Anatomic Investigation of Commonly Used Landmarks for Evaluating Rotation During Forearm Fracture Reduction

Weinberg, Douglas S.; Park, Paul J.; Boden, Kaeleen A.; Malone, Kevin J.; Cooperman, Daniel R.; Liu, Raymond W.

doi:10.2106/jbjs.15.00845

Cited by 17 publications

(9 citation statements)

References 21 publications

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“…Many previous studies have found variation in radial torsion angle among individuals but limited variation between sides of the same individual. 22,23,26,27 Despite this, a study by Dumont et al 25 noted some intra-individual side-to-side variation in normal volunteers, indicating that side-to-side comparison may not be as robust as originally believed. The lack of side-to-side comparison in the present retrospective study prevents us from assessing this.…”

Section: Discussionmentioning

confidence: 97%

Assessing distal radius malrotation following fracture using computed tomography

Filer

Smith

Giddins

2019

J Orthop Surg (Hong Kong)

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Hypothesis: When the distal fracture fragment in distal radius fractures displaces, it commonly rotates as well as shortens and angulates. Aim: The aim of this study was to assess the frequency and magnitude of malrotation of the distal fracture fragment using computed tomography (CT). Methods: A retrospective radiological assessment of 85 CT scans of the distal radius, 35 following fracture and 50 normal radii, was carried out. We developed and applied a simple method for measuring rotation of the distal radius relative to the diaphysis using routine CT scans of the wrist. A Mann-Whitney analysis was used to identify differences in radial rotation between fractures and controls. Intra-and inter-observer reliability were analyzed using intra-class correlation coefficients (ICCs) and Bland-Altman plots. Results: The articular surface of the distal radius is normally rotated in the long axis of the forearm relative to the diaphysis, either into pronation or into supination. The median radial rotation angle of controls was 1 pronation (range À15 to 4 ) compared to 3 pronation (range À24 to 31 ) in the fracture group. The absolute rotation angle was significantly greater in the fracture group (median 10 , range 0-31 vs. 3 , range 0-15 ; p < 0.001) and outside the "normal range" of controls in 26 cases indicating that 75% had rotated appreciably following injury. Intra-and inter-observer reliability of measurements were good with ICCs of 0.99 and 0.98, respectively. Conclusions: Malrotation of the distal radius appears common following distal radius fracture. Malrotation of the distal fracture fragment has been shown to affect distal radio-ulnar joint function. Despite this, rotational deformity is rarely addressed in clinical practice as it is difficult to appreciate on simple radiographs. The simplified method described here is easy to use in routine clinical practice and also appears reliable. Measuring radial rotation may be an important consideration when planning both primary treatment and corrective osteotomy for patients with distal radial malunion.

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Section: Discussionmentioning

confidence: 97%

Assessing distal radius malrotation following fracture using computed tomography

Filer

Smith

Giddins

2019

J Orthop Surg (Hong Kong)

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“…Additionally, the rotation of both forearm bones is subject to scatter within the population, with the ulna varying by >50°. 13 , 17 Landmarks that appear to be easily detected on conventional x-rays and are commonly used for rotational evaluation, such as the bicipital tuberosity or the radial styloid, may only be used to a very limited extent because of high natural variation among the population. 17 As a result, examining the rotational displacement of the fragments using conventional x-ray images is extremely difficult and likely has an underestimated rate of inaccuracy.…”

Section: Discussionmentioning

confidence: 99%

Quantification of Malalignment and Corrective Osteotomies in Patients With Malunion After Elastic Stable Intramedullary Nailing of Pediatric Forearm Fractures

Furrer

Kabelitz

Schweizer

2023

Journal of Hand Surgery Global Online

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“…This highlights the necessity of our data and the need for correct rotational placement of the prosthesis. We are therefore convinced that a preoperative CT scan of the whole forearm will be unavoidable to obtain the correct rotational implantation of the prosthesis with its offset, since distal landmarks, for example, the ulnar styloid, can only be used as a constant landmark to a very limited extent [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

3D analysis of the distal ulna with regard to the design of a new ulnar head prosthesis

Furrer

Nagy

Reissner

et al. 2022

BMC Musculoskelet Disord

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Study design A retrospective, single center, data analysis. Objective Persistent pain and instability are common complications after distal ulnar head arthroplasty. One main reason may be the insufficient representation of the anatomical structures with the prosthesis. Some anatomical structures are neglected such as the ulnar head offset and the ulnar torsion which consequently influences the wrist biomechanics. Methods CT scans of the ulnae of forty healthy and asymptomatic patients were analyzed in a three-dimensional surface calculation program. In the best fit principle, cylinders were fitted into the medullary canal of the distal ulna and the ulnar head to determine their size. The distance between the central axes of the two cylinders was measured, which corresponds to the ulnar offset, and also their rotational orientation was measured, which corresponds to the ulnar torsion. Results The mean medullary canal diameter was 5.8 mm (±0.8), and the ulnar head diameter was 15.8 mm (±1.5). The distance between the two cylinder axes was 3.89 mm (±0.78). The orientation of this offset was at an average of 8.63° (±15.28) of supination, reaching from 23° pronation to 32° supination. Conclusion With these findings, a novel ulnar head prosthesis should have different available stem and head sizes but also have an existing but variable offset between these two elements. A preoperative three-dimensional analysis is due to the high variation of offset orientation highly recommended. These findings might help to better represent the patients natural wrist anatomy in the case of an ulnar head arthroplasty. Level of Evidence III.

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Anatomic Investigation of Commonly Used Landmarks for Evaluating Rotation During Forearm Fracture Reduction

Cited by 17 publications

References 21 publications

Assessing distal radius malrotation following fracture using computed tomography

Assessing distal radius malrotation following fracture using computed tomography

Quantification of Malalignment and Corrective Osteotomies in Patients With Malunion After Elastic Stable Intramedullary Nailing of Pediatric Forearm Fractures

3D analysis of the distal ulna with regard to the design of a new ulnar head prosthesis

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