Forearm Rotation Research Articles

Wrist Total Arthrodesis with Vascularized Fibula Graft in Bone Tumors of the Distal Radius

Objectives: Reconstruction of the wrist after resection of distal forearm tumours involving the joint may often be difficult for surgeons. The aim of this study was to examine the clinical results of 5 patients on whom total wrist arthrodesis was performed with vascularised fibula graft (VFG) after tumour resection in the distal radius. Methods: A retrospective examination was made of 5 patients (4 males, 1 female) applied with wrist arthrodesis with VFG. The patients were evaluated in respect of defect amount after resection, the length of VFG used, time to bone healing, postoperative complications, reconstruction procedures, and forearm rotation. The postoperative clinical evaluation of the patients was made according to the Musculoskeletal Tumour Society (MSTS) score. Results: The resected distal radius segment of the patients was mean 7.05cm and the mean VFG length was 8.19cm. The diagnoses were malignant mesenchymal tumour in 2 patients, osteosarcoma, giant cell tumour, and chondrosarcoma in the other 3. Osseofasciacutaneous VFG was harvested in 4 patients and only osseous VFG in 1. Bone healing was observed radiologically in mean 4.6 months (range, 4-6 months) in all the patients. The mean MSTS sore at the final follow-up examination was 84%. Conclusion: When there is a bone defect involving the wrist joint, wrist arthrodesis applied with VFG is a useful and reliable reconstructive option that provides satisfactory results.

Restoring Voluntary Bimanual Activities of Patients with Chronic Hemiparesis through a Foot-Controlled Hand/Forearm Exoskeleton.

A significant number of stroke patients are permanently left with a hemiparetic upper limb after the poststroke six-month golden recovery period, resulting in a drastic decline in their quality of life. This study develops a novel foot-controlled hand/forearm exoskeleton that enables patients with hemiparetic hands and forearms to restore their voluntary activities of daily living. Patients can accomplish dexterous hand/arm manipulation on their own with the assistance of a foot-controlled hand/forearm exoskeleton by utilizing foot movements on the unaffected side as command signals. The proposed foot-controlled exoskeleton was first tested on a stroke patient with a chronic hemiparetic upper limb. The testing results showed that the forearm exoskeleton can assist the patient in achieving approximately 107°of voluntary forearm rotation with a static control error less than 1.7°, whereas the hand exoskeleton can assist the patient in realizing at least six different voluntary hand gestures with a success rate of 100%. Further experiments involving more patients demonstrated that the foot-controlled hand/forearm exoskeleton can help patients in restoring some of the voluntary activities of daily living with their paretic upper limb, such as picking up food to eat and opening water bottles to drink, and etc. This research implies that the foot-controlled hand/forearm exoskeleton is a viable way to restore the upper limb activities of stroke patients with chronic hemiparesis.

Management of Diaphyseal Forearm Fractures in Paediatric Patients: Lesson Learnt During COVID-19 Pandemic

