pain and diminished grip strength, therefore restoration of radial length has been considered the most important determinant of functional outcome.

Evaluation of the Foveal Involvement of the Ulnar Styloid Fracture: A Comparison of the Plain Radiography and Three-Dimensional Computed Tomography

PURPOSE: There remains uncertain whether to fix or not an ulnar styloid fracture acommpanied by distal radius fracture. Fixation might be required in cases of the fracture involving a fovea of ulnar head, an attachment site of deep triangular fibrocartilage, which is thought to be important to distal radioulnar joint stability. We analyzed a fovea involvement of an accompanied ulnar styloid fracture in patients with distal radius fracture by simple radiograph and three-dimensional computed tomography (3D CT). METHODS: We retrospectively reviewed 168 patients who underwent surgery with volar locking plate for distal radius fracture in our hospital from January 2005 to March 2015 and evaluated a fovea involvement of ulnar head by simple radiographs and 3D CT respectively, and compared. RESULTS: On simple X-ray, 64 cases (38%) were ulnar styloid fovea fractures; however, 21 cases of these revealed non-fovea fractures by 3D CT. And 7 out of 104 cases determined as non-fovea fracture by simple radiographs were diagnosed as fovea fractures by 3D CT. Sensitivity, specificity and accuracy of evaluation by simple radiograph were 86%, 82% and 83% respectively, when compared with those of 3D CT based evaluation. CONCLUSION: Accuracy of evaluating an accompanied ulnar styloid fovea fracture in patients with distal radius fracture by simple radiograph, when compared with 3D CT, was 83%; therefore, we recommend using the 3D CT based evaluation instead of simple radiograph based one for determination of fovea involvement of ulnar head.

Volar Dislocation of the Distal Radioulnar Joint Blocked by Displaced Dorsal Barton Fracture

Distal radioulnar dislocation is commonly associated with radius fracture. Most common dislocation pattern is the dorsal dislocation. We present the unique case of volar dislocation of the distal radioulnar joint blocked by displaced dorsal Barton fracture of distal radius and discuss the injury mechanism and anatomic lesions.

Efficacy of External Fixation and Transfixation Pinning of Distal Radioulnar Joint in Distal Radius Fracture

PURPOSE: The purpose of this study is to evaluate efficacy of percutaneous pinning of distal radioulnar joint in patient with distal radius fracture. METHODS: Thirty-eight patients who underwent percutaneous pinning and external fixation for distal radius fracture were included in this study. Radiologic and clinical outcomes were compared between the patients who underwent percutaneous pinning on the radius only (PD group) and the patients with supplementary pinning on distal radioulnar joint (DRU group) after percutaneous pinning on the radius. External fixation was performed in all patients. RESULTS: Twenty-three patients were PD group and fifteen patients were DRU group. Radial height and radial inclination was significantly higher in DRU group. There was no significant difference in ulnar variance, volar tilt and articular step off between two groups. Among the clinical outcome, there was no significant difference in range of motion between two groups but grip strength was significantly larger in DRU group. CONCLUSION: Percutaneous pinning with K-wires on distal radioulnar joint in distal radius fracture can be a useful procedure for prevention of radial shortening without loss of range of motion of the wrist.

Outcomes of the Sauve-Kapandji Procedure in Patients with Advanced Rheumatoid Arthritis

PURPOSE: We evaluated the clinical and radiographic outcomes of the Sauve-Kapandji procedure for the treatment of advanced rheumatoid arthritis. METHODS: Twenty-severn wrists in twenty-two patients were treated for advanced rheumatoid arthritis with Sauve-Kapandji procedure. Patients were evaluated in terms of wrist pain, bony union, instability of the ulnar proximal stump, ulnar stump pain, range of motion and other complications. Pain was evaluated using a visual analog scale. Radiographic evaluation included calculation of the carpal translation index to assess the extent of ulnar translation of the carpus. RESULTS: The average visual analogue scale score improved from 4+/-1.85 preoperatively to 0.78+/-0.91 at the last follow-up (p=0.003). Bone unions in distal radioulnar joint were obtained in all 22 patients, 27 wrists at mean 10.74 weeks (range, 6-28 weeks) after operation. The supination/pronation range of motion was changed from 55/50 degrees preoperatively to 79/73 degrees at postoperative 6 months follow up (p=0.32). The mean carpal translation index did not change after the operation. CONCLUSION: The Sauve-Kapandji procedure is a reliable methods of relieving pain, preserving range of motion (supination/pronation) and preventing ulnar translation of the carpus in managements of the severely destroyed distal radioulnar joints in rhematoid arthritis.

