The Effect of Distal Radius Fracture Location on Distal Radioulnar Joint Stability: A Cadaveric Study

Published:February 15, 2019DOI:


      To investigate whether the location of distal radius osteotomy/shortening relative to the radial insertion of the distal interosseous membrane (DIOM) is correlated with distal radioulnar joint (DRUJ) instability. We hypothesized that distal radius osteotomy and shortening proximal to the DIOM insertion would result in increased DRUJ instability because of induced laxity in the DIOM.


      Osteotomies of the distal radius were performed proximal and distal to the DIOM insertion in 14 fresh-frozen cadaveric specimens. Using a volar plate, 5 conditions were tested: anatomical radius alignment; 2- and 4-mm shortening at the proximal osteotomy site; and 2- and 4-mm shortening at the distal osteotomy site. Basilar ulnar styloid osteotomy was performed to simulate triangular fibrocartilage complex (TFCC) detachment—specimens were tested with the ulnar styloid detached and the ulnar styloid fixed (to restore normal anatomy). The DRUJ stability was quantified using dorsal-volar displacement of the radius in response to 20 N of force using a force-displacement probe in neutral, pronation, and supination. Posttesting specimen dissections assessed DIOM and distal oblique bundle (DOB) anatomy. The DRUJ stability in each experimental condition was compared with a multifactor repeated measures analysis of variance with the specimen treated as the repeated factor.


      There were no significant differences in dorsal-volar translation of the radius (ie, DRUJ stability) between radial osteotomy/shortening proximal and distal to the DIOM insertion, regardless of forearm rotational position or magnitude of shortening. Five (36%) of the 14 specimens had a DOB present. There was a significant increase in DRUJ instability in the setting of TFCC detachment (via basilar ulnar styloid osteotomy).


      No difference in DRUJ stability was observed between distal radius osteotomy/shortening proximal and distal to the DIOM radial insertion, regardless of forearm rotation, magnitude of shortening, and/or TFCC detachment.

      Clinical relevance

      Distal radius osteotomy and shortening did not affect DRUJ stability regardless of location relative to the DIOM insertion.