Objectives: Our objectives were to study the epidemiology, management and change in trends in management of paediatric diaphyseal forearm fractures during the COVID-19 pandemic. Methods: It was a prospective study which included all fresh (≤ 3 weeks), traumatic, forearm diaphyseal fractures in paediatric patients ≤ 16 years. Closed & compound grade I fractures were included. Pathological fractures, compound grade II/III fractures and fractures ≥ 3 weeks old were excluded. All patients underwent closed reduction and above elbow cast application. Acceptability of reduction was graded as per the criteria described by Noonan KJ, et al. At 2 weeks follow-up, repeat check radiograph was done for assessing acceptable reduction. Patients with acceptable reduction were continued with nonsurgical treatment and patients with loss of reduction were offered operative intervention. But due to refusal of operative intervention by the parents, patients were continued with the nonsurgical treatment. Results: Eighty patients were available for follow-up. Mean age was 7.78 years. Left to right side involvement was 58% & 42% respectively. Out of 80 patients, 20 patients were operated due to failed closed reduction, while 60 patients were managed nonsurgically. Out of 60 patients, 18 (30%) presented with loss of reduction and were offered surgery. Refusal to surgery pushed us to continue with nonsurgical treatment and evaluation as a separate group in the study as nonsurgically treated, not meeting the acceptability criteria. In nutshell out of 80 patients, 20 were managed operatively, while 60 were managed nonsurgically, 42 (70%) patients meeting the acceptable reduction criteria while 18 patients (30%) were not meeting the acceptable reduction criteria. Restriction of forearm rotations was found to be statistically insignificant in all nonsurgically treated patients irrespective of the reduction criteria met or not. Furthermore, on sub-grouping the patients with loss of reduction, on the basis of age and angulation it was observed that there was no significant change in the final functional outcome in the patients with angulation of 15-18 degrees in ≤ 10 years of age and 10-13 degrees in > 10 years of age weather treated conservatively or operatively (p value = 0.522). However, when angulation was > 18 degrees in ≤ 10 years of age and > 13 degrees in > 10 years of age, it was observed that operated patients had statistically significant better functional outcome when compared to conservatively treated patients (p value < 0.05). Conclusion: Our study attempts to highlight the management of paediatric forearm diaphyseal fractures with emphasis on nonsurgical management of these injuries to deal with the scarcity of follow-up care during the global health crisis. The encouraging results of our conservatively treated patients, even when angulation is few degrees more than the acceptable limit, allows us to widen the acceptable limit of reduction in paediatric population, especially when the health care system is challenged by the global pandemic and its restrictions. However more studies are required to confirm our findings before making them generalizable.

Interactive visualization of forearm internal rotation angle in Tai Chi training

Modeling the visual features of the forearm internal rotation angle during Tai Chi training is difficult, and its accurate detection is lacking. To address this issue, this paper proposes an interactive visualization analysis method based on Harris corner detection and edge contour feature extraction to visualize and adjust the internal rotation of the forearm during Tai Chi training in real time. In the proposed method, the visual images of limb movement and forearm rotation during the Tai Chi training are collected as features, and the wavelet image denoising method is used to denoise the images to improve the signal-to-noise ratio of the output. Meanwhile, the image pixel uniform traversal method is used to continuously traverse the image subblocks to extract the edge contour features during the forearm internal rotation interaction. By means of superpixel feature decomposition and grayscale information superposition, the fitting effect of the forearm internal rotation angle is fed back, and based on this, the forearm internal rotation angle is modified to realize the interactive visual analysis of the forearm internal rotation angle. Experimental results show that, compared with existing methods, the interactive visualization performance of the proposed method is better. The proposed method can fit, track, and solve the rotation angle in real time; the required analysis training images are more accurate, and the Tai Chi training data detection and dynamic analysis abilities are improved.

Accuracy of 3D Corrective Osteotomy for Pediatric Malunited Both-Bone Forearm Fractures.

Re-displacement of a pediatric diaphyseal forearm fracture can lead to a malunion with symptomatic impairment in forearm rotation, which may require a corrective osteotomy. Corrective osteotomy with two-dimensional (2D) radiographic planning for malunited pediatric forearm fractures can be a complex procedure due to multiplanar deformities. Three-dimensional (3D) corrective osteotomy can aid the surgeon in planning and obtaining a more accurate correction and better forearm rotation. This prospective study aimed to assess the accuracy of correction after 3D corrective osteotomy for pediatric forearm malunion and if anatomic correction influences the functional outcome. Our primary outcome measures were the residual maximum deformity angle (MDA) and malrotation after 3D corrective osteotomy. Post-operative MDA > 5° or residual malrotation > 15° were defined as non-anatomic corrections. Our secondary outcome measure was the gain in pro-supination. Between 2016-2018, fifteen patients underwent 3D corrective osteotomies for pediatric malunited diaphyseal both-bone fractures. Three-dimensional corrective osteotomies provided anatomic correction in 10 out of 15 patients. Anatomic corrections resulted in a greater gain in pro-supination than non-anatomic corrections: 70° versus 46° (p = 0.04, ANOVA). Residual malrotation of the radius was associated with inferior gain in pro-supination (p = 0.03, multi-variate linear regression). Three-dimensional corrective osteotomy for pediatric forearm malunion reliably provided an accurate correction, which led to a close-to-normal forearm rotation. Non-anatomic correction, especially residual malrotation of the radius, leads to inferior functional outcomes.

