Disruption Of Distal Radioulnar Joint Research Articles

LLarge Exostosis of the Distal Radius in a Pediatric Patient Causing a Dysplastic Ulna and Distal Radioulnar Joint Disruption A Single-Stage Management Approacharge Exostosis of the Distal Radius in a Pediatric Patient Causing a Dysplastic Ulna and Distal Radioulnar Joint Disruption: A Single-Stage Management Approach

LLarge Exostosis of the Distal Radius in a Pediatric Patient Causing a Dysplastic Ulna and Distal Radioulnar Joint Disruption A Single-Stage Management Approacharge Exostosis of the Distal Radius in a Pediatric Patient Causing a Dysplastic Ulna and Distal Radioulnar Joint Disruption: A Single-Stage Management Approach

The role of arthroscopic triangular fibrocartilage complex repair in a case of bilateral Galeazzi fracture-dislocation

This report presents the case of a 23-year-old man with bilateral distal one-third radial shaft fractures and associated distal radioulnar joint disruption, known as Galeazzi fractures, resulting from a fall from a kickboard. After open reduction and plate internal fixation for both radial shafts, the radioulnar joints remained unstable on both sides. We performed arthroscopic repair of the triangular fibrocartilage complex on the left side and used a short arm splint to immobilize the right side. At the 6-month postoperative follow-up, the patient reported mild stiffness in the left wrist, although both sides showed a full range of motion and distal radioulnar joint stability. In conclusion, when achieving anatomic reduction and stable fixation of the radial shaft in a Galeazzi fracture, favorable results can be achieved without additional surgical treatment, even if the distal radioulnar joint is unstable during surgery.

To compare the functional and radiological outcome between external fixation and volar plating for the treatment of intraarticular distal end radius fractures

Background: Fracture of distal radius may be stable that is extra-articular, non-comminuted without distal radio ulnar joint disruption or unstable that is intra-articular, comminuted displaced with distal radio ulnar joint disruption. Complications of unstable fractures are shortening due to bone loss or due to resorption of the cancellous bone from metaphysis, resistant deformity, residual pain, late collapse, radio carpal arthritis and gross functional impairment. Aims and Objective: The purpose of this study to compare the relative efficacy of external fixation versus plating with regard to functional and radiological outcome. Materials and Methods: Total of 60 patients having intraarticular distal end radius fracture were included in this study and was equally divided into two groups, one group treated by external fixator other group with volar locking compression plate with or without augmentation by k-wire. Follow-up was done after 2 weeks, 4 weeks, 6 weeks and 3 ,6 and 12 months. The radiological evaluation was performed with Sarmiento’s Modification of Lindstrom’s Criteria. With the Modified Mayo Wrist Score, the patient’s functional outcomes were assessed and both groups were compared. Results: In this study we found that volar plate group had good to excellent outcome in 73% cases and 07% with fair outcome however with external fixator group found good to excellent in 50% cases and poor in 17% cases. Conclusion: In our study, we showed that the use of an external fixator and a volar locking plate for the treatment of intraarticular distal radial fractures were reliable. The relative simplicity of use, low surgical exposure, and decreased surgical trauma are benefits of external fixation. Despite these volar locking plates augmented with or without k wire had a good to excellent results in terms of early rehabilitation and less complications related to wrist joint. External fixator with ligamentotaxis provide significant good results in communited intraarticular distal end radius fracture.

\u201cSnapping\u201d of the extensor carpi ulnaris tendon in asymptomatic population

