Anatomical Studies on the Geometry and Stability of the Distal Radio Ulnar Joint

Ekenstam, Fredrik af; Hagert, Carl-Göran

doi:10.3109/02844318509052861

Cited by 304 publications

(183 citation statements)

References 12 publications

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“…21,22 Our results are consistent with these observations, but our analysis of forearm rotation did not include measurements beyond 608 of supination or pronation. Ishii et al 23 reported the contact center to shift dorsally in pronation, and palmar in supination in the uninjured DRUJ, which is in contrast to our finding of no appreciable shift during normal forearm rotation.…”

Section: Discussionsupporting

confidence: 82%

“…However, this description of the role of the radioulnar ligaments is not consistent with the observations of af Ekenstam and Hagert. 21 We found that the computed path lengths for the dorsal radioulnar ligament in the uninjured forearm tended to elongate with pronation. The computed path lengths for palmar radioulnar ligaments in our study tended to be longest in the neutral posture, suggesting it became lax in supination and pronation.…”

Section: Discussionmentioning

confidence: 95%

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

Crisco

Moore

Marai

et al. 2007

Journal Orthopaedic Research

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Patients with a malunited distal radius often have painful and limited forearm rotation, and may progress to arthritis of the distal radioulnar joint (DRUJ). The purpose of this study was to determine if DRUJ congruency and mechanics were altered in patients with malunited distal radius fractures. In nine subjects with unilateral malunions, interbone distances and dorsal and palmar radioulnar ligament lengths were computed from tomographic images of both forearms in multiple forearm positions using markerless bone registration (MBR) techniques. The significance of the changes were assessed using a generalized linear model, which controlled for forearm rotation angle (À608 to 608). In the malunited forearm, compared to the contralateral uninjured arm, we found that ulnar joint space area significantly decreased by approximately 25%, the centroid of this area moved an average of 1.3 mm proximally, and the dorsal radioulnar ligament elongated. Despite our previous findings of insignificant changes in the pattern of radioulnar kinematics in patients with malunited fractures, we found significant changes in DRUJ joint area and ligament lengthening. These findings suggest that alterations in joint mechanics and soft tissues may play an important role in the dysfunction associated with these injuries. ß

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 95%

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

Crisco

Moore

Marai

et al. 2007

Journal Orthopaedic Research

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“…The contact is reduced to less then 10% in maximum supination and pronation. 2,30 For this reason, the osseous anatomy provides only little stability (20%). The main stabilizer of the DRUJ (80%) is the three-dimensionally structured triangular fibrocartilage complex (TFCC), which is located between the ulnar head and the corresponding carpal bones.…”

Section: Anatomy and Biomechanics Of The Drujmentioning

confidence: 99%

“…Besides its main function as a stabilizer of the DRUJ and the ulnocarpal joint, the TFCC also supports the axial load transmission and acts as a buffer. 2,31 Essential structures for DRUJ stability are the palmar and dorsal radioulnar ligaments. These bands arise from the dorsal and palmar edge of the sigmoid notch of the radius.…”

Section: Anatomy and Biomechanics Of The Drujmentioning

confidence: 99%

“…The integrity of the distal radioulnar joint (DRUJ) is necessary for stability and load transfer from the forearm to the wrist. [2][3][4] Osteoarthritis of the DRUJ may occur after trauma due to a bony deformity, a ligamentous injury, or combination of both. 1,5,16 In the surgical treatment of osteoarthritis, "salvage operations" are often necessary, in which the ulnar head is resected partially or completely.…”

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confidence: 99%

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Ulnar Head Replacement and Related Biomechanics