Validity and reliability of a portable handheld dynamometer compared to a fixed isokinetic dynamometer to assess forearm torque strength

To evaluate the effect of treatment on forearm rotation, torque muscle strength can be assessed using an isokinetic device (IKD) or a wrist dynamometer (WD). The aims of this study were 1) to determine concurrent validity and intra- and inter-rater reliability using the WD, and to examine correlations between WD and IKD in different positions; and 2) subsequently, to establish the intermethod reproducibility between WD as a handheld (HHD) or fixed device. We conducted a cross-sectional study in which torque strength was measured in healthy participants by two observers using an IKD and a WD. Study endpoints were concurrent validity (Pearson’s r), intra- and inter-rater reliability, intermethod reproducibility (intraclass correlation coefficient: ICC) and measurement error (limits of agreement: LoA). Concurrent validity ranged, in the 2 studies assessing it, from r 0.37 to 0.52 for pronation and from r 0.50 to 0.82 for supination, with wide 95% confidence intervals. ICC for intra-rater reliability for pronation ranged from 0.85 to 0.91 and for supination from 0.91 to 0.95. ICC for inter-rater reliability for pronation ranged from 0.84 to 0.96 and for supination from 0.92 to 0.96. Despite the excellent intra- and inter-rater reliability and intermethod reproducibility for the WD-HHD and fixed WD, validity was low when compared to IKD and wide LoA indicated a high measurement error of approximately 20%. These results suggest that the WD cannot replace the IKD isometric mode for pronation and supination. Level of evidence2.

Kinematic analysis of forearm rotation using four-dimensional computed tomography.

This study aimed to quantify forearm kinematics with a focus on the forearm rotation axis. Ten healthy volunteers were included in the study. One three-dimensional computed tomographic scan and two four-dimensional computed tomographic scans were done in all the arms to capture forearm joint motion. After image processing, the rotation axis and the movement of the radius with respect to various axes were quantified. The rotation axis was calculated using finite helical axis analysis and a circle fitting approach. The mean error of the rotation axis found through circle fitting was 0.2 mm (SD 0.1) distally and 0.1 mm (SD 0.1) proximally, indicating an improvement in precision over the finite helical axis approach. The translations of the radius along the ulnar axis and the forearm rotation axis were 2.6 (SD 0.8) and 0.6 mm (SD 0.9), respectively. The rotation of the radius around the radial axis was 7.2°. The techniques presented provide a detailed description of forearm kinematics.

Clinical outcome and survival rate of the Herbert ulnar head prosthesis for reconstruction of the distal radioulnar joint depending on co-morbidity and different indications.

Ulnar head prostheses have been developed to restore the integrity of the DRUJ and relieve pain. This study aims to evaluate the long-term outcome of the clinical and radiographic results as well as the survival rate of the Herbert ulnar head prosthesis (UHP) depending on co-morbidity and different indications. The Herbert ulnar head prosthesis was implanted in 62 patients. In the majority of the patients, the indication was given due to pain during forearm rotation. This was on account of painful instability of the distal ulna following Bowers (59.7%) or Kapandji procedure (16.1%), Darrach procedure (8.1%) or painful post-traumatic (12.9%) or primary osteoarthritis (3.2%). Of the 62 patients, 34 were men and 28 women. The mean age at the time of operation was 49years (range 18-84years). A clinical and radiographic evaluation was performed including pain scale, range of motion, grip strength and the DASH and modified Mayo wrist scores. The average follow-up was 84.5months (range 8-206months), and statistically significant reduction of pain was observed (p < 0.05). The range of motion of pro- and supination improved slightly, but not significantly, whereas the DASH score improved significantly from 56 to 43 (p < 0.05). Patients without an arthrodesis achieved better results in the DASH and in the modified Mayo wrist score. In 39 cases, a small amount of bone resorption was seen at the collar of the prosthesis in the follow-up radiographs. A revision surgery was necessary in 14 patients. The Kaplan-Meier survival rate after 15years was 90.3%. The long-term results of the UHP are encouraging regardless of different indications with a survival rate of more than 90% 7years following surgery, high patient satisfaction and good clinical and radiographic results. IV.