BackgroundExtensor carpi ulnaris tendinopathy (ECU) can be one cause of ulnar side wrist pain and it is more prominent in pronation-supination movements against resistance. In supination, flexion, and ulnar deviation within the ulnar groove, the tendon is tense and becomes predisposed to subluxation or dislocation. Snapping occurs during this dislocation and relocation. As a result of this friction between the tendon sheath and ulnar groove, tendinopathy and pain occur. ECU tendon is an important structure that contributes to the dynamic stability of wrist therefore resulting degeneration contributes disruption of distal radioulnar joint and causes wrist instability.MethodsParticipants without active wrist complaints who presented to the outpatient clinic between 2019 and 2020 were included. Provocation test was performed and participants with snapping were evaluated with ultrasound to determine subluxation or dislocation. Participants asked to indicate approximately how much time they spent daily on the phone, computer and game console. The distribution of data was evaluated with the Kolmogorov-Smirnov test. Quantitative data that were not normally distributed were evaluated using the Mann-Whitney U test, and Student’s t-test was used for normally distributed data. The Chi-square test was used to compare categorical variables. For all tests, p < 0.05 was considered statistically significant.ResultsFour hundred and fifteen women and 340 men were included in the study. Fifty of the 755 participants (6.6 %) had snapping. 22 of the 755 participants (2.9 %) had dislocation or subluxation on ultrasound. Three (13.6 %) participants had dislocation and 19 (%86.4) participants had subluxation on ultrasound. All 50 of the participants with snapping had significant repetitive trauma and sports activities. It was determined that 21 of the 22 participants who were found to have subluxation or dislocation by ultrasound had more than two hours of hobby activity and significantly more participants had more than two hours of activity compared to the group without subluxation or dislocation.ConclusionsThis study with a large number of participants will contribute to the literature in terms of evaluating the contribution of technological devices, such as computers, smartphones, and consoles to chronic wrist pain and the prevalence of ECU snapping in the asymptomatic population.Trial registrationDate of Approval; 19.02.2019, Approval Number; 19-KAEK-045.

An unusual case of both bones forearm shaft fracture with ipsilateral distal radio-ulnar joint disruption

Objective: Distal radioulnar joint (DRUJ) subluxation with associated both bones forearm fracture is a rare clinical entity and is easily missed, leading to significant functional limitations. Case Presentation: A 28-year-old male fell on the outstretched hand and suffered left side both bones forearm shaft fracture with ipsilateral DRUJ disruption. Operative intervention in the form of plating was done for both bones forearm shaft fracture and DRUJ was stabilised with one k wire and above elbow plaster splint in full supination was given for 6 weeks. At one-year follow-up, fracture was united and Disabilities of the Arm, Shoulder and Hand (DASH) score was 11.7, and he was well satisfied. Conclusion: DRUJ disruption should be carefully evaluated in all the patients with associated shaft fractures of radius and ulna. Timely diagnosis and optimal intervention may prevent any functional limitations.

Comment on Yuan et al: The use of external fixation for the management of acute and chronic Monteggia fractures in children.

Journal of Children's OrthopaedicsVol. 14, No. 2 Letter to the EditorsOpen AccessOpen Access licenseComment on Yuan et al: The use of external fixation for the management of acute and chronic Monteggia fractures in childrenOzan Ali Erdal, Muharrem InanOzan Ali ErdalCorrespondence should be sent to Ozan Ali Erdal, Ortopediatri Istanbul, Academy of Pediatric Orthopaedics, Istanbul, Turkey. E-mail: E-mail Address: [email protected]Ortopediatri Istanbul, Academy of Pediatric Orthopaedics, Istanbul, TurkeySearch for more papers by this author, Muharrem InanOrtopediatri Istanbul, Academy of Pediatric Orthopaedics, Istanbul, TurkeySearch for more papers by this authorPublished Online:19 Mar 2020https://doi.org/10.1302/1863-2548.14.200005AboutSectionsPDF/EPUB ToolsDownload CitationsTrack CitationsPermissionsAdd to Favourites ShareShare onFacebookTwitterLinked InRedditEmail Sirs,We have read the article written by Yuan et al1 with great interest. We want to congratulate the authors for their study, which will be a valuable contribution to the scientific literature and patient care. Although Monteggia fractures are seen infrequently, we are aware of their importance primarily due to the high risk of missed diagnosis and their disabling results. This article is precious due to the quite high number of cases of such a rare paediatric orthopaedic condition. However, we noticed a distal radio-ulnar joint disruption in Figures 1, 3 and 5, which had not been mentioned as a complication or a limitation in the manuscript.Proximal ulnar osteotomy, lengthening and grafting if needed, together with a transient transcapitellar radial fixation has been recommended in the literature regarding chronic Monteggia fractures.2–4 Previous articles also suggest that external fixator use for fixation of the ulnar osteotomy has the advantage of more lengthening and less need for graft.2 From this point of view, it is noticed from the radiographs in the paper1 that ulnae were not lengthened. Moreover, the ulnae seem to be relatively shortened due to isolated angulation at the osteotomy site. This relative shortening of the ulna is probably the reason for those distal radio-ulnar disruptions seen in postoperative radiographs of the cases.In conclusion, we would recommend the authors to revise the cases, surgical technique description or the technique itself.Yours faithfully,The AuthorsOpen accessThis article is distributed under the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC BY-NC 4.0) licence (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed.Compliance with ethical standardsICMJE Conflict of interest statementThe authors declare no conflict of interest.

