Optimizing the Orientation of a Suture Button to Stabilize the Distal Radioulnar Joint in a Sawbones Model

Mau, Makoa; Livingstone, John P; Lee, Gordon; Murray, Patrick

doi:10.1016/j.jhsg.2022.06.007

“…Yet controversy remains as to whether it should be done in supination or neutral position. [ 1 , 7 , 8 , 10 , 25 – 36 ].…”

Section: Introductionmentioning

confidence: 99%

“…Whether this should be done arthroscopically or open depends on the kind and extent of the damage. This can be done using suture anchors for ligamental damage or screw osteosynthesis in case of a fractured styloid process of the ulnar head [7][8][9]. If this is unsuccessful or not indicated, i.e.…”

Section: Introductionmentioning

confidence: 99%

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Analyzing the reduction quality of the distal radioulnar joint after closed K-wire transfixation in a cadaver model: is supination or neutral position superior?

El Barbari,

Kohlhas,

Franke

et al. 2024

Arch Orthop Trauma Surg

0

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Introduction Distal radioulnar joint (DRUJ) instabilities are challenging and their optimal treatment is controversial. In special cases or when reconstruction of the stabilizing triangular fibrocartilage complex (TFCC) fails, K-wire transfixation can be performed. However, no consensus has been reached regarding the rotational position of the forearm in which this should be done. Therefore, it was investigated whether anatomical reduction would best be achieved by transfixation in neutral position or supination of the forearm. Materials and methods Twelve cadaveric upper limbs were examined before dissection of the DRUJ stabilizing ligaments and after closed transfixation in both positions by C-arm cone-beam CT. Whether this was first done in neutral position or in supination was randomized. The change in the radioulnar ratio (RR) in percentage points (%points) was analyzed using Student's t-test. RR was used since it is a common and sensitive method to evaluate DRUJ reduction, expressing the ulnar head's position in the sigmoid notch as a length ratio. Results The analysis showed an increased change in RR in neutral position with 5.4 ± 9.7%points compared to fixation in supination with 0.2 ± 16.1%points, yet this was not statistically significant (p = 0.404). Conclusions Neither position leads to a superior reduction in general. However, the result was slightly closer to the anatomical position in supination. Thus, transfixation of the DRUJ should be performed in the position in which reduction could best be achieved and based on these data, that tends to be in supination. Further studies are necessary to validate these findings and to identify influential factors.

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“…It also forms a concomitant injury of fractures of the distal radius in up to 35% of cases 3 – 5 . Chronic DRUJ instability results in a highly disabling condition, including ulnar-sided wrist pain, grip strength weakness, painful and limited pronation/supination as well as degenerative arthritis as long-term sequalae 4 – 7 . Several surgical procedures have been postulated for reinforcing the soft tissue stabilizers of the DRUJ.…”

Section: Introductionmentioning

confidence: 99%

Distal oblique bundle influence on distal radioulnar joint stability: a biomechanical study

Hohenberger,

Pirrung,

Hammer

et al. 2023

Sci Rep

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Chronic instability of the distal radioulnar joint (DRUJ) presents a highly disabling condition. Several surgical techniques have been reported for its treatment. These involve reconstruction of the distal oblique bundle (DOB) of the interosseous membrane (IOM) of the forearm. The aim of this study was to examine whether surgical reconstruction of the DOB is necessary to restore DRUJ stability following trauma with DOB disruption and to compare two restoration techniques utilizing a tendon or suture-button graft. Stability in supination and pronation was assessed by means of maximum torque and force in twenty forearms. Test cycles were performed with the DOB/IOM in an intact condition, with the DOB or distal IOM transected, and following surgical reconstruction of the DOB with either tendon graft or suture-button system. In pronation, the relative change in maximum axial force was significantly lower in samples with a transected DOB in comparison to samples without a preexisting DOB. No statistically significant differences were observed between forearms including DOB reconstruction and specimens in the intact and transected state. Neither were there statistically significant differences concerning the two surgical techniques. From a biomechanical perspective, surgical DOB reconstruction is hence not indicated in cases of isolated DOB rupture.

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“…Further causes of DRUJ instability include lesions to the triangular brocartilage complex (TFCC) and Essex-Lopresti injuries [2]. It also forms a concomitant injury of fractures of the distal radius in up to 35% of cases [3][4][5]. Chronic DRUJ instability results in a highly disabling condition, including ulnar-sided wrist pain, grip strength weakness, painful and limited pronation/supination as well as degenerative arthritis as long-term sequalae [4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Distal oblique bundle influence on distal radioulnar joint stability – a biomechanical study

Hohenberger

¹

,

Pirrung

²

,

Hammer

³

et al. 2023

Preprint

0

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Chronic instability of the distal radioulnar joint (DRUJ) presents a highly disabling condition. Several surgical techniques have been reported for its treatment. These involve reconstruction of the distal oblique bundle (DOB) of the interosseous membrane (IOM) of the forearm. The aim of this study was to examine whether surgical reconstruction of the DOB is necessary to restore DRUJ stability following trauma with DOB disruption and to compare two restoration techniques utilizing a tendon or suture-button graft. Stability in supination and pronation was assessed by means of maximum torque and force in twenty forearms. Test cycles were performed with the DOB/IOM in an intact condition, with the DOB or distal IOM transected, and following surgical reconstruction of the DOB with either tendon graft or suture-button system. In pronation, the relative change in maximum axial force was significantly lower in samples with a transected DOB in comparison to samples without a preexisting DOB. No statistically significant differences were observed between forearms including DOB reconstruction and specimens in the intact and transected state. Neither were there statistically significant differences concerning the two surgical techniques. From a biomechanical perspective, surgical DOB reconstruction is hence not indicated in cases of isolated DOB rupture.

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Optimizing the Orientation of a Suture Button to Stabilize the Distal Radioulnar Joint in a Sawbones Model

Cited by 4 publications

References 23 publications

Analyzing the reduction quality of the distal radioulnar joint after closed K-wire transfixation in a cadaver model: is supination or neutral position superior?

Analyzing the reduction quality of the distal radioulnar joint after closed K-wire transfixation in a cadaver model: is supination or neutral position superior?

Distal oblique bundle influence on distal radioulnar joint stability: a biomechanical study

Distal oblique bundle influence on distal radioulnar joint stability – a biomechanical study

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