Factors Affecting the Occurrence of Distal Radioulnar Joint Arthritis after Ulnar Shortening Osteotomy

PURPOSE: Ulnar shortening osteotmy is a common operation for the treatment of ulnar impaction syndrome. The purpose of this study was to evaluate factors that may affect the occurrence of distal radioulnar joint (DRUJ) arthritis after ulnar shortening osteotomy. METHODS: From September 2005 to August 2012, we performed 81 ulnar shortening osteotomies for ulnar impaction syndrome, and evaluated occurrence or deterioration of DRUJ arthritis in 58 patients with a minimum follow-up of 1 year. We analyzed potential factors that may affect the occurrence of DRUJ arthritis, such as, age, sex, hand dominance, pre- and postoperative ulnar variance, preexisting DRUJ arthritis, types of radial sigmoid notch, amount of ulnar shortening, and follow up period. RESULTS: DRUJ arthritis occurred or deteriorated in 32 out of the 58 patients. Regression analysis indicated a significant correlation between the type of radial sigmoid notch (type 1) and DRUJ arthritis. Other factors were not found to be correlated with occurrence or deterioration of DRUJ arthritis. CONCLUSION: This study suggests that patients with type 1 radial sigmoid notch (ulnar inclination of more than 10 degrees) are more likely to develop DRUJ arthritis after ulnar shortening osteotomy.

Acute Dislocation of Distal Radioulnar Joint

Traumatic injuries of the distal radioulnar joint (DRUJ) is important problem that requires special consideration for treatment to prevent disability arising from failure to the diagnosis, treatment, and rehabilitation. Stability of the DRUJ is provided by a combination of bony and soft tissue architecture. The bony architecture of the DRUJ account for only 20% of the DRUJ stability and soft tissues including triangular fibrocartilage complex (TFCC), pronator quadratus, and interosseous membrane give major role on the stability. TFCC is generally accepted as the most essential soft tissue stabilizer of the DRUJ. Acute dislocation of DRUJ injury is commonly associated with forearm fractures but it occurs as an isolated injury even though it is relatively rare. DRUJ injury is the one of main source of chronic wrist pain, instability and the focus of this article is on acute dislocation injury of DRUJ and their management.

Chronic Instability of Distal Radioulnar Joint

Chronic instability of distal radioulnar joint (DRUJ) can develop after injury such as fractures or dislocations, to the bony structures or to the soft tissue as like ligament, capsule. If proper treatment is not performed, normal biomechanics of DRUJ would be altered, thus arthritic joint with chronic functional impairment, pain resulted in. The proper treatments included several procedures for repair of the bony structures and recovery of realignment, various methods for soft tissue repair and reconstruction in unstable condition without bony structures destruction. Several salvage methods such as Darrach procedure, hemiresectional interposition arthroplasty, Sauve-Kapandji procedure, were recommended for the advanced arthritic DRUJ. Wide ulnar resection, one-bone forearm procedure, prosthetic replacement for DRUJ were rarely indicated, but the a few long-term results were reported. Operative stabilization (repair or reconstruction) for each structure assumed as DRUJ instability, is essential and proper selection among the several salvage procedures for the advanced arthritis joint, is needed.

Transscaphoidal Dorsal Perilunar Dislocation Associated with Dislocation of Distal Radioulnar Joint: A Case Report

Dorsal perilunar dislocations are rare traumatic entities. Associated fractures such as carpal bones and radial styloid processes can occur. However, the dorsal perilunar dislocation associated with dislocation of distal radioulnar joint is extremely rare. The authors herein report the case of a 34-year-old man who was presented with transscaphoidal perilunar dislocation which is associated with dislocation of distal radioulnar joint.

Current Treatment of Triangular Fibrocartilage Complex Injuries

The Palmer class 1B triangular fibrocartilage complex injury has two entities: a lesion with stable distal radioulnar joint and a lesion with distal radioulnar joint instability. Arthroscopic debridement of fibrocartilage disk is used in Palmer class 1A lesion. The surgeon should remove the portion of the fibrocartilage tissue until a mechanically stable and smooth residual rim remains. Arthroscopic repair is used in Palmer class 1B or 1D lesion using meniscal repair sutures. Ulnar detachment that can produce distal radioulnar ligament instability can also be repaired using bone anchor or pull out suture. Old age as well as positive ulnar variance is poor prognostic factors.

Treatment of Distal Radioulnar Joint Injuries Associated with a Distal Radius Fracture

PURPOSE: Distal radius fractures involving distal radioulnar joint (DRUJ) are common. After the fracture treatment, pain on the ulnar side of wrist, limitation of forearm rotation and instabilities can be remained. The purpose of this study was to address the importance of anatomical reduction for DRUJ injuries. METHODS: Of 115 cases with a distal radius fracture involving DRUJ, 61 cases involving sigmoid notch of the radius or having a ulnar styloid process base fracture were evaluated. At an average of six months follow-up, their final outcomes were investigated using radiologic findings, functional disabilities of the arm, shoulder and hand (DASH) and visual analogue scale (VAS) pain scores and wrist motion of pronation/supination. RESULTS: Satisfied radiologic reduction rate was 73.8%(45/61) in average, which was most favorable in external fixator group (82.4%, 28/34). The mean functional DASH score was 29.0 points and mean VAS for pain was 5.0. The mean range of wrist motions for pronation/supination was 59.5degrees/55.7degrees. CONCLUSION: Distal radius fractures involving DRUJ should be classified into the basic categories of unstable distal radius fracture, and immediate anatomical reduction is needed by operative treatment to avoid painful forearm rotation.