Preoperative radius head dislocation affects forearm rotation after mobilization of congenital radioulnar synostosis

BackgroundThe present study was carried out to answer three questions: 1) How much forearm rotation can be expected after mobilization of congenital radioulnar synostosis (CRUS)? 2) Does preoperative radius head dislocation affect forearm rotation after mobilization? 3) What factors other than radius head dislocation affect postoperative forearm rotation? MethodsWe performed mobilization of CRUS with a free vascularized fascio-fat graft and a radius osteotomy (Kanaya’s procedure) on 26 forearms of 25 patients. The age at the surgery ranged from 5.3 to 13.4 years. The follow-up duration ranged 24–111 months. We classified CRUS into 3 groups according to the dislocation of the radius head: posterior dislocation (N = 13), anterior dislocation (N = 9) and no dislocation (N = 4). Since major complaints of patients and parents were poor forearm rotation and lack of supination, they were evaluated separately. ResultsMean preoperative forearm ankylosis angle was 34.8° (range; neutral to 90° pronation). Preoperative pronation ankylosis angle was higher in the posterior dislocation group (mean 55.3°) than the anterior dislocation (mean 11.6°) and no dislocation groups (mean 5.0°). There was no re-ankylosis after mobilization and the mean postoperative active range of motion (ROM) was 86.5°. The mean active ROM was 75.7° in the posterior dislocation group, 96.1° in anterior dislocation group and 100.0° in no dislocation group. The mean active supination was 6.9, 33.9 and 47.5° respectively. The posterior dislocation group showed less ROM and less supination than other groups. Preoperative pronation ankylosis angle showed negative correlation with postoperative ROM (ρ = − 0.59) and postoperative supination (ρ = − 0.73). ConclusionThe mean postoperative active ROM of this mobilization was 86.5°. Posterior dislocation group showed higher pronation ankylosis angle preoperatively, and less postoperative ROM and less supination than anterior and no dislocation groups. Preoperative pronation ankylosis angle showed negative correlation with postoperative ROM and supination.

A novel sensor-embedded holding device for monitoring upper extremity functions.

There are several causes that can lead to functional weakness in the hands or upper extremities (UE), such as stroke, trauma, or aging. Therefore, evaluation and monitoring of UE rehabilitation have become essential. However, most traditional evaluation tools (TETs) and assessments require clinicians to assist or are limited to specific clinical settings. Several novel assessments might apply to wearable devices, yet those devices will still need clinicians or caretakers to help with further tests. Thus, a novel UE assessment device that is user-friendly and requires minimal assistance would be needed. The cylindrical grasp is one of the common UE movements performed in daily life. Therefore, a cylindrical sensor-embedded holding device (SEHD) for training and monitoring was developed for a usability test within this research. The SEHD has 14 force sensors with an array designed to fit holding positions and a six-axis inertial measurement unit (IMU) to monitor grip strength, hand dexterity, acceleration, and angular velocity. Six young adults, six healthy elderly participants, and three stroke survivors had participated in this study to see if the SEHD could be used as a reference to TETs. During result analyses, where the correlation coefficient analyses were applied, forearm rotation smoothness and the Purdue Pegboard Test (PPT) showed a moderate negative correlation [r (16) = -0.724, p < 0.01], and the finger independence showed a moderate negative correlation with the PPT [r (10) = -0.615, p < 0.05]. There was also a highly positive correlation between the maximum pressing task and Jamar dynamometer in maximum grip strength [r (16) = 0.821, p < 0.01]. These outcomes suggest that the SEHD with simple movements could be applied as a reference for users to monitor their UE ability.