Concomitant Distal Radioulnar Joint Disruption in Distal End Radius Fracture Cases Admitted to Emergency Ward Hasan Sadikin Hospital January 2013 – December 2015

Abstract: The distal end radius and ulna is an integral part of the wrist joint and preservation of its normal anatomy is essential for the mobility of the wrist. The most common cause of residual wrist disability after distal end radius fractures is the disruption of distal radioulnar joint (DRUJ). Early recognition and management in the acute stage aim at the anatomic reconstruction of the DRUJ in an effort to reduce incidence of chronic pain and loss of wrist motion. The purpose of this study is to identify the prevalence of accompanying DRUJ in distal end radius fracture cases, highlighting its significance in occurance. This was a retrospective study with an analytic descriptive method and data from January 2013-December 2015 taken from medical records of Dr. Hasan Sadikin Hospital. From research, we found 74 cases of distal end radius fracture. The most common injured wrist were dominant hand as 46 cases (62,2%), and non-dominant hand as 28 cases (37,8%). From all data, DRUJ disruption were marked as 37 cases (50%). Extraarticular fracture with concomitant DRUJ disruption were marked in 3 cases (8,1%) and in intraarticular involvement were 34 cases (91,9 %). From this study, we can conclude that half of the distal end radius fracture cases, especially intraarticular, were accompanied by DRUJ disruption. This should be an issue to be concerned by the physician when evaluating distal end radius fracture cases and to perform proper treatment.

Assessment of Sauvé-Kapandji procedure as a treatment for malunited distal end radius fractures with limited forearm rotation

Background The most common cause of residual wrist disability after fracture distal radius involves shorting of the radius and ulnar side of the wrist. The three basic conditions responsible for pain associated with limitation of forearm rotation are incongruency, impaction, and instability of the distal radioulnar joint. Sauve-Kapandji procedure is a simple procedure to restore forearm rotation and to relieve pain. Aim To evaluate the results of Sauve-Kapandji procedure for management of distal radioulnar joint disruption after malunited distal radial fracture with shorting to restore forearm rotation and relieve pain. Patients and methods A total of 15 patients with painful and limited forearm rotation owing to malunited distal end radius fracture were treated with Sauve-Kapandji procedure. There were nine males and six females, with a mean age 45 years, with range from 25 to 70 years. They were followed up for a mean time of 16 months, with range 12–24 months. Results All arthrodesis sites were united at a mean time of 11.2 weeks (range, 8–15 weeks). Preoperative pronation/supination arc was 57.5°, (range, 35–90°), and postoperative arc was 140°, (range, 120–155°) (P˂0.05). Preoperatively, the pain was 6.3 on numeric rating scale for pain (range, 5–8). Postoperatively, the mean score was 2, with range from 1 to 4 (P˂0.05). At 12-month follow-up, grip strength measured 86% of the contralateral side compared with 47.9% preoperatively (P˂0.05). All 15 patients were functional with respect to daily household activities, eleven previously working patients were back to work, and all patients felt that their postoperative status has a significant improvement over their preoperative status. Conclusion Sauve-Kapandji procedure is simple and effective in restoring pronation and supination, diminishing wrist pain, and increasing function in patients with limited painful forearm rotation as a result of malunited distal radius fracture with disruption of inferior radioulnar joint.

Diaphyseal Fracture of both Bone Forearm with Distal Radio-Ulnar Joint Dislocation: An Unusual Entity

Introduction: Diaphyseal fractures of both radius and ulna are a common entity. The indirect forces which can lead to diaphyseal fracture of radius and ulna are also responsible for injuring distal radio-ulnar joint (DRUJ). However, simultaneous occurrence of fractures of both forearm bones, along with DRUJ disruption, is an uncommon entity. Case report: We came across a patient, who sustained fractures of both forearm bones with DRUJ dislocation. He was treated with open reduction and internal fixation of both the forearm fractures. His DRUJ reduced spontaneously after anatomical reduction of both fractures and was found to be stable on intra-operative assessment. He was immobilized in long arm splint for healing of DRUJ for 4 weeks. The fracture healed and the patient attained full range of motion at 12 weeks follow up. Conclusion: Distal and proximal joints should be thoroughly examined in all the forearm fractures. Anatomical reduction of forearm bones is essential to obtain congruent DRUJ. Any instability of DRUJ should be assessed intra-operatively and dealt with accordingly for favorable functional outcome.

