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. 2017 May;6(2):88-96.
doi: 10.1055/s-0037-1601367. Epub 2017 Mar 22.

A Biomechanical Perspective on Distal Radioulnar Joint Instability

Shohei Omokawa  1 , Akio Iida  2 , Kenji Kawamura  2 , Yasuaki Nakanishi  2 , Takamasa Shimizu  2 , Tsutomu Kira  2 , Tadanobu Onishi  2 , Naoki Hayami  2 , Yasuhito Tanaka  2
Affiliations

A Biomechanical Perspective on Distal Radioulnar Joint Instability

Shohei Omokawa et al. J Wrist Surg. 2017 May.

Abstract

Background The purpose of this article was to review the anatomy, kinematics of the distal radioulnar joint (DRUJ), and to discuss definition, classification, and diagnosis of DRUJ instability. Methods A biomechanical perspective on physical examination of DRUJ ballottement test was documented. Physiological dynamic DRUJ translation and differences of the translation following sequential ligament sectioning and changes in different forearm and wrist positions were demonstrated. The clinical significance of each ligament's contribution to joint stability in specific wrist positions was addressed. Conclusion Each ligament stabilizing the DRUJ contributed to joint stability depending on the direction (palmer or dorsal) and different positions of the wrist and forearm. DRUJ ballottement test in each wrist and forearm position may detect tears of specific ligament stabilizing the DRUJ.

Keywords: DRUJ; TFCC; anatomy; biomechanics; function.

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Conflict of interest statement

Conflict of Interest None.

Figures

Fig. 1
Fig. 1
(Left) Palmar plating for intra-articular distal radius fracture. (Center left) 3D CT indicating a displaced volar rim fragment. (Center right) Intra-articular fracture displacement of the sigmoid notch in the coronal plane. (Right) Dorsal subluxation of the ulnar head relative to the sigmoid notch malunion. CT, computed tomography; 3D, three-dimensional.
Fig. 2
Fig. 2
(Left) Preoperative MRI showing a focal high-intensity signal at the fovea, demonstrating complete avulsion of the radioulnar ligaments from the ulnar fovea. (Right) Postoperative MRI showing successful healing of the ligamentous attachment following open surgery. MRI, magnetic resonance imaging.
Fig. 3
Fig. 3
(Left) Schematic drawing of the experimental setup. (Right) Schematic drawing of sequential sectioning of the TFCC, followed by DOB sectioning. DOB, distal oblique bundle; TFCC, triangular fibrocartilage complex.
Fig. 4
Fig. 4
(Left) Schematic drawing of the holding technique used during the DRUJ ballottement test, demonstrating accurate testing for tears of the TFCC ligament complex. (Right) Schematic drawing of the nonholding technique used during the DRUJ ballottement test, demonstrating the possibility of assessing not only the TFCC ligaments but also the radiocarpal ligament complex. DRUJ, distal radioulnar joint; TFCC, triangular fibrocartilage complex.
See this image and copyright information in PMC

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