J Wrist Surg 2016; 05(01): 052-058
DOI: 10.1055/s-0035-1570742
Scientific Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Intra-articular Fractures of the Sigmoid Notch of the Distal Radius: Analysis of Progression to Distal Radial Ulnar Joint Arthritis and Impact on Upper Extremity Function in Surgically Treated Fractures

Mark A. Vitale
1   ONS Foundation for Clinical Research and Education, ONS, Greenwich, Connecticut
,
David M. Brogan
2   Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
,
Alexander Y. Shin
3   Division of Hand Surgery, Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota
,
Richard A. Berger
3   Division of Hand Surgery, Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota
› Author Affiliations
Further Information

Publication History

20 July 2015

01 December 2015

Publication Date:
06 January 2016 (online)

Abstract

Background Studies have established an increased risk of radiocarpal joint posttraumatic arthritis in patients with displaced intra-articular fractures of the distal radius, although this phenomenon has yet to be evaluated in the distal radioulnar joint (DRUJ).

Purpose We hypothesized that patients with displaced intra-articular fractures of the sigmoid notch would have a higher prevalence of DRUJ arthritis and greater upper extremity dysfunction after operative treatment of distal radius fractures compared with fractures without sigmoid notch involvement. We also hypothesized that the degree of sigmoid notch incongruity would be correlated with the grade of DRUJ arthritis and the severity of upper extremity dysfunction.

Patients and Methods A retrospective review was conducted on surgically treated patients with distal radius fractures with pre- and/or postoperative computed tomography (CT) scans. Patients were divided into groups based on presence or absence of fracture extension into the sigmoid notch. Within the sigmoid notch group, postoperative CT scans were used to measure sigmoid notch fracture step-off and diastasis (mm), as well as volar or dorsal DRUJ subluxation (%). Patients were administered Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaires and radiographs were obtained to grade DRUJ arthritis using the Kellgren-Lawrence (KL) radiographic criteria.

Results Thirty-three patients were included (19 with sigmoid notch involvement and 14 without) with an average radiographic follow-up of 6.3 years (range: 3.5–10.1 years). DASH scores were available for all patients, and radiographic follow-up was available in 24 patients (73%). A trend toward higher grade of DRUJ arthritis and poorer average DASH was found in those with sigmoid notch involvement, but was not statistically different. In the sigmoid notch group there were poorer DASH scores in patients with coronal step-off > 1.0-mm (p < 0.05). There were no significant correlations between sigmoid notch step-off, diastasis or DRUJ subluxation and either KL grade of arthritis or DASH scores.

Conclusion Fractures involving the sigmoid notch did not appear to have a greater prevalence of DRUJ posttraumatic arthritis in operatively treated patients at greater than 6 years of follow-up. Postoperative sigmoid notch step-off, diastasis or DRUJ subluxation had a minimal effect on upper extremity function, but fractures with a coronal step-off of > 1.0-mm exhibited higher levels of upper extremity dysfunction.

Level of Evidence Prognostic, Level III–Case control.

Note

This study has been approved by the Institutional Review Board. IRB number: 12–005434 Intra-articular fractures of the sigmoid notch: predictors of radiographic distal radioulnar joint arthritis and upper extremity dysfunction.


 
  • References

  • 1 Baron JA, Karagas M, Barrett J , et al. Basic epidemiology of fractures of the upper and lower limb among Americans over 65 years of age. Epidemiology 1996; 7 (6) 612-618
  • 2 Nellans KW, Kowalski E, Chung KC. The epidemiology of distal radius fractures. Hand Clin 2012; 28 (2) 113-125
  • 3 Knirk JL, Jupiter JB. Intra-articular fractures of the distal end of the radius in young adults. J Bone Joint Surg Am 1986; 68 (5) 647-659
  • 4 Kopylov P, Johnell O, Redlund-Johnell I, Bengner U. Fractures of the distal end of the radius in young adults: a 30-year follow-up. J Hand Surg [Br] 1993; 18 (1) 45-49
  • 5 Forward DP, Davis TR, Sithole JS. Do young patients with malunited fractures of the distal radius inevitably develop symptomatic post-traumatic osteoarthritis?. J Bone Joint Surg Br 2008; 90 (5) 629-637
  • 6 Giannoudis PV, Tzioupis C, Papathanassopoulos A, Obakponovwe O, Roberts C. Articular step-off and risk of post-traumatic osteoarthritis. Evidence today. Injury 2010; 41 (10) 986-995
  • 7 Hollevoet N, Verdonk R, Van Maele G. The influence of articular morphology on non-traumatic degenerative changes of the distal radioulnar joint. A radiographic study. J Hand Surg [Br] 2006; 31 (2) 221-225
  • 8 Tanabe K, Nakajima T, Sogo E, Denno K, Horiki M, Nakagawa R. Intra-articular fractures of the distal radius evaluated by computed tomography. J Hand Surg Am 2011; 36 (11) 1798-1803
  • 9 Nakanishi Y, Omokawa S, Shimizu T, Nakano K, Kira T, Tanaka Y. Intra-articular distal radius fractures involving the distal radioulnar joint (DRUJ): three dimensional computed tomography-based classification. J Orthop Sci 2013; 18 (5) 788-792
  • 10 Zimmerman RM, Kim JM, Jupiter JB. Arthritis of the distal radioulnar joint: from Darrach to total joint arthroplasty. J Am Acad Orthop Surg 2012; 20 (10) 623-632
  • 11 Ehman EC, Hayes ML, Berger RA, Felmlee JP, Amrami KK. Subluxation of the distal radioulnar joint as a predictor of foveal triangular fibrocartilage complex tears. J Hand Surg Am 2011; 36 (11) 1780-1784
  • 12 Smith MV, Calfee RP, Baumgarten KM, Brophy RH, Wright RW. Upper extremity-specific measures of disability and outcomes in orthopaedic surgery. J Bone Joint Surg Am 2012; 94 (3) 277-285
  • 13 Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand). The Upper Extremity Collaborative Group (UECG). Am J Ind Med 1996; 29 (6) 602-608
  • 14 Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis 1957; 16 (4) 494-502
  • 15 Yamazaki H, Uchiyama S, Hata Y, Murakami N, Kato H. Extensor tendon rupture associated with osteoarthritis of the distal radioulnar joint. J Hand Surg Eur Vol 2008; 33 (4) 469-474
  • 16 Porrino Jr JA, Tan V, Daluiski A. Misquotation of a commonly referenced hand surgery study. J Hand Surg Am 2008; 33 (1) 2-7
  • 17 Porter ML, Tillman RM. Pilon fractures of the wrist. Displaced intra-articular fractures of the distal radius. J Hand Surg [Br] 1992; 17 (1) 63-68
  • 18 Haus BM, Jupiter JB. Intra-articular fractures of the distal end of the radius in young adults: reexamined as evidence-based and outcomes medicine. J Bone Joint Surg Am 2009; 91 (12) 2984-2991
  • 19 Rozental TD, Bozentka DJ, Katz MA, Steinberg DR, Beredjiklian PK. Evaluation of the sigmoid notch with computed tomography following intra-articular distal radius fracture. J Hand Surg Am 2001; 26 (2) 244-251
  • 20 Heo YM, Roh J-Y, Kim S-B , et al. Evaluation of the sigmoid notch involvement in the intra-articular distal radius fractures: the efficacy of computed tomography compared with plain X-ray. Clin Orthop Surg 2012; 4 (1) 83-90
  • 21 Mulford JS, Axelrod TS. Traumatic injuries of the distal radioulnar joint. Hand Clin 2010; 26 (1) 155-163