Comparative Evaluation of Postreduction Intra-Articular Distal Radial Fractures by Radiographs and Multidetector Computed Tomography

Computed tomography can be an adjunct to radiographs when evaluating intra-articular fractures of the distal part of the radius. Acute-phase multidetector computed tomography has better temporal, spatial, and contrast resolution than a conventional scanner has. The aim of this study was to determine prospectively whether the addition of a multidetector computed tomography scan (with various reconstructions) results in changes in the evaluation of intra-articular distal radial fractures and thus changes in the plans for further management. Radiographs and multidetector computed tomography scans were compared prospectively in the evaluation of 117 patients (120 wrists) with acute intra-articular distal radial fractures. The parameters that were measured included the ability to detect intra-articular step and gap displacements, central articular depression, coronal plane fracture, the number of articular fragments, comminution, and associated injuries in the wrist region (carpal bone fractures, distal radioulnar joint disruption, and ulnar styloid fracture). The average measurements for intra-articular step and gap were 0.4 mm and 0.9 mm, respectively, on post-reduction radiographs and 1.3 mm and 2.4 mm, respectively, on sagittal multidetector computed tomography images (p < 0.0001 for each). Central articular depression was found in twenty-one wrists (18% of the total) on radiographs, but on multidetector computed tomography it was found to be present in seventy-four wrists (62% of the total) (p < 0.0001). Twenty-six radiographically occult injuries in the wrist region, including six scaphoid fractures, were detected with the help of multidetector computed tomography. Overall, the recommended treatment plan changed in 23% of the cases when the evaluation included multidetector computed tomography images in addition to conventional radiographs. Interobserver and intraobserver agreements were significantly increased when radiographs and multidetector computed tomography images both were available for evaluation (κ = 0.73 and 0.91, respectively) as compared with interobserver and intraobserver agreement with radiographs alone (κ = 0.43 and 0.69, respectively). Multidetector computed tomography provides more accurate information regarding the anatomy of intra-articular distal radial fractures than radiography provides. The addition of multidetector computed tomography to plain films frequently changes the therapeutic recommendations for such cases.

Suture-Button Construct for Interosseous Ligament Reconstruction in Longitudinal Radioulnar Dissociations: A Biomechanical Study

Longitudinal radioulnar dissociation is a triad of injuries consisting of distal radioulnar joint disruption, interosseous ligament complex (IOLC) tear, and radial head fracture. This renders the forearm longitudinally unstable, resulting in proximal migration of the radius and ulnar-sided wrist degeneration. We hypothesized that reconstruction of the central band of the IOLC in cadaver forearms using a Mini-TightRope suture-button construct would restore native forearm stability. We implanted 8 fresh-frozen cadaver arms with steel beads into the distal radius and ulna, mounted them on an MTS machine, and cyclically loaded them from 13 N distraction to 130 N compression. Bead motion was recorded fluoroscopically and analyzed using Image-Pro Express software. We measured distal ulnar forces using strain gauge transducers. Longitudinal radioulnar dissociation injuries were created by radial head excision and complete IOLC and triangular fibrocartilage complex disruption. At each stage, arms were tested with and without a radial head implant. We reconstructed the central band of the IOLC using a Mini-TightRope and tightened until the distal radioulnar joint was reduced fluoroscopically. We used multiple-comparison analysis of variance with Tukey's Honestly Significant Difference test for statistical analysis. The intact arms had an average radioulnar axial displacement of 0.7 ± 0.8 mm and distal ulnar impaction force of 16.7 ± 11.1 N (per 100 N of axial load on the forearm). After destabilization, the radioulnar displacement increased to 10.7 ± 3.9 mm (p < .001) and ulnar load increased 312%, to an average of 52.2 ± 25.7 N (p < .001). After IOLC reconstruction, average displacement decreased to 2.2 ± 0.9 mm with a distal ulnar load of 19.05 ± 13.5 N (not significantly different from intact arms). In this cadaveric study, Mini-TightRope IOLC reconstruction with or without a radial head prosthesis significantly reduced distal ulnar impaction forces to that of the native forearm, while limiting radioulnar displacement to near-anatomic levels.