COMPARATIVE STUDY OF FUNCTIONAL AND RADIOLOGICAL OUTCOME OF AUGMENTED EXTERNAL FIXATOR VERSUS VOLAR LOCKING PLATE IN INTRAARTICULAR FRACTURES OF DISTAL END RADIUS.

Introduction: Augmented external fixation and Open reduction with volar locking plate are two frequently used modalities in the management of intraarticular fractures of distal end radius. However, there is still controversy regarding the optimal surgical modality. The present study was performed to compare the functional and radiological outcomes of augmented external fixation (AEF) versus volar plate fixation (VPF) in the management of patients with intraarticular fractures of distal end of radius. This prospective study was done between December 2019 Materials and Methods: and December 2021. This study included 40 patients with intraarticular fractures of distal end of radius. All patients fulfilling inclusion criteria were randomly allocated into two groups. Group A was treated with an AEF and Group B with VPF. Functional assessment was done by measuring the wrist range of motion, hand grip strength and Mayo Wrist Score. The radiographic parameters included radial height, radial inclination, and volar tilt. Follow-up was done at 6 weeks, 3 months, and 6 months post-operatively. In our study at all follow-ups, the VPF group had a significa Results: ntly better Mayo wrist score and wrist flexion, wrist extension, forearm supination and pronation compared to the AEF group (p &lt; 0.05). There were no significant differences in terms of hand grip strength and postoperative radiologic parameters (p &gt; 0.05). VPF is a better surgical option as compared to AEF based on our short-term functional outcome Conclusion: in the management of patients with intraarticular fractures of the distal end of radius, on account of better wrist flexion and extension, forearm rotation and Mayo wrist scores, and fewer complication rates.

Effect of Radiocapitellar Joint Over/Under Stuffing on Elbow Joint Contact Pressure

Comminuted radial head fractures are commonly treated by surgical resection or replacement with a prosthesis. A potential problem with radial head replacement is overlengthening of the radial neck ("overstuffing" of the radial head), which has been shown to affect both ulnohumeral kinematics and radiocapitellar pressures. We hypothesized that an overstuffed radial head prosthesis increases capitellar pressure and reduces coronoid pressure. Seven human cadaveric elbows were prepared on a custom-designed apparatus simulating stabilizing muscle loads, and passively flexed from 0° to 90° under gravity valgus torque while joint contact pressures were measured. Each elbow was tested sequentially with different neck lengths, starting with the intact specimen followed by insertion of understuffed (-2 mm), standard-height (0 mm), and overstuffed (+2 mm) radial head prostheses in neutral forearm rotation, 40° pronation, and 40° supination positions, respectively. Capitellar mean contact pressures significantly increased after insertion of an overstuffed radial head prosthesis. In valgus position with neutral forearm rotation, capitellar mean contact pressure on the joint with an intact radial head averaged 227 ± 70 kPa. Insertion of understuffed, standard-height, and overstuffed radial head prostheses changed the mean contact pressures to 152 ± 76 kPa, 212 ± 68 kPa, and 491 ± 168 kPa, respectively. The overstuffed radial head group had significantly lower whole coronoid mean contact pressures (153 ± 56 kPa) compared with the intact (390 ± 138 kPa) and standard-height (376 ± 191 kPa) radial head groups. An increase in radial prosthesis height significantly increases capitellar contact pressures and reduces coronoid contact pressures. Restoration of the anatomic radial head height is critical when performing radial head arthroplasty to maintain normal joint biomechanics. Elevated capitellar contact pressures can potentially lead to pain and early degenerative changes.

Validating Clinical Distal Radioulnar Joint Examination With Radiographic Parameters.

