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The Effect of Distal Radius Fracture Location on Distal Radioulnar Joint Stability: A Cadaveric Study.

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Citation: Journal of Hand Surgery - American Volume. 44(6):473-479, 2019 Jun.PMID: 30777398Institution: Curtis National Hand CenterForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Joint Instability/pp [Physiopathology] | *Radius Fractures/pp [Physiopathology] | *Wrist Joint/pp [Physiopathology] | Cadaver | Humans | Interosseous Membrane/ah [Anatomy & Histology] | Osteotomy | Pronation/ph [Physiology] | Radius/su [Surgery] | Supination/ph [Physiology]Year: 2019 Local holdings: Available in print through MWHC library: 1999 - 2002, Available online from MWHC library: 1995 - presentISSN:

0363-5023

Name of journal: The Journal of hand surgeryAbstract: CLINICAL RELEVANCE: Distal radius osteotomy and shortening did not affect DRUJ stability regardless of location relative to the DIOM insertion.CONCLUSIONS: No difference in DRUJ stability was observed between distal radius osteotomy/shortening proximal and distal to the DIOM radial insertion, regardless of forearm rotation, magnitude of shortening, and/or TFCC detachment.Copyright (c) 2019 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.METHODS: Osteotomies of the distal radius were performed proximal and distal to the DIOM insertion in 14 fresh-frozen cadaveric specimens. Using a volar plate, 5 conditions were tested: anatomical radius alignment; 2- and 4-mm shortening at the proximal osteotomy site; and 2- and 4-mm shortening at the distal osteotomy site. Basilar ulnar styloid osteotomy was performed to simulate triangular fibrocartilage complex (TFCC) detachment-specimens were tested with the ulnar styloid detached and the ulnar styloid fixed (to restore normal anatomy). The DRUJ stability was quantified using dorsal-volar displacement of the radius in response to 20 N of force using a force-displacement probe in neutral, pronation, and supination. Posttesting specimen dissections assessed DIOM and distal oblique bundle (DOB) anatomy. The DRUJ stability in each experimental condition was compared with a multifactor repeated measures analysis of variance with the specimen treated as the repeated factor.PURPOSE: To investigate whether the location of distal radius osteotomy/shortening relative to the radial insertion of the distal interosseous membrane (DIOM) is correlated with distal radioulnar joint (DRUJ) instability. We hypothesized that distal radius osteotomy and shortening proximal to the DIOM insertion would result in increased DRUJ instability because of induced laxity in the DIOM.RESULTS: There were no significant differences in dorsal-volar translation of the radius (ie, DRUJ stability) between radial osteotomy/shortening proximal and distal to the DIOM insertion, regardless of forearm rotational position or magnitude of shortening. Five (36%) of the 14 specimens had a DOB present. There was a significant increase in DRUJ instability in the setting of TFCC detachment (via basilar ulnar styloid osteotomy).All authors: Gould HP, Meyers KN, Trehan SK, Wolfe SWOriginally published: Journal of Hand Surgery - American Volume. 2019 Feb 15Fiscal year: FY2019Digital Object Identifier:

https://dx.doi.org/10.1016/j.jhsa.2019.01.002

Date added to catalog: 2019-03-14

Holdings ( 1 )
Title notes ( 8 )

Holdings
Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	30777398	Available		30777398

Available in print through MWHC library: 1999 - 2002, Available online from MWHC library: 1995 - present

CLINICAL RELEVANCE: Distal radius osteotomy and shortening did not affect DRUJ stability regardless of location relative to the DIOM insertion.

CONCLUSIONS: No difference in DRUJ stability was observed between distal radius osteotomy/shortening proximal and distal to the DIOM radial insertion, regardless of forearm rotation, magnitude of shortening, and/or TFCC detachment.

METHODS: Osteotomies of the distal radius were performed proximal and distal to the DIOM insertion in 14 fresh-frozen cadaveric specimens. Using a volar plate, 5 conditions were tested: anatomical radius alignment; 2- and 4-mm shortening at the proximal osteotomy site; and 2- and 4-mm shortening at the distal osteotomy site. Basilar ulnar styloid osteotomy was performed to simulate triangular fibrocartilage complex (TFCC) detachment-specimens were tested with the ulnar styloid detached and the ulnar styloid fixed (to restore normal anatomy). The DRUJ stability was quantified using dorsal-volar displacement of the radius in response to 20 N of force using a force-displacement probe in neutral, pronation, and supination. Posttesting specimen dissections assessed DIOM and distal oblique bundle (DOB) anatomy. The DRUJ stability in each experimental condition was compared with a multifactor repeated measures analysis of variance with the specimen treated as the repeated factor.

PURPOSE: To investigate whether the location of distal radius osteotomy/shortening relative to the radial insertion of the distal interosseous membrane (DIOM) is correlated with distal radioulnar joint (DRUJ) instability. We hypothesized that distal radius osteotomy and shortening proximal to the DIOM insertion would result in increased DRUJ instability because of induced laxity in the DIOM.

RESULTS: There were no significant differences in dorsal-volar translation of the radius (ie, DRUJ stability) between radial osteotomy/shortening proximal and distal to the DIOM insertion, regardless of forearm rotational position or magnitude of shortening. Five (36%) of the 14 specimens had a DOB present. There was a significant increase in DRUJ instability in the setting of TFCC detachment (via basilar ulnar styloid osteotomy).

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