The effect of the wafer procedure on pressure in the distal radioulnar joint

Lapner, Peter; Poitras, Philippe; Bäckman, David; Giachino, A. Alan; Conway, Anna F.

doi:10.1016/j.jhsa.2003.10.012

Cited by 20 publications

(11 citation statements)

References 15 publications

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“…There was a trend towards increasing joint contact pressure with ulnar shortening, as has been demonstrated previously . However, shortening the ulna led to a substantial increase in contact area.…”

Section: Discussionmentioning

confidence: 99%

A finite element model to investigate the effect of ulnar variance on distal radioulnar joint mechanics

Greybe

Boland

et al. 2016

Numer Methods Biomed Eng

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Ulnocarpal impaction syndrome involves excessive loading of the ulnocarpal joint. Ulnar shortening osteotomies are an effective way to reduce ulnocarpal loading but alter contact mechanics at the distal radioulnar joint (DRUJ). This study used a computational model to investigate the relationship between ulnar length and DRUJ mechanics. Detailed, finite element models of the radius and ulna bones were constructed from magnetic resonance imaging data. The length of the ulna bone model was increased and decreased up to 5 mm in 1 mm increments. A computational model was used to predict joint contact at the DRUJ for each ulnar length. Lengthening the ulna caused a slight decrease in DRUJ contact pressure, with a more substantial decrease in contact area. Shortening the ulna caused a substantial increase in contact area, with a smaller increase in DRUJ contact pressure. The location of contact on the radial sigmoid notch changed with 2 mm lengthening and 3 mm shortening. The results of this study demonstrate the sensitivity of DRUJ contact to ulnar length changes, which may explain the DRUJ cartilage degeneration that often follows ulnar osteotomies. The joint contact model implemented in this study allowed the relationship between ulnar length and DRUJ contact to be examined systematically, in a way that is difficult to achieve through cadaveric experimentation. The results confirmed published experimental data showing an increased DRUJ contact pressure with ulnar shortening. It is important that clinicians consider the influence of ulnar osteotomies, not only on ulnocarpal loading but also on DRUJ mechanics. Copyright © 2016 John Wiley & Sons, Ltd.

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Section: Discussionmentioning

confidence: 99%

A finite element model to investigate the effect of ulnar variance on distal radioulnar joint mechanics

Greybe

Boland

et al. 2016

Numer Methods Biomed Eng

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“…27,28 A recent systematic review demonstrated favorable outcomes after open wafer resection. 29 However, Lapner et al 30 reported 2 cases of early osteoarthritis after wafer resection. They also demonstrated that wafer resection resulted in increased DRUJ pressure.…”

Section: Discussionmentioning

confidence: 99%

“…Prior methods of measuring forces acting across the DRUJ have required arthrotomy and insertion of pressure-sensitive films and devices into the joint. 3,6,12,13,30,33,34 Violation of the stabilizing soft tissues about the wrist alters normal biomechanics and may confound measurements of forces acting across the wrist. In addition, it is challenging to obtain an accurate assessment of true pressure when these devices are inserted into joints.…”

Section: Discussionmentioning

confidence: 99%

“…Wafer resection does not alter DRUJ JRF, but previous work demonstrates that it increases DRUJ pressure by decreasing joint contact area. 30 Therefore, both techniques could contribute to the development of DRUJ arthrosis. Distal metaphyseal ulnar shortening osteotomy may theoretically decrease the risk of DRUJ arthrosis because it does not decrease DRUJ contact area and does not increase DRUJ JRF.…”

Section: Discussionmentioning

confidence: 99%

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Distal Radioulnar Joint Reaction Force Following Ulnar Shortening: Diaphyseal Osteotomy Versus Wafer Resection

Canham

Schreck

Maqsoodi

et al. 2015

The Journal of Hand Surgery

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Purpose To compare how ulnar diaphyseal shortening and wafer resection affect distal radioulnar joint (DRUJ) joint reaction force (JRF) using a nondestructive method of measurement. Our hypothesis was that ulnar shortening osteotomy would increase DRUJ JRF more than wafer resection. Methods Eight fresh-frozen human cadaveric upper limbs were obtained. Under fluoroscopic guidance, a threaded pin was inserted into the lateral radius orthogonal to the DRUJ and a second pin was placed in the medial ulna coaxial to the radial pin. Each limb was mounted onto a mechanical tensile testing machine and a distracting force was applied across the DRUJ while force and displacement were simultaneously measured. Data sets were entered into a computer and a polynomial was generated and solved to determine the JRF. This process was repeated after ulnar diaphyseal osteotomy, ulnar re-lengthening, and ulnar wafer resection. The JRF was compared among the 4 conditions. Results Average baseline DRUJ JRF for the 8 arms increased significantly after diaphyseal ulnar shortening osteotomy (7.2 vs 10.3 N). Average JRF after re-lengthening the ulna and wafer resection was 6.9 and 6.7 N, respectively. There were no differences in JRF among baseline, relengthened, and wafer resection conditions. Conclusions Distal radioulnar joint JRF increased significantly after ulnar diaphyseal shortening osteotomy and did not increase after ulnar wafer resection. Clinical relevance Diaphyseal ulnar shortening osteotomy increases DRUJ JRF, which may lead to DRUJ arthrosis.

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“…Seul Lapner [8] a montré dans une étude anatomique et biomécanique que la technique de wafer augmentait les pressions dans l'articulation radiocubitale inférieure, susceptible d'induire une arthrose précoce.…”

Section: Résultatsunclassified

Traitement arthroscopique des conflits ulnolunaires

Leclercq

2006

Chirurgie de la Main

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The effect of the wafer procedure on pressure in the distal radioulnar joint

Cited by 20 publications

References 15 publications

A finite element model to investigate the effect of ulnar variance on distal radioulnar joint mechanics

A finite element model to investigate the effect of ulnar variance on distal radioulnar joint mechanics

Distal Radioulnar Joint Reaction Force Following Ulnar Shortening: Diaphyseal Osteotomy Versus Wafer Resection

Traitement arthroscopique des conflits ulnolunaires

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