Sauerbier¹,

Arsalan-Werner

Enderle³

et al. 2013

Jnl Wrist Surg

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Up to 30% of patients after distal radius fractures suffer from ulnar-sided wrist pain. 1 This is manifested in the form of wrist pain, restricted movement, weakness, and instability, even after correct reduction of the fracture and bony union. The integrity of the distal radioulnar joint (DRUJ) is necessary for stability and load transfer from the forearm to the wrist. [2][3][4] Osteoarthritis of the DRUJ may occur after trauma due to a bony deformity, a ligamentous injury, or combination of both. 1,5,16 In the surgical treatment of osteoarthritis, "salvage operations" are often necessary, in which the ulnar head is resected partially or completely. 7-10 Numerous clinical studies have demonstrated a reduction of painful clinical symptoms for all these techniques. 11-14 Biomechanically, even a partial resection of the distal ulna destabilizes the wrist, and clinically, it may lead to instability of the distal ulnar stump and the radius. 15,16 Distal radioulnar impingement occurs because the distal support of the radius for rotation and the "cam effect" of the distal ulna have been ablated. As a result, instability of the DRUJ may again lead to restriction of motion and strength as well as to increased pain. [17][18][19] To reduce DRUJ instability, various "soft tissue stabilization operations" have been developed. The most common techniques are the pronator quadratus-interposition flap (Johnson procedure) 20 and the extensor carpi ulnaris (ECU)-flexor carpi ulnaris (FCU) tenodesis (Breen-Jupiter tenodesis). [21][22][23] Biomechanical studies, however, show that these procedures do not provide adequate stabilization of the distal ulna. 24 Ulnar head prostheses have also been developed to restore the integrity of the DRUJ, which has been shown experimentally 6 and clinically. [25][26][27][28] Keywords ► distal radioulnar joint (DRUJ) ► osteoarthritis ► arthroplasty ► ulnar head resection ► ulnar head prosthesis AbstractA stable distal radioulnar joint (DRUJ) is mandatory for the function and load transmission in the wrist and forearm. Resectional salvage procedures such as the Darrach procedure, Bowers arthroplasty, and Sauvé-Kapandji procedure include the potential risk of radioulnar instability and impingement, which can lead to pain and weakness. Soft tissue stabilizing techniques have only limited success rates in solving these problems. In an attempt to stabilize the distal forearm mechanically following ulnar head resection, various endoprostheses have been developed to replace the ulnar head. The prostheses can be used for secondary treatment of failed ulnar head resection, but they can also achieve good results in the primary treatment of osteoarthritis of the DRUJ. Our experience consists of twenty-five patients (follow-up 30 months) with DRUJ osteoarthritis who were treated with an ulnar head prosthesis, with improvement in pain, range of motion, and grip strength. An ulnar head prosthesis should be considered as a treatment option for a painful DRUJ.

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Morphology of the articular surfaces of the distal radio-ulnar joint

1996

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Background The two articular surfaces of the distal ulna get an important role in load transmission and stabilization of the distal radio‐ulnar joint. The present study describes the morphology of the distal radio‐ulnar joint surfaces in terms of the functional relationships between the shape of the ulnar articular facets and the predominant contact situation in this joint. Methods Besides macroscopic dissection and radiological investigation the model of the “inclined plane” has been used to simulate force transmission across the radio‐ulnar joint concerning the angle between the distal and the radial articular surfaces of the ulnar head. Results The presented morphological parameters of the radio‐ulnar joint surfaces verify that the transmitted forces are effective in both a radio‐ulnar and an axial direction. The protection and the captaincy of this joint are limited by its great mobility. The investigations show that signs of an increased load pressure are frequently found in the joints that also show degenerative changes. As a morphological sign of the force transmission, distinct spongious trabecles are formed perpendicularly to the articular circumference in those ulnar heads that show a stolid angle between their articular facets. Conclusions Because of the individuality of the morphological data only qualitative statements can be made both the predominant shapes of the ulnar head, in particular about the loading of its articular surfaces. The angle between its two articular facets influences the force transmission through the radio‐ulnar joint as well as the spongious architecture of the subchondral bone of the ulnar head. © Wiley‐Liss, Inc.

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Anatomical Studies on the Geometry and Stability of the Distal Radio Ulnar Joint

Cited by 304 publications

References 12 publications

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

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

Ulnar Head Replacement and Related Biomechanics

Morphology of the articular surfaces of the distal radio-ulnar joint

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