A Cadaveric Study of The Anatomy and Stability of The Distal Radioulnar Joint in The Coronal and Transverse Planes

Tolat, A. R.; Stanley, John; Trail, I. A.

doi:10.1016/s0266-7681(96)80136-7

Cited by 213 publications

(168 citation statements)

References 14 publications

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“…The DRUJ is mainly stabilized by soft tissues such as the IOM with it important distal oblique bundle, and the triangular fibrocartilaginous complex (TFCC) consisting of the dorsal and volar radioulnar ligaments (RUL) as primary stabilizers, and the extensor carpi ulnaris tendon sheath, the ulnolunate and ulnotriquetral ligaments, and the lunotriquetral interosseous ligament as secondary stabilizers [2][3][4][5][6][7][8][9][10][11][12]. Typically, on PA radiographs (i.e.…”

Section: Case Presentationmentioning

confidence: 99%

“…Case presentation and brief overview of literature with regard to general, specific and practicable aspects to primary trauma-related surgical treatment including possible salvage options at the distal radioulnar joint both articulating partners the bony contact surface is 60% to 80% in neutral position and its significantly decreases to 10% only at terminal ranges of rotation, and so, the bony articulation accounts for only 20% of the overall DRUJ stability. The DRUJ is mainly stabilized by soft tissues such as the IOM with it important distal oblique bundle, and the triangular fibrocartilaginous complex (TFCC) consisting of the dorsal and volar radioulnar ligaments (RUL) as primary stabilizers, and the extensor carpi ulnaris tendon sheath, the ulnolunate and ulnotriquetral ligaments, and the lunotriquetral interosseous ligament as secondary stabilizers [2][3][4][5][6][7][8][9][10][11][12]. Typically, on PA radiographs (i.e.…”

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confidence: 99%

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Who introduced the "quadrangular-construct" modification of the Sauvé Kapandji procedure first? Case presentation and brief overview of literature with regard to general, specific and practicable aspects to primary trauma-related surgical treatment including possible salvage options at the distal radioulnar joint

Schmidt¹,

Schmitz²,

Muradyan³

et al. 2017

Trauma Emerg Care

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A 26-year-old male sustained a left wrist injury after an occupational fall from height that was diagnosed as wrist sprain and treated conservatively by a plaster splint in another institution. Eight weeks after injury, the patient could be re-employed in his original occupation as a truck driver. Six years after injury, the patient came in our institution for the first time, and reported increasing pain in his left wrist accompanied with marked restriction of his left forearm's supination and pronation leading to the non-ability to carry out his occupational job 8 weeks previously. On clinical examination, there was pronounced dorsal subluxation of the ulnar head without any given possibilities for it manual closed reduction (i.e. static instability in transverse plane) ( Figure 1A). Posterior-anterior (PA) radiographs of both wrists showed no concomitant ulnar positiv variance (UPV) (i.e. no longitudinal instability) and no posttraumatic arthritic changes in the distal radioulnar joint (DRUJ), but the configuration of the ulnar styloid at the formerly injured left wrist could not be well assessed that suggested an additional rotation deformity of the ulnar head ( Figure 1B). Lateral radiographs of both wrist showed marked fixed subluxation of the ulnar head in dorsal direction (i.e. static instability in transverse plane) ( Figure 1C). Due to these findings, the Sauvé-Kapandji procedure, modified by creating a "quadrangularconstruct", was detected by us. At the preoperative radiographs of the left elbow in both planes there were no signs of any pre-existing degenerative changes with specific regard to the radiocapitellar joint.Intraoperatively, first, the 2 cm long ulna segment was excised typically proximal to the DRUJ, then a Kirschner-wire was drilled into the ulnar head parallel to the plane of the operation table on which the left forearm was positioned at terminal range of pronation (i.e. 90°) ( Figure 2A). After that, the ulnar head was rotated 90° perpendicular to the operation table's plane in dorsal direction using the formerly drilled Kirschner-wire, and so the neutral position of DRUJ could be achieved in which the arthrodesis had to be performed ( Figure 2B). Then, the cartilage of both corresponding surfaces in DRUJ was excised, and the DRUJ arthrodesis in neutral position was carried out using a 3.5 mm titanium malleolar screw, and the Kirschner-wire was removed. The next step included the several years later introduced "quadrangularconstruct" modification of the original Sauvé-Kapandji procedure: After decorticalization of the corresponding radius and ulna shafts proximal to the DRUJ arthrodesis and distal to resection plane of the ulna segment, the formerly excised ulna segment has been inserted transversely between both forearm bones and fixated with a second 3.5 mm titanium cortical screw through the ulna segment graft, and finally, complete restoration of rotation motion arc could be achieved ( Figures 2C-D). The correctly performed surgical procedure was confirmed intraoperatively by flu...