The purpose of this study was to quantify the in vivo displacement of bilateral distal radioulnar joints (DRUJs) in resisted pronosupination. We hypothesize that this will demonstrate no appreciable difference between the left and right DRUJ, thus validating the concept of using the uninjured wrist as a control for physical examination as well as dynamic imaging studies. Thirty-two participants without a history of wrist pathology underwent a dynamic computed tomography (CT) protocol evaluating bilateral forearm rotation in neutral forearm rotation, 60° pronation, and 60° supination, including maximal isometric muscle loading. The DRUJ alignment, specifically the absolute degree and direction of subluxation of the ulna relative to the sigmoid notch, was then assessed using a modification of the radioulnar line method. There was no significant difference in the mean displacement when comparing the right and left sides in neutral, pronation, or supination. The mean displacement was also compared between male and female patients, and there was no statistically significant difference in absolute displacement in neutral (male 0.99 mm vs female 1.38 mm) or supination (male -0.57 mm vs female -0.23 mm). However, the difference in pronation was statistically significant (male 2.69 mm vs female 3.26 mm). Of the 192 sequences, the measurements of displacement of the authors were within 1 mm 86% of the time (166 of 192). Dynamic CT of bilateral DRUJs in resisted pronation, supination, and neutral demonstrated symmetry between the right and left DRUJ, supporting the concept of using the contralateral side as a control to identify instability in an injured wrist.

A randomized controlled trial comparing two modern total wrist arthroplasties : improved function with stable implants, but high complication rates in non-rheumatoid wrists at two years.

To analyze the short-term outcome of two types of total wrist arthroplasty (TWA) in terms of wrist function, migration, and periprosthetic bone behaviour. A total of 40 patients suffering from non-rheumatoid wrist arthritis were enrolled in a randomized controlled trial comparing the ReMotion and Motec TWAs. Patient-rated and functional outcomes, radiological changes, blood metal ion levels, migration measured by model-based radiostereometric analysis (RSA), bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA), complications, loosening, and revision rates at two years were compared. Patient-Rated Wrist and Hand Evaluation (PRWHE) scores, abbreviated version of the Disabilities of the Arm, Shoulder and Hand questionnaire scores, and pain improved similarly and significantly in both groups. Wrist motion improved significantly in the Motec group only, and forearm rotation in the ReMotion group only. Cobalt (Co) and chromium (Cr) blood ion levels were significantly higher in the metal-on-metal (MoM) Motec group than in the metal-on-polyethylene (MoP) ReMotion group. Mean total translation was 0.65 mm (95% confidence interval (CI) 0.26 to 1.12) and 0.27 mm (95% CI 0.14 to 0.47) for the ReMotion carpal and radial components, and 0.32 mm (95% CI 0.22 to 0.45) and 0.26 mm (95% CI 0.20 to 0.34) for the Motec metacarpal and radial components, respectively. Apart from dorsal and volar tilts, which were significantly higher for the radial ReMotion than for the Motec component, no significant differences in absolute migration occurred. BMD around the radial components never returned to baseline. Almost one-third of patients required reoperation due to complications. Two ReMotion implants were revised to Motec TWAs due to carpal component loosening, and three Motec MoM articulations were revised to metal-on-polyether ether ketone due to painful synovitis. Both implants provided matched function and were stable at short-term follow-up, but with a high complication rate. This procedure should be restricted to specialist centres undertaking prospective analysis until its role is clarified.Cite this article: Bone Joint J2022;104-B(10):1132-1141.

A Soft, Wearable Skin-Brace for Assisting Forearm Pronation and Supination With a Low-Profile Design

Neurological diseases affect more than 50 million people living with persistent upper limb impairments worldwide, and 40% of patients remain impaired even after intensive hospital care. Wearable robots have been developed for enhancing functionality in activities of daily living (ADL). The role of forearm movement is as crucial as the hand and wrist. However, the coincidence of the rotation axis with the forearm presents design challenges, and thus there are few studies on wearable devices for assisting forearm pronation/supination movement. In this study, we propose a bioinspired soft wearable skin-brace for the forearm pronation/supination to assist patients in ADL and perform rehabilitation training. The low-profile design that can fit the forearm like clothing combines features of a rail structure and tendon driving mechanism with high transfer efficiency. We conducted a biomechanical analysis to quantify the movement of wrist landmarks during forearm rotation, as well as a performance evaluation and user tests with our prototype. We demonstrate that it can provide patients with sufficient and compliant support in terms of range of motion and output torque. The user-friendly design allows patients to don and doff the device independently and quickly, as well as for individual customization. With the advantage of not restricting other joint movements, the device also shows the possibility of co-use with other rehabilitation devices.

