Advertisement

Biomechanical Evaluation of Distal Radioulnar Joint Instability and Adams Procedure

      Purpose

      Distal radioulnar joint (DRUJ) instability may occur after an injury, resulting in pain and reduced strength. When primary repair is not possible or initial fixation has failed, chronic instability may result, requiring a reconstructive procedure such as the Adams procedure. The first purpose of this study was to evaluate the role of the triangular fibrocartilage complex and various components of the interosseous membrane as they were sectioned. The second purpose was to evaluate the Adams procedure in stabilizing the forearm.

      Methods

      Eight fresh cadaver forearms were dynamically moved through an average range of 56.8° pronation to 54.8° supination and tested first with the forearm intact and then after sectioning each of the following structures: the dorsal (DRUL) and palmar radioulnar ligaments (PRUL), the distal interosseous membrane, and the central band. Finally, they were tested after reconstruction using the Adams procedure. During each forearm motion and provocative shuck, the motion of the radius and ulna were measured and the locations of the radial attachments of the DRUL, PRUL, and sigmoid notch and ulnar fovea were computed.

      Results

      Significant increases in the gap between the ulnar fovea and the attachment sites of the DRUL and PRUL were observed with incremental sectioning, most notably after sectioning of the central band. Reconstruction significantly reduced the gap at the DRUL and PRUL sites during dynamic motion.

      Conclusions

      This study reinforces the concept that DRUJ stability depends on more than the radioulnar ligaments, ulnocarpal ligaments, and triangular fibrocartilage complex, but is also significantly affected by the distal and central interosseous membrane. Reconstruction reduces gapping.

      Clinical relevance

      These results suggest that the Adams reconstruction is a reasonable option to address DRUJ instability but may be an incomplete solution in the setting of a ruptured interosseous ligament.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Hand Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Lawler E.
        • Adams B.D.
        Reconstruction for DRUJ instability.
        Hand (N Y). 2007; 2: 123-126
        • Adams B.D.
        Distal radioulnar joint instability.
        in: Wolfe S.W. Hotchkiss R.N. Pederson W.C. Kozin S.H. Green’s Operative Hand Surgery. 6th ed. Elsevier/Churchill Livingstone, Philadelphia, PA2011: 523-560
        • Petersen M.S.
        • Adams B.D.
        Biomechanical evaluation of distal radioulnar reconstructions.
        J Hand Surg Am. 1993; 18: 328-334
        • Adams B.D.
        • Lawler E.
        Chronic instability of the distal radioulnar joint.
        J Am Acad Orthop Surg. 2007; 15: 571-575
        • Farr L.D.
        • Werner F.W.
        • McGrattan M.L.
        • Zwerling S.R.
        • Harley B.J.
        Anatomy and biomechanics of the forearm interosseous membrane.
        J Hand Surg Am. 2015; 40 (1145.e2–1151.e.2)
        • Werner F.W.
        • LeVasseur M.R.
        • Harley B.J.
        • Anderson A.
        Role of the interosseous membrane in preventing distal radioulnar gapping.
        J Wrist Surg. 2017; 6: 97-101
        • Werner F.W.
        • Palmer A.K.
        • Somerset J.H.
        • et al.
        Wrist joint motion simulator.
        J Orthop Res. 1996; 14: 639-646
        • Anderson A.
        • Werner F.W.
        • Tucci E.R.
        • Harley B.J.
        Role of the interosseous membrane and annular ligament in stabilizing the proximal radial head.
        J Shoulder Elbow Surg. 2015; 24: 1926-1933
        • Green J.K.
        • Werner W.W.
        • Wang H.
        • Weiner M.M.
        • Sack J.M.
        • Short W.H.
        Three-dimensional modeling and animation of two carpal bones: a technique.
        J Biomechanics. 2004; 37: 757-762
        • Kleinman W.
        Physcial examination of the wrist: useful provocative maneuvers.
        J Hand Surg Am. 2015; 40: 1486-1500
        • Jang E.
        • Dy C.J.
        • Wolfe S.W.
        Selection of tendon grafts for distal radioulnar ligament reconstruction and report of a modified technique.
        J Hand Surg Am. 2014; 39: 2027-2032
        • Tolat A.R.
        • Stanley J.K.
        • Trail I.A.
        A cadaveric study of the anatomy and stability of the distal radioulnar joint in the coronal and transverse planes.
        J Hand Surg Br. 1996; 21: 587-594
        • Onishi T.O.S.
        • Iida A.
        • Nakanishi Y.
        • Kira T.
        • et al.
        Biomechanical study of distal radioulnar joint ballottement test.
        J Orthop Res. 2017; 35: 1123-1127
        • Short W.H.
        • Werner W.F.
        • Fortino M.D.
        • Palmer A.K.
        • Mann K.A.
        A dynamic biomechanical study of scapholunate ligament sectioning.
        J Hand Surg Am. 1995; 20: 986-999
        • Noda K.
        • Goto A.
        • Murase T.
        • et al.
        Interosseous membrane of the forearm: an anatomical study of ligament attachment locations.
        J Hand Surg Am. 2009; 34: 415-422
        • Omokawa S.
        • Iida A.
        • Kawamura K.
        • et al.
        A biomechanical perspective on distal radioulnar joint instability.
        J Wrist Surg. 2017; 6: 88-96
        • 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