Cargando…

Evaluation of radiological instability signs in the distal radioulnar joint in children and adolescents with arthroscopically-verified TFCC tears

INTRODUCTION: Recent reports in the adult literature reported the use of standardized radiographic measurement techniques to determine distal radioulnar joint (DRUJ) instability. The aim of this study was to evaluate the efficacy and accuracy of (1) the MRI-based modified radioulnar ratio technique...

Descripción completa

Detalles Bibliográficos
Autores principales: Schachinger, Florian, Wiener, Sascha, Carvalho, Marcos F., Weber, Michael, Ganger, Rudolf, Farr, Sebastian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7295725/
https://www.ncbi.nlm.nih.gov/pubmed/32382940
http://dx.doi.org/10.1007/s00402-020-03470-y
_version_ 1783546698996383744
author Schachinger, Florian
Wiener, Sascha
Carvalho, Marcos F.
Weber, Michael
Ganger, Rudolf
Farr, Sebastian
author_facet Schachinger, Florian
Wiener, Sascha
Carvalho, Marcos F.
Weber, Michael
Ganger, Rudolf
Farr, Sebastian
author_sort Schachinger, Florian
collection PubMed
description INTRODUCTION: Recent reports in the adult literature reported the use of standardized radiographic measurement techniques to determine distal radioulnar joint (DRUJ) instability. The aim of this study was to evaluate the efficacy and accuracy of (1) the MRI-based modified radioulnar ratio technique and (2) the pisoscaphoid (PiSca) and radioulnar (RaUl) distances in true lateral radiographs in children and adolescents with arthroscopically-verified TFCC tears. MATERIALS AND METHODS: We retrospectively assessed lateral wrist radiographs and axial MRI sequences of 18 adolescent patients (22 wrists) who had arthroscopically-confirmed TFCC tears and compared them to similar imaging of a control group of 28 healthy patients (28 wrists). Three raters assessed the images twice in a 2-week interval. Intraclass correlation coefficients (ICCs), unifactorial ANOVA, and ROC analysis were performed with regards to the different radiographic variables. RESULTS: The interrater ICCs were almost perfect for all measurements except RaUl1, which showed a substantial agreement (0.751) among the three observers. The intrarater ICCs were almost perfect when measuring PiSca and MRI, and substantial to almost perfect for RaUl. Pearson‘s correlation showed a moderate, positive correlation between PiSca and RaUl distances (r = 0.608; p < 0.001), and a moderate, negative correlation between RaUl distance and MRI shift (r = − 0.486; p = 0.010). When the three core groups (peripheral, central tear, controls) were compared to each other regarding the radiographic instability parameters, only the MRI shift revealed a statistically significant difference (p = 0.003). Comparisons revealed significant differences between patients and controls (p = 0.004) and peripheral tears vs. controls (p = 0.001 and p = 0.010). The ROC analysis revealed a significant AUC only for the MRI (AuC 0.787 and p = 0.002). CONCLUSIONS: Children and adolescents with peripheral TFCC tears showed significantly increased instability parameters in MRI compared to controls. These measurement techniques are no replacement for a thorough clinical examination but may be helpful for indicating diagnostic wrist arthroscopy in ambiguous cases. LEVEL OF EVIDENCE: Level III; Diagnostic.
format Online
Article
Text
id pubmed-7295725
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher Springer Berlin Heidelberg
record_format MEDLINE/PubMed
spelling pubmed-72957252020-06-19 Evaluation of radiological instability signs in the distal radioulnar joint in children and adolescents with arthroscopically-verified TFCC tears Schachinger, Florian Wiener, Sascha Carvalho, Marcos F. Weber, Michael Ganger, Rudolf Farr, Sebastian Arch Orthop Trauma Surg Handsurgery INTRODUCTION: Recent reports in the adult literature reported the use of standardized radiographic measurement techniques to determine distal radioulnar joint (DRUJ) instability. The aim of this study was to evaluate the efficacy and accuracy of (1) the MRI-based modified radioulnar ratio technique and (2) the pisoscaphoid (PiSca) and radioulnar (RaUl) distances in true lateral radiographs in children and adolescents with arthroscopically-verified