Challenging the mechanism of distal biceps tendon rupture using a video analysis study.

The conventionally described mechanism of distal biceps tendon rupture (DBTR) is of a 'considerable extension force suddenly applied to a resisting, actively flexed forearm'. This has been commonly paraphrased as an 'eccentric contracture to a flexed elbow'. Both definitions have been frequently used in the literature with little objective analysis or citation. The aim of the present study was to use video footage of real time distal biceps ruptures to revisit and objectively define the mechanism of injury. An online search identified 61 videos reporting a DBTR. Videos were independently reviewed by three surgeons to assess forearm rotation, elbow flexion, shoulder position, and type of muscle contraction being exerted at the time of rupture. Prospective data on mechanism of injury and arm position was also collected concurrently for 22 consecutive patients diagnosed with an acute DBTR in order to corroborate the video analysis. Four videos were excluded, leaving 57 for final analysis. Mechanisms of injury included deadlift, bicep curls, calisthenics, arm wrestling, heavy lifting, and boxing. In all, 98% of ruptures occurred with the arm in supination and 89% occurred at 0° to 10° of elbow flexion. Regarding muscle activity, 88% occurred during isometric contraction, 7% during eccentric contraction, and 5% during concentric contraction. Interobserver correlation scores were calculated as 0.66 to 0.89 using the free-marginal Fleiss Kappa tool. The prospectively collected patient data was consistent with the video analysis, with 82% of injuries occurring in supination and 95% in relative elbow extension. Contrary to the classically described injury mechanism, in this study the usual arm position during DBTR was forearm supination and elbow extension, and the muscle contraction was typically isometric. This was demonstrated for both video analysis and 'real' patients across a range of activities leading to rupture.Cite this article: Bone Jt Open2022;3(10):826-831.

Clinical Study of Wrist Arthroscopy Combined with Oblique Ulnar Shortening Osteotomy in the Treatment of Ulnar Impaction Syndrome.

To explore the clinical effects of wrist arthroscopy combined with oblique ulnar shortening osteotomy in the treatment of ulnar impaction syndrome. This was a retrospective study of 60 patients with ulnar impaction syndrome who were admitted to our department from January 2016 to December 2019. According to different surgical methods, they were divided into an observation group and a control group, with 30 cases in each group. The control group was treated with oblique ulnar shortening osteotomy, and the observation group used wrist arthroscopy based on the control group. The two groups of patients were compared in terms of wrist function before and 12months after surgery. We compared the Disabilities of the Arm, Shoulder, and Hand Score (DASH Score), Patient-Rated Wrist Evaluation Score (PRWE Score), Visual Analog Score (VAS), and ulnar variation between the two groups at 12months after surgery. The excellent and good rates by Mayo wrist score were compared between the two groups at the last follow-up. All patients were followed up for 12-36months, with an average of 14.5months. Bone union was achieved at the oblique osteotomy of the ulna, with an average healing time of 13.6 weeks. The observation group was examined by wrist arthroscopy, and the triangular fibrocartilage complex (TFCC) Palmer classification was confirmed in three cases of type IIA, seven cases of type IIB, 14 cases of type IIC, and six cases of type IID. Compared with before surgery, the grip strength, flexion-extension, ulnar radial deflection, and forearm rotation of the two groups of patients were significantly improved at 12months after surgery. The DASH score, PRWE score, and VAS score of the observation group were better than those of the control group, and the difference in ulnar shortening length was not statistically significant between the two groups. The excellent and good rates of the observation group (93.3%) were better than those of the control group (87.5%) at the last follow-up, and the difference was statistically significant. Compared with oblique ulnar shortening osteotomy alone, combined wrist arthroscopy can better reduce the pain of patients with ulnar impaction syndrome, restore wrist function, and improve the excellent and good rates. Therefore, it is clinically worthy of promotion.

