Stabilization of the distal radioulnar joint by reconstructing the interosseous membrane's distal oblique bundle: Cadaver study

Delbast, Laurent; Pic, Jean-Baptiste; Marty-Diloy, Thibault; Dimet, Jérôme; Lepetit, Cédric

doi:10.1016/j.otsr.2020.03.041

Cited by 11 publications

(16 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In our study, we found a DOB incidence of 37.5% in our specimens, consistent with the variable incidence reported by other authors ranging from 29 to 70%. 21 23 24 34 Although the dorsal and volar RUL are considered to be the most important stabilizers of the DRUJ, 35 the DOB is thought to function as a secondary isometric stabilizer of the DRUJ under constant tension throughout the arc of forearm rotation. 36 37 This was demonstrated by Kihara et al after selective sectioning of the dorsal and volar RUL, the DOB with PQ, and the entire IOM.…”

Section: Discussionmentioning

confidence: 99%

Suture-Based Distal Radioulnar Joint Stabilization: A Biomechanical Evaluation in a Cadaveric Model

Graf,

Ahmed,

Thompson

et al. 2024

J Wrist Surg

View full text Add to dashboard Cite

Purpose Management of acute distal radioulnar joint (DRUJ) instability is complex and controversial. Common treatment options include prolonged immobilization, stabilization with wires, and acute triangular fibrocartilage complex repair. However, none of these permits an early range of motion. The purpose of this study is to investigate the feasibility of a suture-based stabilization (SBS) technique for acute DRUJ instability to permit early active motion. Methods A biomechanical study utilizing eight cadaveric arms was performed. All specimens were tested in the intact state prior to the creation of bidirectional DRUJ instability. For the SBS group, 2-mm suture tapes with suture button fixation were utilized to recreate the respective contributions of distal oblique bundle and volar and dorsal radioulnar ligaments to DRUJ stability. All specimens were cyclically loaded with a simulated ballottement stress of 20N in forearm positions of neutral, 60 degrees of pronation and 60 degrees of supination. Range of motion and total translation were measured and then compared between the two groups. Results The average range of motion in the intact and SBS specimens was 174 and 175 degrees, respectively. There were no significant differences in displacement between the intact and SBS group in neutral and in supination. However, the SBS group had less translation than the intact group in pronation. Conclusions For acute DRUJ instability, the described SBS technique provides similar stability to the native intact DRUJ without compromising the range of motion in a cadaveric model. Future comparative studies are warranted prior to translation into the clinical arena. Clinical Relevance This is a biomechanical study investigating a treatment technique for acute DRUJ instability that would allow an early range of motion.

show abstract

Section: Discussionmentioning

confidence: 99%

Suture-Based Distal Radioulnar Joint Stabilization: A Biomechanical Evaluation in a Cadaveric Model

Graf,

Ahmed,

Thompson

et al. 2024

J Wrist Surg

View full text Add to dashboard Cite

show abstract

“…Even though studies on cadavers have shown that the extra-articular method is a good choice and less invasive, the intra-articular anatomical reconstruction methods can restore the DRUJ's stability to where it was before the surgery. 1,[8][9][10][11] In our case, instability is the main problem, and the patient has a demanding boxing activity that requires a stable wrist with a strong grip. Thus, an intra-articular ligament reconstruction using a tendon graft is the treatment of choice.…”

Section: Discussionmentioning

confidence: 99%

“…Although there are many modifications to simplify the technique and move towards a more minimally invasive fashion, the DRUJ reconstruction method that was first described by Adams and Berger 3 in 2002 remains the gold standard for stabilizing the DRUJ. 3,9 The graft is passed into two interosseous tunnels within the ulnar styloid and lunate facet of the distal radius. If the graft has an adequate length, both limbs are sutured to each other after passing around the neck.…”

Section: Dovepressmentioning

confidence: 99%

“…2,15 The incidence of PL duplication varies between 0.8 and 3.1%, and the incidence of attachment variation is even rarer (0.5%). 9 Some structures have been identified as the PL insertion sites, such as fascia (antebrachial, thenar, and hypothenar fascia), carpal bones (scaphoid, lunate), muscles (thenar or hypothenar muscles), tendons (flexor carpi ulnaris, long flexor tendons), transverse carpal ligament, and the interosseous membrane. The end of the PL tendon may be split in two, and an extra slip may be added to any of the above structures.…”

mentioning

confidence: 99%

See 1 more Smart Citation

The Unpredictable Palmaris Longus Tendon Variation in Distal Radio-Ulnar Joint Reconstruction: A Technical Consideration for Undersized Graft

