Download PDF
J Wrist Surg 2013; 02(04): 330-336
DOI: 10.1055/s-0033-1358546
Scientific Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Distal Oblique Bundle Reconstruction and Distal Radioulnar Joint Instability

Michael D. Riggenbach
1   Orlando Orthopaedic Center, Orlando, Florida
,
Bryan P. Conrad
2   Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, Florida
,
Thomas W. Wright
2   Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, Florida
,
Paul C. Dell
2   Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, Florida
› Author Affiliations
Further Information

Publication History

Publication Date:
08 November 2013 (online)

    Permissions and Reprints

Abstract

Background This study created an anatomic reconstruction of the distal oblique bundle (DOB) of the interosseous membrane to determine its effect on distal radioulnar joint (DRUJ) instability and compare this technique with distal radioulnar ligament (DRUL) reconstruction.

Questions/Purposes We hypothesized that this reconstruction would provide equivalent stability to DRUL reconstruction and that combining the two techniques would enhance stability.

Methods Six cadaveric upper limbs were affixed to a custom frame. The volar/dorsal translation of the radius relative to the ulna was measured in 60° pronation, neutral, and 60° supination. Translation was sequentially measured with the DRUJ intact, with sectioned DRULs and triangular fibrocartilaginous complex (TFCC), and with sectioned DOBs. Reconstructions were performed on the DRULs, on the DOB tensioned in both neutral and supination, and employing both techniques.

Results The DOB reconstruction, tensioned both in the neutral position and in 60° supination, was more stable than the partial and complete instability in 6/6 specimens in pronation and the neutral position and in 5/6 specimens in supination. The DOB reconstruction and the DOB reconstruction tensioned in supination were more stable than the DRUL reconstruction in 4/6 patients. Combining the two techniques did not further reduce translation.

Conclusions The DOB reconstruction is capable of improving stability in the unstable DRUJ.

Keywords

distal oblique bundle - distal radioulnar joint - stability - wrist
 

  • References

  • 1 Radin EL, Riseborough EJ. Fractures of the radial head. A review of eighty-eight cases and analysis of the indications for excision of the radial head and non-operative treatment. J Bone Joint Surg Am 1966; 48 (6) 1055-1064
    PubMedGoogle Scholar
  • 2 Watanabe H, Berger RA, Berglund LJ, Zobitz ME, An KN. Contribution of the interosseous membrane to distal radioulnar joint constraint. J Hand Surg Am 2005; 30 (6) 1164-1171
    CrossrefPubMedGoogle Scholar
  • 3 Noda K, Goto A, Murase T, Sugamoto K, Yoshikawa H, Moritomo H. Interosseous membrane of the forearm: an anatomical study of ligament attachment locations. J Hand Surg Am 2009; 34 (3) 415-422
    CrossrefPubMedGoogle Scholar
  • 4 Arimitsu S, Moritomo H, Kitamura T , et al. The stabilizing effect of the distal interosseous membrane on the distal radioulnar joint in an ulnar shortening procedure: a biomechanical study. J Bone Joint Surg Am 2011; 93 (21) 2022-2030
    CrossrefPubMedGoogle Scholar
  • 5 Petersen MS, Adams BD. Biomechanical evaluation of distal radioulnar reconstructions. J Hand Surg Am 1993; 18 (2) 328-334
    CrossrefPubMedGoogle Scholar
  • 6 Moritomo H. The distal interosseous membrane: current concepts in wrist anatomy and biomechanics. J Hand Surg Am 2012; 37 (7) 1501-1507
    CrossrefPubMedGoogle Scholar
  • 7 Moritomo H, Noda K, Goto A, Murase T, Yoshikawa H, Sugamoto K. Interosseous membrane of the forearm: length change of ligaments during forearm rotation. J Hand Surg Am 2009; 34 (4) 685-691
    CrossrefPubMedGoogle Scholar
  • 8 Kitamura T, Moritomo H, Arimitsu S , et al. The biomechanical effect of the distal interosseous membrane on distal radioulnar joint stability: a preliminary anatomic study. J Hand Surg Am 2011; 36 (10) 1626-1630
    CrossrefPubMedGoogle Scholar
  • 9 Polhemus Inc. Liberty Specifications. Available at: http://polhemus.com/polhemus_editor/assets/LIBERTY.pdf
    PubMedGoogle Scholar
  • 10 Conrad BP, Rossi GD, Horodyski MB, Prasarn ML, Alemi Y, Rechtine GR. Eliminating log rolling as a spine trauma order. Surg Neurol Int 2012; 3 (Suppl. 03) S188-S197
    CrossrefPubMedGoogle Scholar
  • 11 Adams BD. Anatomic reconstruction of the distal radioulnar ligaments for DRUJ instability. Tech Hand Up Extrem Surg 2000; 4 (3) 154-160
    CrossrefPubMedGoogle Scholar
  • 12 Acosta R, Hnat W, Scheker LR. Distal radio-ulnar ligament motion during supination and pronation. J Hand Surg [Br] 1993; 18 (4) 502-505
    PubMedGoogle Scholar
  • 13 Kihara H, Short WH, Werner FW, Fortino MD, Palmer AK. The stabilizing mechanism of the distal radioulnar joint during pronation and supination. J Hand Surg Am 1995; 20 (6) 930-936
    CrossrefPubMedGoogle Scholar
  • 14 Gofton WT, Gordon KD, Dunning CE, Johnson JA, King GJ. Comparison of distal radioulnar joint reconstructions using an active joint motion simulator. J Hand Surg Am 2005; 30 (4) 733-742
    Google Scholar
  • 15 Petersen MS, Adams BD. Biomechanical evaluation of distal radioulnar reconstructions. J Hand Surg Am 1993; 18 (2) 328-334
    CrossrefPubMedGoogle Scholar
  • 16 Adams BD, Berger RA. An anatomic reconstruction of the distal radioulnar ligaments for posttraumatic distal radioulnar joint instability. J Hand Surg Am 2002; 27 (2) 243-251
    CrossrefPubMedGoogle Scholar