Fractures in Brief: Radial Head Fractures

Fractures of the radial head are common [4], constituting approximately one-third of all elbow fractures. These fractures typically occur when an axial load is applied to the forearm, causing the radial head to hit the capitellum of the humerus. The severity of these injuries runs the gamut from minimally displaced fractures needing minimal treatment to those with major displacement or comminution, requiring surgical fixation, excision, or replacement.

Divergent Dislocation of Elbow with Ipsilateral Distal Radioulnar Joint Dislocation in a Gymnast

Divergent dislocation of the elbow is a rare injury. It is a result of longitudinal disruption of interosseous membrane of forearm. Although it can logically result in disruption of distal radioulnar joint, according to the authors’ knowledge this combination has not been reported before. The case of a young gymnast is presented who suffered this injury. She was treated successfully in a hinged external fixator and with stabilization of distal radioulnar joint by a K-wire. She regained almost full range of movement and returned to national level gymnastics.

Complications Following Distal Radial Fractures

Union with deformity is the most common complication following a distal radial fracture1-5. The deformity may be extra-articular, characterized by loss of length and metaphyseal angulation; it may be intra-articular, involving either the radiocarpal or the radioulnar joint, or both; or it may be a combination of the two. Surgical treatment of a symptomatic malunion of the distal part of the radius has been recognized for more than 200 years. Resection of the distal aspect of the ulna for the management of pain at the distal radioulnar joint after a distal radial fracture, a procedure attributed to Darrach after his description in 19136, had been suggested by Desault in 17917 and again by Moore in 18808. In 1937, Campbell described a corrective osteotomy of the distal part of the radius with use of an interpositional bone graft obtained from the distal part of the ulna9. In 1945, Merle d’Aubigne and Joussement described a multiple-facet curved osteotomy without the need for an interpositional bone graft10. This concept is currently being revisited and will be described. A deformity following fracture of the distal part of the radius is not necessarily symptomatic. In fact, it is not uncommon for an older patient to have acceptable wrist and forearm function without pain even when there is an apparent deformity. Therefore, impairment of function rather than radiographic deformity is the reason to treat a distal radial malunion, and, consequently, the patient’s wrist and forearm function must be assessed. The most common deformity following a malunited extra-articular Colles type of fracture is the loss of the normal volar tilt of the articular surface in the sagittal plane, loss of ulnar inclination in the frontal plane, loss of length relative to the ulna, and …

Acute elbow dislocation: evaluation and management.

Most elbow dislocations are stable after closed reduction. Treatment with an early range-of-motion program generally leads to favorable results. Care must be taken to rule out neurovascular involvement and associated osseous or ligamentous injury in the wrist. Late elbow instability and stiffness are rare after simple dislocations. Complex elbow dislocations with associated fractures may require surgical intervention to obtain joint stability; ligament and/or fracture repair is frequently necessary in this situation. Larger periarticular fractures adversely affect functional results. Potential late complications of elbow dislocation include posttraumatic stiffness, posterolateral joint instability, ectopic ossification, and occult distal radioulnar joint disruption.

The Stabilizing Effect of Soft-Tissue Constraints in Artificial Galeazzi Fractures

Shortening of the radius is observed in Galeazzi (Piedmont) fractures and results from muscle pull after distal radioulnar joint disruption. A cadaver study was designed to examine the normal laxity at the distal radioulnar joint and contributions of the fibrocartilaginous complex (triangular ligament) and the interosseous membrane in prevention of proximal displacement of the distal radius fragment. It was found that up to 5 mm of radial shortening occurred after osteotomy alone. Shortening of over 10 mm did not occur unless both the interosseous ligament and the triangular ligament were sectioned. Some Galeazzi-type fractures may occur in the absence of distal radioulnar joint disruption, and others may result in disruption of the interosseous membrane of the forearm in addition to disruption of the triangular ligament at the wrist. Diaphyseal fractures of the distal radius may occur in several stages of severity. Attempts to produce a Galeazzi lesion by axial loading and pronation of the forearm above the dorsiflexed wrist caused a variety of injuries but did not result in an isolated fracture of the distal radius or disruption of the distal radioulnar joint.