Distal Radioulnar Joint Incongruity After Shortening of the Ulna

Deshmukh, S. C.; Shanahan, Donal; Coulthard, D.

doi:10.1016/s0266-7681(00)80006-6

Cited by 36 publications

(31 citation statements)

References 6 publications

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“…Some authors maintain that problems may occur in the DRUJ aft er ulnar shortening at the last follow-up. Deshmukh et al10) reported that the the DRUJ was incongruent after ulnar shortening in a cadaveric study. Miura et al18) reported that the peak DRUJ pressure had increased in normal cadavers when the ulna was shortened, and especially in the type I and type III joints.…”

Section: Discussionmentioning

confidence: 98%

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Long-term Outcomes of Ulnar Shortening Osteotomy for Idiopathic Ulnar Impaction Syndrome: At Least 5-Years Follow-up

et al. 2011

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BackgroundThere have been few outcomes studies with follow-up after performing ulnar shortening osteotomy for ulnar impaction syndrome. We investigated the long-term clinical and radiological outcomes of ulnar shortening osteotomy for the treatment of idiopathic ulnar impaction syndrome.MethodsWe retrospectively reviewed 36 patients who had undergone ulnar shortening osteotomy for idiopathic ulnar impaction syndrome for a mean follow-up of 79.1 months (range, 62 to 132 months). The modified Gartland and Werley scores were measured pre- and postoperatively. The radiographic parameters for the assessment of the distal radioulnar joint (DRUJ) as well as the relationship between these radiographic parameters and the clinical and radiological outcomes were determined.ResultsThe average modified Gartland and Werley wrist score improved from 65.5 ± 8.1 preoperatively to 93.4 ± 5.8 at the last follow-up visit. The average preoperative ulnar variance of 4.7 ± 2.0 mm was reduced to an average of -0.6 ± 1.4 mm postoperatively. Osteoarthritic changes of the DRUJ were first seen at 34.8 ± 11.1 months follow-up in 6 of 36 wrists (16.7%). Those who had osteoarthritic changes in the DRUJ had significantly wider preoperative ulnar variance, a longer distal radioulnar distance and a greater length of ulnar shortening, but the wrist scores of the patients who had osteoarthritic changes in the DRUJ were comparable to those who did not have osteoarthritic changes in the DRUJ.ConclusionsThe clinical outcomes are satisfactory for even more than 5 years after ulnar shortening osteotomy for treating idiopathic ulnar impaction syndrome despite the osteoarthritic changes of the DRUJ. The patients who need a larger degree of ulnar shortening may develop DRUJ arthritis.

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Section: Discussionmentioning

confidence: 98%

“…Nishiwaki et al9) showed that the greater the amount of ulnar shortening, the higher the peak pressure is at the DRUJ, suggesting that excessive pressure at the DRUJ can lead to osteoarthritis of this joint. Furthermore, morphological variations in the DRUJ may influence the congruity and the pressure at the DRUJ after ulnar shortening osteotomy 8,10,11)…”

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confidence: 99%

Long-term Outcomes of Ulnar Shortening Osteotomy for Idiopathic Ulnar Impaction Syndrome: At Least 5-Years Follow-up

et al. 2011

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“…Although Bronstein et al 10 reported that dorsal tilt to 308 in a cadaver model did not restrict forearm rotation, it is generally accepted that increasing dorsal tilt increases DRUJ incongruity, especially in cases where angulation exceeds 208 (or >108 dorsal tilt), and limits maximum pronation and supination, 9 as does radial shortening. 19 Isolated radial shortening, epiphyseal inclination and axial malunion reduce radioulnar contact at the DRUJ, which is exacerbated at the extremes of supination and pronation. 20 These studies are consistent with our findings, which indicate that distal radius malunion of 20.9 AE 5.88 resulted in a significant reduction in joint interbone space area and a significant proximal shift in the location of the joint interbone space centroid.…”

Section: Discussionmentioning

confidence: 99%

Effects of distal radius malunion on distal radioulnar joint mechanics—an in vivo study

Crisco

Moore

Marai

et al. 2007

Journal Orthopaedic Research

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Patients with a malunited distal radius often have painful and limited forearm rotation, and may progress to arthritis of the distal radioulnar joint (DRUJ). The purpose of this study was to determine if DRUJ congruency and mechanics were altered in patients with malunited distal radius fractures. In nine subjects with unilateral malunions, interbone distances and dorsal and palmar radioulnar ligament lengths were computed from tomographic images of both forearms in multiple forearm positions using markerless bone registration (MBR) techniques. The significance of the changes were assessed using a generalized linear model, which controlled for forearm rotation angle (À608 to 608). In the malunited forearm, compared to the contralateral uninjured arm, we found that ulnar joint space area significantly decreased by approximately 25%, the centroid of this area moved an average of 1.3 mm proximally, and the dorsal radioulnar ligament elongated. Despite our previous findings of insignificant changes in the pattern of radioulnar kinematics in patients with malunited fractures, we found significant changes in DRUJ joint area and ligament lengthening. These findings suggest that alterations in joint mechanics and soft tissues may play an important role in the dysfunction associated with these injuries. ß

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“…1,2,21 However, diaphyseal osteotomy alters the biomechanics of the DRUJ, which could lead to arthrosis. Deshmukh et al 22 demonstrated that shortening of the ulna by 2 mm resulted in DRUJ articular incongruity and Nishiwaki et al 6 demonstrated that ulnar shortening increased pressure at the DRUJ. Furthermore, clinical studies have shown radiographic changes within the DRUJ in 16% to 50% of patients within an average of 18 to 60 months after ulnar shortening procedures.…”

Section: Discussionmentioning

confidence: 99%

“…However, ulnar shortening osteotomy also alters the congruity of the DRUJ (affecting surface area) and therefore results in altered pressure distributions across the joint. 22 This can lead to decreased contact areas and result in regions subjected to peak pressures much higher than they would be in a congruous joint. Some ulnar-positive wrists may have incongruent DRUJs at baseline, and ulnar shortening may potentially increase joint congruity (which would be expected to decrease contact pressures).…”

Section: Discussionmentioning

confidence: 99%

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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Distal Radioulnar Joint Incongruity After Shortening of the Ulna

Cited by 36 publications

References 6 publications

Long-term Outcomes of Ulnar Shortening Osteotomy for Idiopathic Ulnar Impaction Syndrome: At Least 5-Years Follow-up

Long-term Outcomes of Ulnar Shortening Osteotomy for Idiopathic Ulnar Impaction Syndrome: At Least 5-Years Follow-up

Effects of distal radius malunion on distal radioulnar joint mechanics—an in vivo study

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

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