      Key words

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        • Geissler W.B.
        • Fernandez D.L.
        • Lamey D.M.
        Distal radioulnar joint injuries associated with fractures of the distal radius.
        Clin Orthop Relat Res. 1996; 327: 135-146
        • Lindau T.
        • Aspenberg P.
        The radioulnar joint in distal radial fractures.
        Acta Orthop Scand. 2002; 73: 579-588
        • Szabo R.M.
        Distal radioulnar joint instability.
        J Bone Joint Surg Am. 2006; 88: 884-894
        • Ploegmakers J.J.
        • The B.
        • Brutty M.
        • Ackland T.R.
        • Wang A.W.
        The effect of a Galeazzi fracture on the strength of pronation and supination two years after surgical treatment.
        Bone Joint J. 2013; 95-B: 1508-1513
        • Stuart P.R.
        • Berger R.A.
        • Linscheid R.L.
        • An K.N.
        The dorsopalmar stability of the distal radioulnar joint.
        J Hand Surg Am. 2000; 25: 689-699
        • Kihara H.
        • Short W.H.
        • Werner F.W.
        • Fortino M.D.
        • Palmer A.K.
        The stabilizing mechanism of the distal radioulnar joint during pronation and supination.
        J Hand Surg Am. 1995; 20: 930-936
        • Moritomo H.
        The distal oblique bundle of the distal interosseous membrane of the forearm.
        J Wrist Surg. 2013; 2: 93-94
        • Watanabe H.
        • Berger R.A.
        • Berglund L.J.
        • Zobitz M.E.
        • An K.N.
        Contribution of the interosseous membrane to distal radioulnar joint constraint.
        J Hand Surg Am. 2005; 30: 1164-1171
        • Moritomo H.
        The distal interosseous membrane: current concepts in wrist anatomy and biomechanics.
        J Hand Surg Am. 2012; 37: 1501-1507
        • 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: 415-422
        • 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: 1626-1630
        • Dy C.J.
        • Jang E.
        • Taylor S.A.
        • Meyers K.N.
        • Wolfe S.W.
        The impact of coronal alignment on distal radioulnar joint stability following distal radius fracture.
        J Hand Surg Am. 2014; 39: 1264-1272
        • Ross M.
        • Di Mascio L.
        • Peters S.
        • Cockfield A.
        • Taylor F.
        • Couzens G.
        Defining residual radial translation of distal radius fractures: a potential cause of distal radioulnar joint instability.
        J Wrist Surg. 2014; 3: 22-29
        • Moritomo H.
        • Omori S.
        Influence of ulnar translation of the radial shaft in distal radius fracture on distal radioulnar joint instability.
        J Wrist Surg. 2014; 3: 18-21
        • Nishiwaki M.
        • Welsh M.
        • Gammon B.
        • Ferreira L.M.
        • Johnson J.A.
        • King G.J.
        Distal radioulnar joint kinematics in simulated dorsally angulated distal radius fractures.
        J Hand Surg Am. 2014; 39: 656-663
        • Saito T.
        • Nakamura T.
        • Nagura T.
        • Nishiwaki M.
        • Sato K.
        • Toyama Y.
        The effects of dorsally angulated distal radius fractures on distal radioulnar joint stability: a biomechanical study.
        J Hand Surg Eur. 2013; 38: 739-745
        • Kihara H.
        • Palmer A.K.
        • Werner F.W.
        • Short W.H.
        • Fortino M.D.
        The effect of dorsally angulated distal radius fractures on distal radioulnar joint congruency and forearm rotation.
        J Hand Surg Am. 1996; 21: 40-47
        • Fujitani R.
        • Omokawa S.
        • Akahane M.
        • Iida A.
        • Ono H.
        • Tanaka Y.
        Predictors of distal radioulnar joint instability in distal radius fractures.
        J Hand Surg Am. 2011; 36: 1919-1925
        • Kwon B.C.
        • Seo B.K.
        • Im H.J.
        • Baek G.H.
        Clinical and radiographic factors associated with distal radioulnar joint instability in distal radius fractures.
        Clin Orthop Relat Res. 2012; 470: 3171-3179
        • Omokawa S.
        • Iida A.
        • Fujitani R.
        • Onishi T.
        • Tanaka Y.
        Radiographic predictors of DRUJ instability with distal radius fractures.
        J Wrist Surg. 2014; 3: 2-6
        • Korompilias A.V.
        • Lykissas M.G.
        • Kostas-Agnantis I.P.
        • Beris A.E.
        • Soucacos P.N.
        Distal radioulnar joint instability (Galeazzi type injury) after internal fixation in relation to the radius fracture pattern.
        J Hand Surg Am. 2011; 36: 847-852
        • Rettig M.E.
        • Raskin K.B.
        Galeazzi fracture-dislocation: a new treatment-oriented classification.
        J Hand Surg Am. 2001; 26: 228-235
        • Ring D.
        • Rhim R.
        • Carpenter C.
        • Jupiter J.B.
        Isolated radial shaft fractures are more common than galeazzi fractures.
        J Hand Surg Am. 2006; 31: 17-21
        • Mann F.A.
        • Wilson A.J.
        • Gilula L.A.
        Radiographic evaluation of the wrist: what does the hand surgeon want to know?.
        Radiology. 1992; 184: 15-24
        • 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: 2022-2030
        • Onishi T.
        • Omokawa S.
        • Iida A.
        • et al.
        Biomechanical study of distal radioulnar joint ballottement test.
        J Orthop Res. 2017; 35: 1123-1127
        • Pidgeon T.S.
        • Crisco J.J.
        • Waryasz G.R.
        • Moore D.C.
        • DaSilva M.F.
        Ulnar styloid base fractures cause distal radioulnar joint instability in a cadaveric model.
        Hand (N Y). 2018; 13: 65-73