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Section: Case Presentationmentioning

confidence: 99%

mentioning

confidence: 99%

Who introduced the "quadrangular-construct" modification of the Sauvé Kapandji procedure first? Case presentation and brief overview of literature with regard to general, specific and practicable aspects to primary trauma-related surgical treatment including possible salvage options at the distal radioulnar joint

Schmidt¹,

Schmitz²,

Muradyan³

et al. 2017

Trauma Emerg Care

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“…Absolute contraindications F Symptomatic DRUJ arthritis F Reverse inclination of the DRUJ (type III according to Tolat et al [29]) F Posttraumatic malunion of the distal radius with a dorsal radius tilt greater than 10° and a palmar radius tilt greater than 20°, with rotation deformity and/or translation of the distal fragment [23] Patient information F Usual surgical risks F Cast immobilisation F Early physical therapy F Restriction of motion and reduced weight bearing until bone healing (8 weeks) F Return to heavy manual work after 3 months F Additional bone grafts if required F Implant removal in soft tissue alteration, risk of refracture F Nonunion: revision surgery F Complex regional dysfunction syndrome (CRDS)/complex regional pain syndrome (CRPS): physiotherapy, occupational therapy, pain treatment F Alternative procedures: conservative treatment, alternative DRUJ levelling procedures F Persistent symptoms…”

Section: Contraindicationsmentioning

confidence: 99%

Ulnar shortening with the ulna osteotomy locking plate

Schmidle

Arora

Gabl

2012

Oper Orthop Traumatol

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Sixteen ulnar shortening osteotomies were performed in 15 patients (6 men, 9 women, average age 49 years) and evaluated retrospectively. In 10 cases a trauma-related pathology was the indication for the procedure. The average follow-up time was 53 weeks (range 12-93 weeks). Bone union was observed at a median of 10 weeks (range 6-33 weeks). Overall good clinical results could be achieved with an average shortening of 3.7 mm (range 2.1-16 mm). In this series, there was one nonunion.

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“…This means that in the neutral forearm position, only about 60% of the joint surfaces are in contact, and in full pronation and supination, only 10% (Johnson 1976, af Ekenstam and Hagert 1985a,b, Tolat et al 1996, Garcia-Elias 1998. The sigmoid notch is more often at than C-shaped (Tolat et al 1996), which places a high load on the ligamentous support. The various shapes of the notch explain why malalignment of the distal radius causes laxity of the DRU-joint in some cases, and not in others.…”

Section: Functional Anatomy-ligaments Are Important Stabilizersmentioning

confidence: 99%

The radioulnar joint in distal radial fractures: A review

Lindau

Aspenberg

2002

Acta Orthopaedica Scandinavica

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-We searched The Cochrane Library andMedline regarding the radioulnar joint in distal radial fractures and found no randomized or controlled studies. This review presents the descriptive literature by summarizing accepted views and controversies. There is only weak support for the commonly accepted treatments. Current research has shown that distal radial fractures are often associated with ligament injuries not seen on radiographs. These injuries can lead to laxity of the DRU-joint and subsequent worse outcome, which indicates that we must have a complete diagnosis including ligament injuries if we want to understand better the fracture and its sequelae. Randomized studies should be done before advocating surgical treatment of these unforeseen injuries. n What's the problem?

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A Cadaveric Study of The Anatomy and Stability of The Distal Radioulnar Joint in The Coronal and Transverse Planes

Cited by 213 publications

References 14 publications

Ulnar shortening with the ulna osteotomy locking plate

The radioulnar joint in distal radial fractures: A review

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