Missed Variation of the Essex-Lopresti Injury Associated with Type-I Monteggia Equivalent Lesion: A Case Report

The authors report the case of a patient with the combination of a Type I Monteggia equivalent lesion and Essex-Lopresti injury. This combination of injury is very rare, and an associated distal radioulnar injury is often missed. We hope our experience illustrates the need to examine the wrist joint carefully and to be aware of the potential for distal radioulnar joint instability in all patients with type I Monteggia equivalent lesions.

Long-term Outcomes of Ulnar Shortening Osteotomy for Idiopathic Ulnar Impaction Syndrome: At Least 5-Years Follow-up

BACKGROUND: There have been few outcomes studies with follow-up after performing ulnar shortening osteotomy for ulnar impaction syndrome. We investigated the long-term clinical and radiological outcomes of ulnar shortening osteotomy for the treatment of idiopathic ulnar impaction syndrome. METHODS: We retrospectively reviewed 36 patients who had undergone ulnar shortening osteotomy for idiopathic ulnar impaction syndrome for a mean follow-up of 79.1 months (range, 62 to 132 months). The modified Gartland and Werley scores were measured pre- and postoperatively. The radiographic parameters for the assessment of the distal radioulnar joint (DRUJ) as well as the relationship between these radiographic parameters and the clinical and radiological outcomes were determined. RESULTS: The average modified Gartland and Werley wrist score improved from 65.5 +/- 8.1 preoperatively to 93.4 +/- 5.8 at the last follow-up visit. The average preoperative ulnar variance of 4.7 +/- 2.0 mm was reduced to an average of -0.6 +/- 1.4 mm postoperatively. Osteoarthritic changes of the DRUJ were first seen at 34.8 +/- 11.1 months follow-up in 6 of 36 wrists (16.7%). Those who had osteoarthritic changes in the DRUJ had significantly wider preoperative ulnar variance, a longer distal radioulnar distance and a greater length of ulnar shortening, but the wrist scores of the patients who had osteoarthritic changes in the DRUJ were comparable to those who did not have osteoarthritic changes in the DRUJ. CONCLUSIONS: The clinical outcomes are satisfactory for even more than 5 years after ulnar shortening osteotomy for treating idiopathic ulnar impaction syndrome despite the osteoarthritic changes of the DRUJ. The patients who need a larger degree of ulnar shortening may develop DRUJ arthritis.

Anatomic Reconstruction of the Distal Radioulnar Ligament for Posttraumatic Distal Radioulnar Joint Instability

BACKGROUND: To analyze clinical outcomes after anatomical reconstruction of distal radioulnar ligaments in patients with chronic post-traumatic instability of the distal radioulnar joint. METHODS: Anatomical reconstruction was performed in 16 patients with subluxation or dynamic instability of distal radioulnar joint following trauma. Osteotomy was performed simultaneously in 10 patients with radial malunion. The average follow-up period was 18.9 months. For clinical outcome assessment, we performed the anteroposterior stress test, measured the range of motion and grip strength, and performed radiological examination. For assessment of the pain and function, we used the Patient Rated Wrist Evaluation, the Disabilities of the Arm, Shoulder and Hand, and the Modified Mayo Wrist Score. RESULTS: Anteroposterior stress test performed at the last follow-up showed normal in 12 patients, mild laxity in 3, and residual subluxation in one. The average Patient Rated Wrist Evaluation was 9.1 for pain and 11.2 for function. The average Disabilities of the Arm, Shoulder and Hand score was 10.5. The average Modified Mayo Wrist Score was 92.8; there were 10 excellent, 5 good, and 1 poor case. The average grip strength improved from 69.7 1b to 80.9 1b. A revision osteotomy was performed on the patient with residual subluxation in order to obtain normal alignment of the joint. CONCLUSIONS: Anatomical reconstruction of the distal radioulnar ligaments is recommended to restore distal radioulnar joint stability. In addition to ligament reconstruction, realignment of the distal radioulnar joint seems critical when the instability is combined with malunion of the radius.

Anterior Dislocation of Distal Radio-Ulnar Joint: A Case Report

There are variable types in wrist joint injury. Most common case is simple distal radius fracture. And ulnar head dislocation associated with disruption of distal radioulnar ligament is unusual. Among thease injury types. volar dislocation of ulnar head in the distal radioulnar joint is not common and it is misdiagnosis frequently. So it needs to surgical operation frequently. The author reviews this injury with the relevant literature.