Effects of forearm rotation on the clinical evaluation of ulnar variance

Yeh, George L.; Beredjiklian, Pedro K.; Katz, Mark A.; Steinberg, David R.; Bozentka, David J.

doi:10.1053/jhsu.2001.26657

Cited by 56 publications

(40 citation statements)

References 18 publications

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“…For example, Schuurman et al examined ulna variance with the forearm in neutral rotation with the elbow at 90° of flexion compared to the forearm in full supination with the elbow at full extension and found differences of −0.18 ± 1.56 mm v. −0.86 ± 1.47 mm (1). Yeh et al studied ulnar variance at maximum pronation, neutral rotation, and maximum supination using anteroposterior radiographs and found a total proximal-distal translation of 0.6 mm with confidence intervals of 0.4 mm to 0.8 mm, but also did not control for elbow flexion other than in neutral rotation (2). Using static CT scans, Tay et al found proximal-distal translation of 1.67mm when moving from full pronation to full supination (5).…”

Section: Discussionmentioning

confidence: 99%

Elbow Position Affects Distal Radioulnar Joint Kinematics

Souer

et al. 2009

The Journal of Hand Surgery

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Previous in vivo and in vitro studies of forearm supination/pronation suggest that distal radioulnar joint kinematics may be affected by elbow flexion. The primary hypotheses tested by this study were that in vivo: 1) ulnar variance changes with elbow flexion and forearm rotation and 2) the arc of forearm rotation changes in relationship to elbow flexion.Materials and Methods-Changes in radioulnar kinematics during forearm supination/pronation and elbow flexion (0-90°) were studied in five uninjured subjects using computed tomography, dualorthogonal fluoroscopy, and three-dimensional modeling. Analysis of variance and post-hoc testing was performed. Discussion-Elbow position affects the kinematics of the distal radioulnar joint. The kinematics of the distal radioulnar joint are primarily affected by forearm rotation and secondarily affected by elbow flexion. These findings have clinical relevance to our understanding of ulnar impaction, and how elbow position affects the proximal-distal translation of the radius. These findings have implications upon the treatment of ulna impaction, radiographic evaluation of the distal ulna, and future biomechanical studies. Results-Proximal

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Section: Discussionmentioning

confidence: 99%

Elbow Position Affects Distal Radioulnar Joint Kinematics

Souer

et al. 2009

The Journal of Hand Surgery

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“…8,9 This method was chosen because it is relatively straightforward, has been shown to have a high level of interobserver and intra-observer reliability, 8 and has been used to measure ulnar variance in several recent studies in the literature. 3,10,11 This method entails first drawing a line along the longitudinal axis of the radius. Next, a line is drawn through the distal ulnar aspect of the radius that is perpendicular to the longitudinal axis.…”

Section: Methodsmentioning

confidence: 99%

Ulnar Variance: Correlation of Plain Radiographs, Computed Tomography, and Magnetic Resonance Imaging With Anatomic Dissection

Laino

Petchprapa

Lee

2012

The Journal of Hand Surgery

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“…We routinely use radiographs as our initial line of investigation (Edwards and Jupiter 1988, Jungbluth et al 2006, Yeh et al 2001). Radiographs of the wrist should include a “true lateral” radiograph, as well as satisfactory true posterior-anterior views in neutral rotation, to ascertain whether there is subluxation or dislocation of the distal radioulnar joint (Edwards and Jupiter 1988, Yeh et al 2001).…”

Section: Discussionmentioning

confidence: 99%

“…Radiographs of the wrist should include a “true lateral” radiograph, as well as satisfactory true posterior-anterior views in neutral rotation, to ascertain whether there is subluxation or dislocation of the distal radioulnar joint (Edwards and Jupiter 1988, Yeh et al 2001). Bilateral comparison enables assessment of the individual's normal ulnar variance on the uninjured side.…”

Section: Discussionmentioning

confidence: 99%

Radial shortening following a fracture of the proximal radius

Duckworth

Watson

Will³

et al. 2011

Acta Orthopaedica

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Background and purposeThe Essex-Lopresti lesion is thought to be rare, with a varying degree of disruption to forearm stability probable. We describe the range of radial shortening that occurs following a fracture of the proximal radius, as well as the short-term outcome in these patients.Patients and methodsOver an 18-month period, we prospectively assessed all patients with a radiographically confirmed proximal radial fracture. Patients noted to have ipsilateral wrist pain at initial presentation underwent bilateral radiography to determine whether there was disruption of the distal radio-ulnar joint suggestive of an Essex-Lopresti lesion. Outcome was assessed after a mean of 6 (1.5–12) months using clinical and radiographic results, including the Mayo elbow score (MES) and the short musculoskeletal function assessment (SMFA) questionnaire. One patient with a Mason type-I fracture was lost to follow-up after initial presentation.Results60 patients had ipsilateral wrist pain at the initial assessment of 237 proximal radial fractures. Radial shortening of ≥ 2mm (range: 2–4mm) was seen in 22 patients (mean age 48 (19–79) years, 16 females). The most frequent mechanism of injury was a fall from standing height (10/22). 21 fractures were classified as being Mason type-I or type-II, all of which were managed nonoperatively. One Mason type-III fracture underwent acute radial head replacement. Functional outcome was assessed in 21 patients. We found an excellent or good MES in 18 of the 20 patients with a Mason type-I or type-II injury.InterpretationThe incidence of the Essex-Lopresti lesion type is possibly under-reported as there is a spectrum of injuries, and subtle disruptions often go unidentified. A full assessment of all patients with a proximal radial fracture is required in order to identify these injuries, and the index of suspicion is raised as the complexity of the fracture increases.

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Effects of forearm rotation on the clinical evaluation of ulnar variance

Cited by 56 publications

References 18 publications

Elbow Position Affects Distal Radioulnar Joint Kinematics

Elbow Position Affects Distal Radioulnar Joint Kinematics

Ulnar Variance: Correlation of Plain Radiographs, Computed Tomography, and Magnetic Resonance Imaging With Anatomic Dissection

Radial shortening following a fracture of the proximal radius

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