Hidajat¹,

Arsa²,

Fadli³

et al. 2022

ORR

View full text Add to dashboard Cite

Background: Distal radioulnar joint (DRUJ) instability results from the disruption of the triangular fibrocartilaginous complex consisting of DRUJ's primary and secondary stabilizers. The gold standard of stabilization procedure remains ligament reconstruction that utilizes tendon grafts to reanimate the volar and dorsal radioulnar ligament (RUL) as the primary stabilizers of the joint. The palmaris longus (PL) tendon, the graft of choice in reconstructive surgery, is commonly used in DRUJ reconstruction. However, it can exhibit anatomic variations from agenesis to the variation in morphology, location, and attachment that is rarely encountered other than in cadaveric studies. Case Presentation: We present a case of a 14-year-old boy with ulnar-sided wrist pain and instability following an injury in a boxing match four months before admission. The clinical and radiological results suggested a DRUJ injury with extensor carpi ulnaris (ECU) tendinitis. A ligament reconstruction using the PL tendon graft was planned. Intraoperatively, the PL was found anomalous with dual distal attachments and a short graft length. Results: We performed Adams ligament reconstruction technique with some modifications to the original design. To overcome the under-sized graft, instead of passing it around the ulnar neck, we added one more bone tunnel on the ulna to enhance the construct stability by a tendon to bone healing. Conclusion:In reconstructive surgeries, surgeons should consider the other sources of grafts as graft variations exist. Otherwise, as in our case, modifications to the standard technique can be made.

show abstract

“…Coronal displacement affects DRUJ stability 7 . Soft tissue stabilizers include TFCC, pronator quadratus, ulnar carpal extensor tendon, DRUJ capsule, and interosseous membrane 8 . Distal interosseous membrane acts as a secondary stabilizer 9 .…”

Section: Introductionmentioning

confidence: 99%

Surgical treatment of distal radius fractures: impact on forearm rotation in non-elderly patients

Kong,

Li,

Bai

et al. 2024

Sci Rep

View full text Add to dashboard Cite

Forearm rotation restriction (FRR) is common after surgery for distal radius fractures (DRFs). The aim of the current study was to investigate the effect of DRFs on forearm rotation. This retrospective study reviewed patients with DRFs who underwent surgical treatment from January 2019 to December 2021. The patients' basic data and radiographic parameters were analyzed. Forearm rotation, including pronation and supination, was assessed using a standard goniometer. The Patient-Rated Wrist Evaluation (PRWE) score was evaluated, and the incidence of FRR at the 6-month follow-up was recorded. Univariate and multivariate logistic regression analyses were performed to identify risk factors correlated with FRR. A total of 127 patients with DRFs were included in this study. After surgery, 46 cases were considered to have FRR, with a rate of 36.2%, while the remaining 81 cases (63.8%) did not have FRR. The PRWE scores were 22.8 ± 5.2 and 17.9 ± 4.2 in the FRR group and non-FRR group, respectively, and the difference was statistically significant (P < 0.05). Multivariate analysis showed that the involvement of the sigmoid notch (OR, 2.88; 95% CI 1.49–5.56), post-operative volar tilt < 0° (OR, 2.16; 95% CI 1.34–3.50), and post-operative ulnar variance > 0 mm (OR, 1.37; 95% CI 1.06–1.78) were independently associated with the incidence of FRR. The FRR is associated with an increased PRWE score and may have had some impact on the patient's daily life. Fractures involving the sigmoid notch, dorsal angulation, and radial shortening deformity were found to be correlated with the incidence of FRR. Preoperative risk notification and intraoperative preventive measures are necessary for these patients.

show abstract

Stabilization of the distal radioulnar joint by reconstructing the interosseous membrane's distal oblique bundle: Cadaver study

Cited by 11 publications

References 34 publications

Suture-Based Distal Radioulnar Joint Stabilization: A Biomechanical Evaluation in a Cadaveric Model

Suture-Based Distal Radioulnar Joint Stabilization: A Biomechanical Evaluation in a Cadaveric Model

The Unpredictable Palmaris Longus Tendon Variation in Distal Radio-Ulnar Joint Reconstruction: A Technical Consideration for Undersized Graft

Surgical treatment of distal radius fractures: impact on forearm rotation in non-elderly patients

Contact Info

Product

Resources

About