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Pathomechanisms of ulnar ligament lesions of the wrist in a cadaveric distal radius fracture model

BACKGROUND AND PURPOSE: Mechanisms of injury to ulnar-sided ligaments (stabilizing the distal radioulnar joint and the ulna to the carpus) associated with dorsally displaced distal radius fractures are poorly described. We investigated the injury patterns in a human cadaver fracture model. METHODS:...

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Autores principales: Scheer, Johan H, Adolfsson, Lars E
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Informa Healthcare 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3235317/
https://www.ncbi.nlm.nih.gov/pubmed/21504313
http://dx.doi.org/10.3109/17453674.2011.579517
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author Scheer, Johan H
Adolfsson, Lars E
author_facet Scheer, Johan H
Adolfsson, Lars E
author_sort Scheer, Johan H
collection PubMed
description BACKGROUND AND PURPOSE: Mechanisms of injury to ulnar-sided ligaments (stabilizing the distal radioulnar joint and the ulna to the carpus) associated with dorsally displaced distal radius fractures are poorly described. We investigated the injury patterns in a human cadaver fracture model. METHODS: Fresh frozen human cadaver arms were used. A dorsal open-wedge osteotomy was performed in the distal radius. In 8 specimens, pressure was applied to the palm with the wrist in dorsiflexion and ulnar-sided stabilizing structures subsequently severed. Dorsal angulation was measured on digitized radiographs. In 8 other specimens, the triangular fibrocartilage complex (TFCC) was forced into rupture by axially loading the forearm with the wrist in dorsiflexion. The ulnar side was dissected and injuries were recorded. RESULTS: Intact ulnar soft tissues limited the dorsal angulation of the distal radius fragment to a median of 32(o) (16–34). A combination of bending and shearing of the distal radius fragment was needed to create TFCC injuries. Both palmar and dorsal injuries were observed simultaneously in 6 of 8 specimens. INTERPRETATION: A TFCC injury can be expected when dorsal angulation of a distal radius fracture exceeds 32(o). The extensor carpi ulnaris subsheath may be a functionally integral part of the TFCC. Both dorsal and palmar structures can tear simultaneously. These findings may have implications for reconstruction of ulnar sided soft tissue injuries.
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spelling pubmed-32353172011-12-16 Pathomechanisms of ulnar ligament lesions of the wrist in a cadaveric distal radius fracture model Scheer, Johan H Adolfsson, Lars E Acta Orthop Article BACKGROUND AND PURPOSE: Mechanisms of injury to ulnar-sided ligaments (stabilizing the distal radioulnar joint and the ulna to the carpus) associated with dorsally displaced distal radius fractures are poorly described. We investigated the injury patterns in a human cadaver fracture model. METHODS: Fresh frozen human cadaver arms were used. A dorsal open-wedge osteotomy was performed in the distal radius. In 8 specimens, pressure was applied to the palm with the wrist in dorsiflexion and ulnar-sided stabilizing structures subsequently severed. Dorsal angulation was measured on digitized radiographs. In 8 other specimens, the triangular fibrocartilage complex (TFCC) was forced into rupture by axially loading the forearm with the wrist in dorsiflexion. The ulnar side was dissected and injuries were recorded. RESULTS: Intact ulnar soft tissues limited the dorsal angulation of the distal radius fragment to a median of 32(o) (16–34). A combination of bending and shearing of the distal radius fragment was needed to create TFCC injuries. Both palmar and dorsal injuries were observed simultaneously in 6 of 8 specimens. INTERPRETATION: A TFCC injury can be expected when dorsal angulation of a distal radius fracture exceeds 32(o). The extensor carpi ulnaris subsheath may be a functionally integral part of the TFCC. Both dorsal and palmar structures can tear simultaneously. These findings may have implications for reconstruction of ulnar sided soft tissue injuries. Informa Healthcare 2011-06 2011-07-08 /pmc/articles/PMC3235317/ /pubmed/21504313 http://dx.doi.org/10.3109/17453674.2011.579517 Text en Copyright: © Nordic Orthopaedic Federation http://creativecommons.org/licenses/by/2.5/ This is an open-access article distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the source is credited.
spellingShingle Article
Scheer, Johan H
Adolfsson, Lars E
Pathomechanisms of ulnar ligament lesions of the wrist in a cadaveric distal radius fracture model
title Pathomechanisms of ulnar ligament lesions of the wrist in a cadaveric distal radius fracture model
title_full Pathomechanisms of ulnar ligament lesions of the wrist in a cadaveric distal radius fracture model
title_fullStr Pathomechanisms of ulnar ligament lesions of the wrist in a cadaveric distal radius fracture model
title_full_unstemmed Pathomechanisms of ulnar ligament lesions of the wrist in a cadaveric distal radius fracture model
title_short Pathomechanisms of ulnar ligament lesions of the wrist in a cadaveric distal radius fracture model
title_sort pathomechanisms of ulnar ligament lesions of the wrist in a cadaveric distal radius fracture model
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3235317/
https://www.ncbi.nlm.nih.gov/pubmed/21504313
http://dx.doi.org/10.3109/17453674.2011.579517
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