Soft-tissue stabilizers of the distal radioulnar joint: an in vitro kinematic study

Gofton, Wade; Gordon, Karen D.; Dunning, Cynthia E.; Johnson, James A.; King, Graham J.W.

doi:10.1016/j.jhsa.2004.01.020

Cited by 126 publications

(84 citation statements)

References 43 publications

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“…13 Stability of the distal radio ulnar joint is provided by the joint surface morphology, the joint capsule, the dorsal and palmar radio ulnar ligaments, the interosseous membrane, and the musculotendinous units, primarily the extensor carpi ulnaris and pronator quadratus. 8,9 The difference in radii of curvature of ulnar head and the sigmoid notch causes translation of ulna volarly in supination and dorsally in pronation. Pathological instability can be acute or chronic and is a result of soft tissue injury or osseous malunion or a combination of both.…”

Section: Discussionmentioning

confidence: 99%

“…This would suggest that the important cause for clinical symptoms in these patients may not be due to antero-posterior displacement, rather may be due to rotational and abnormal axial forces as described in various biomechanical studies. 7,8 Scheker LR.et al in their study stated that preserving balanced rotation of the forearm after reconstruction around the ulnar head is difficult, and limitation of supination and pronation is a possible sequelae. 7 In our study the average loss of motion of pronation was more than supination.…”

Section: Discussionmentioning

confidence: 99%

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Functional Outcome Following Reconstruction for Chronic Isolated Dorsal Distal Radioulnar Joint Instability by Fulkerson-Watson Method-a Prospective Study

Santhamoorthy¹,

Arun²

2014

jemds

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BACKGROUND: Chronic isolated distal radioulnar joint instability is a relatively rare entity. Several methods of reconstruction were available to stabilize the joint and each method has some advantage over others. We proposed to assess the functional outcome following reconstruction of chronic dorsal distal radio ulnar instability using extra articular reconstruction by FulkersonWatson method. AIM: To assess the functional outcome following reconstruction for chronic isolated dorsal distal radio ulnar instability using Fulkerson -Watson method. METHODS: We conducted a prospective study in five patients over three years from 2010 to 2013 with chronic isolated dorsal distal radio ulnar instability who were treated by Fulkerson-Watson method of reconstruction. All patients underwent MRI evaluation before surgery to assess ligament pathology and for adequacy of sigmoid notch. Arthroscopy performed in all patients. Functional outcomes were assessed using VAS score, quick-DASH score and Mayo wrist score at every 6 months follow-up. Radiological assessment done using plain x-rays at each follow up. RESULTS: Three patients required Arthroscopic debridement for TFCC. All five patients had achieved stability at distal radio ulnar joint after surgery and remained so till their last follow up. One patient had persistent pain near ulnar styloid. The average loss of motion for pronation was 10 degrees and supination was 3 degrees in reference to the normal side. All except one patient achieved ulnar grip strength of >90 % compared to normal side. The mean pre and postoperative VAS score, quick-DASH score, Mayo wrist score were 76.6 and 17.2, 37.3 and 11.3, 45 and 77 respectively. CONCLUSION: Though extra articular reconstruction for DRUJ by Fulkerson-Watson method is non-anatomical, the procedure is simple than intra articular reconstruction and gives similar functional outcome like intra articular reconstructions as shown by our results.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Functional Outcome Following Reconstruction for Chronic Isolated Dorsal Distal Radioulnar Joint Instability by Fulkerson-Watson Method-a Prospective Study

Santhamoorthy¹,

Arun²

2014

jemds

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“…Several biomechanical studies revealed that the UCL does not contribute significantly to DRUJ stability in wrist neutral position. 4,5,13 Although, the UCL itself does not stabilize the DRUJ, the UCL might contribute to stability of the DRUJ in specific wrist positions.11,12 Moritomo et al14 investigated the lengths of the UCL in wrist radial deviation and extension with 3D in vivo analysis using computed tomography. They found that the UCL elongates and is likely stretched more in these positions.…”

mentioning

confidence: 99%

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confidence: 99%

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Effect of wrist position on distal radioulnar joint stability: A biomechanical study

et al. 2014

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We investigated distal radioulnar joint (DRUJ) stability in different wrist positions and examined the relative contribution of each ligamentous component of the triangular fibrocartilage complex (TFCC) to DRUJ stability. We used nine fresh-frozen cadavers. The humerus and ulna were fixed at 90˚elbow flexion. The radiocarpal unit was translated relative to the ulna in dorsopalmar directions with the wrist in five positions. Displacement of the unit was measured by an electromagnetic tracking device. Magnitudes of displacement were compared between different wrist positions in various sectioning stages: ulnocarpal ligament (UCL) sectioning, radioulnar ligaments (RUL) sectioning, and extensor carpi ulnaris (ECU) floor sectioning. Wrist position and sectioning stage significantly influenced the displacement. In intact wrists, the displacement in wrist extension was significantly lower than that in neutral. However, after UCL sectioning, there were no longer any significant differences. After RUL sectioning, the displacement in radial deviation was significantly lower than that in neutral. Following ECU floor sectioning, there were no longer any significant differences. Thus, in intact wrists, DRUJ stability in wrist extension is likely due to tightening of the UCL. After complete RUL sectioning, DRUJ is stabilized in radial deviation due to tightening of the ECU floor. the DRUJ capsule, 6 and musculotendinous structures. 7,8 The dominant stabilizing structures are the ligamentous components of the triangular fibrocartilage complex (TFCC), and the primary stabilizers are the dorsal and volar radioulnar ligament (RUL). 4 The other ligamentous components of the TFCC are the ulnocarpal ligament (UCL) and the floor of the extensor carpi ulnaris (ECU).2,9 The ulnar collateral ligament consists of a component of the floor of the ECU. 10The UCL arises from the ulnar fovea and palmar RUL and inserts distally into the palmar aspects of the lunate, capitate, and triquetrum.11 The UCL supports the ulnar carpus from the palmer aspect, stabilizing the ulnocarpal joint. Several biomechanical studies revealed that the UCL does not contribute significantly to DRUJ stability in wrist neutral position. 4,5,13 Although, the UCL itself does not stabilize the DRUJ, the UCL might contribute to stability of the DRUJ in specific wrist positions.11,12 Moritomo et al.14 investigated the lengths of the UCL in wrist radial deviation and extension with 3D in vivo analysis using computed tomography. They found that the UCL elongates and is likely stretched more in these positions. Therefore, we speculated that the UCL stabilizes the DRUJ in wrist radial deviation and extension. Moreover, the ECU floor includes fibers of ulnar collateral ligament, contributing ulnar collateral stability of the ulnocarpal joint. Therefore, we also speculated that when the wrist is radially deviated, increasing tension of the floor stabilizes the DRUJ by radial shift of the distal ulna.To our knowledge, only a single previous clinical study investigated D...

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Chronic Distal Radio-ulna Instability

Bransby-Zachary

Trail

2014

Disorders of the Hand

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Soft-tissue stabilizers of the distal radioulnar joint: an in vitro kinematic study

Cited by 126 publications

References 43 publications

Functional Outcome Following Reconstruction for Chronic Isolated Dorsal Distal Radioulnar Joint Instability by Fulkerson-Watson Method-a Prospective Study

Functional Outcome Following Reconstruction for Chronic Isolated Dorsal Distal Radioulnar Joint Instability by Fulkerson-Watson Method-a Prospective Study

Effect of wrist position on distal radioulnar joint stability: A biomechanical study

Chronic Distal Radio-ulna Instability

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