Fixed Subluxation of the Distal Radioulnar Joint following Malunion of the Ulnar Styloid Process.

Purpose Recent literature on significance and treatment of ulnar styloid fractures suggest that the ulnar styloid is not the central problem but the radioulnar ligaments and their impact on joint stability. However, specifically displaced ulnar styloid process fractures that secondarily heal in an ectopic position remain a rare situation for which diagnostics and treatment options remain a topic of discussion. Methods This case series presents four patients with limited supination due to a fixed dorsal subluxation of the distal radioulnar joint (DRUJ). The reason here fore was a significant malunion of ulnar styloid fracture that was addressed by corrective ulnar styloid osteotomy. Three of these osteotomies used three-dimensional (3D) preoperative planning and patient specific guides. Results All patients presented with a significant displacement of the malunited ulnar styloid fracture (average 32-degree rotation and 5-mm translation). In all four patients, the fixed subluxation of the ulnar head was resolved clinically and radiographically, and the forearm rotation restored after corrective osteotomy of the ulnar styloid and fixation in an anatomical position. Conclusion This case series presents a very specific subset of patients with nonanatomically healed ulnar styloid fractures responsible for a chronic DRUJ dislocation and limited prosupination and its treatment. Level of evidence This is a Level IV, therapeutic study.

Movement preferences of the wrist and forearm during activities of daily living

BackgroundDuring activities of daily living, the main degrees of freedom of the forearm and wrist—forearm pronation-supination (PS), wrist flexion-extension (FE), and wrist radial-ulnar deviation (RUD)—combine seamlessly to allow the hand to engage with and manipulate objects in our environment. Yet the combined behavior of these three degrees of freedom is relatively unknown. PurposeTo provide a characterization of natural forearm and wrist kinematics (joint configuration, movement direction, and speed) during activities of daily living. Study designThis is a descriptive cross-sectional study. MethodsTen healthy subjects performed 24 activities of daily living chosen to represent a wide variety of activities, while we measured their PS, FE, and RUD angles using electromagnetic motion capture. The orientation of the forearm and wrist was represented in the three-dimensional “configuration space” spanned by PS, FE, and RUD. From the time course of forearm and wrist orientation in configuration space, we extracted three-dimensional distributions of joint configuration, movement direction, and speed. ResultsMost joint configurations were focused in a relatively small area: subjects spent roughly 50% of the time in the central 20% of their functional range of motion. Some movement directions were significantly more common than others (p < 0.001); in particular, the direction of the dart-thrower's motion (DTM) was about three times more common than motion perpendicular to it. Most movements were slow: the likelihood of moving at increasing speeds dropped off exponentially. Interestingly, the most common high-speed motion combined the DTM with a twist from pronation to supination. As this motion allows one to pick up an object in front of one's body and bring it to the head, it is essential for self-care. Thus, although many activities of daily living follow the DTM without significant forearm rotation, the greatest importance of the DTM may lie in its combination with forearm rotation. ConclusionsDespite the wide variety of activities, we found evidence of preferred movement behavior, and this behavior showed significant coupling between the wrist and forearm.

The influence of sagittal deformity of the distal radius on pronosupination: a cadaver study.

We performed a cadaver study using seven fresh-frozen adult upper limbs to assess the impact of increasingly larger distal radial deformity in the sagittal plane on the range of motion in pronation/supination. Three palmar (20°, 30° and 40° angulations) and three dorsal (10°, 20° and 30° angulations) tilt deformities, without any radial shortening, were simulated by performing a radial osteotomy and using custom-made three-dimensional-printed anterior plates. We measured the maximum unconstrained pronation and supination before the osteotomy and after each induced deformation. There was a decrease in the median pronation and supination values for all palmar and dorsal tilt deformities. The pronation range was more impaired than the supination range, and dorsal tilt deformities caused the greatest loss in forearm rotation. Our results suggest that forearm rotation in both pronation and supination is reduced as soon as 10° to 20° distal radial deformity occurs in the palmar or dorsal direction.