TFCC tears. MATERIALS AND METHODS: We retrospectively assessed lateral wrist radiographs and axial MRI sequences of 18 adolescent patients (22 wrists) who had arthroscopically-confirmed TFCC tears and compared them to similar imaging of a control group of 28 healthy patients (28 wrists). Three raters assessed the images twice in a 2-week interval. Intraclass correlation coefficients (ICCs), unifactorial ANOVA, and ROC analysis were performed with regards to the different radiographic variables. RESULTS: The interrater ICCs were almost perfect for all measurements except RaUl1, which showed a substantial agreement (0.751) among the three observers. The intrarater ICCs were almost perfect when measuring PiSca and MRI, and substantial to almost perfect for RaUl. Pearson‘s correlation showed a moderate, positive correlation between PiSca and RaUl distances (r = 0.608; p < 0.001), and a moderate, negative correlation between RaUl distance and MRI shift (r = − 0.486; p = 0.010). When the three core groups (peripheral, central tear, controls) were compared to each other regarding the radiographic instability parameters, only the MRI shift revealed a statistically significant difference (p = 0.003). Comparisons revealed significant differences between patients and controls (p = 0.004) and peripheral tears vs. controls (p = 0.001 and p = 0.010). The ROC analysis revealed a significant AUC only for the MRI (AuC 0.787 and p = 0.002). CONCLUSIONS: Children and adolescents with peripheral TFCC tears showed significantly increased instability parameters in MRI compared to controls. These measurement techniques are no replacement for a thorough clinical examination but may be helpful for indicating diagnostic wrist arthroscopy in ambiguous cases. LEVEL OF EVIDENCE: Level III; Diagnostic. Springer Berlin Heidelberg 2020-05-07 2020 /pmc/articles/PMC7295725/ /pubmed/32382940 http://dx.doi.org/10.1007/s00402-020-03470-y Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
spellingShingle Handsurgery
Schachinger, Florian
Wiener, Sascha
Carvalho, Marcos F.
Weber, Michael
Ganger, Rudolf
Farr, Sebastian
Evaluation of radiological instability signs in the distal radioulnar joint in children and adolescents with arthroscopically-verified TFCC tears
title Evaluation of radiological instability signs in the distal radioulnar joint in children and adolescents with arthroscopically-verified TFCC tears
title_full Evaluation of radiological instability signs in the distal radioulnar joint in children and adolescents with arthroscopically-verified TFCC tears
title_fullStr Evaluation of radiological instability signs in the distal radioulnar joint in children and adolescents with arthroscopically-verified TFCC tears
title_full_unstemmed Evaluation of radiological instability signs in the distal radioulnar joint in children and adolescents with arthroscopically-verified TFCC tears
title_short Evaluation of radiological instability signs in the distal radioulnar joint in children and adolescents with arthroscopically-verified TFCC tears
title_sort evaluation of radiological instability signs in the distal radioulnar joint in children and adolescents with arthroscopically-verified tfcc tears
topic Handsurgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7295725/
https://www.ncbi.nlm.nih.gov/pubmed/32382940
http://dx.doi.org/10.1007/s00402-020-03470-y
work_keys_str_mv AT schachingerflorian evaluationofradiologicalinstabilitysignsinthedistalradioulnarjointinchildrenandadolescentswitharthroscopicallyverifiedtfcctears
AT wienersascha evaluationofradiologicalinstabilitysignsinthedistalradioulnarjointinchildrenandadolescentswitharthroscopicallyverifiedtfcctears
AT carvalhomarcosf evaluationofradiologicalinstabilitysignsinthedistalradioulnarjointinchildrenandadolescentswitharthroscopicallyverifiedtfcctears
AT webermichael evaluationofradiologicalinstabilitysignsinthedistalradioulnarjointinchildrenandadolescentswitharthroscopicallyverifiedtfcctears
AT gangerrudolf evaluationofradiologicalinstabilitysignsinthedistalradioulnarjointinchildrenandadolescentswitharthroscopicallyverifiedtfcctears
AT farrsebastian evaluationofradiologicalinstabilitysignsinthedistalradioulnarjointinchildrenandadolescentswitharthroscopicallyverifiedtfcctears