Load-Bearing Radioulnar Distances to Evaluate an Unstable Distal Radioulnar Joint in Patients With Triangular Fibrocartilage Complex Tears

Published:March 02, 2022DOI:https://doi.org/10.1016/j.jhsa.2022.01.008

      Purpose

      Tears of the proximal component of the triangular fibrocartilage complex (pc-TFCC) lead to instability in the distal radioulnar joint. The aim of this study was to measure the load-bearing radioulnar distances (RaUls) and to evaluate its diagnostic suitability in patients with pc-TFCC tears.

      Methods

      We retrospectively assessed and compared the lateral wrist radiographs of 61 adult patients with arthroscopically confirmed tears of pc-TFCC with those of a control group of 64 healthy participants. The RaUl was measured on lateral radiographs, and the difference in RaUl (D-value) between load-bearing and nonloading conditions was calculated in the 2 groups. Receiver operator characteristic curves were plotted to determine the diagnostic accuracy and optimal cutoff-score of load-bearing RaUl and RaUl D-value. The diagnostic performance was verified in a validation sample of patients (30 wrists) with pc-TFCC tears and a control group of healthy individuals (30 wrists).

      Results

      In the training sample, load-bearing RaUls of the affected wrists were higher than the same side of the controls (12.0 mm vs 7.1 mm). The TFCC-injury group showed a significantly higher RaUl D-value than the control group (8.5 mm vs 3.4 mm). Using a receiver operator characteristic curve, the cutoff value of load-bearing RaUl was 10 mm (sensitivity = 97.6%, specificity = 85.7%) and that of RaUl D-value was 6.5 mm (sensitivity = 90.2%, specificity = 78.5%). The areas under the curve of load-bearing RaUl and RaUl D-value were 0.96 and 0.88, respectively. In the test sample, the sensitivity, specificity, and accuracy of RaUl were 0.93, 0.70, and 0.82 and those of RaUl D-value were 0.77, 0.83, and 0.80 respectively.

      Conclusions

      Load-bearing RaUl measurement is a simple method to diagnose an unstable distal radioulnar joint in patients with TFCC injury. The load bearing RaUl of >10 mm or RaUl D-value of >6.5 mm can be used to differentiate TFCC injuries and showed acceptable accuracy.

      Type of study/level of evidence

      Diagnostic II.

      Key words

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      References

        • Haugstvedt J.R.
        • Langer M.F.
        • Berger R.A.
        Distal radioulnar joint: functional anatomy, including pathomechanics.
        J Hand Surg Eur Vol. 2017; 42: 338-345
        • Lindau T.
        • Hagberg L.
        • Adlercreutz C.
        • Jonsson K.
        • Aspenberg P.
        Distal radioulnar instability is an independent worsening factor in distal radial fractures.
        Clin Orthop Relat Res. 2000; 376: 229-235
        • Luchetti R.
        • Atzei A.
        • Cozzolino R.
        • Fairplay T.
        • Badur N.
        Comparison between open and arthroscopic-assisted foveal triangular fibrocartilage complex repair for post-traumatic distal radio-ulnar joint instability.
        J Hand Surg Eur Vol. 2014; 39: 845-855
        • Gofton W.T.
        • Gordon K.D.
        • Dunning C.E.
        • Johnson J.A.
        • King G.J.W.
        Comparison of distal radioulnar joint reconstructions using an active joint motion simulator.
        J Hand Surg Am. 2005; 30: 733-742
        • Palmer A.K.
        • Werner F.W.
        The triangular fibrocartilage complex of the wrist--anatomy and function.
        J Hand Surg Am. 1981; 6: 153-162
        • Wedemeyer A.
        • Wedemeyer C.
        • Heckelei W.
        • Preissler P.
        [Arthroscopic refixation of traumatic 1B-lesions of the TFCC--a retrospective study].
        Handchir Mikrochir Plast Chir. 2009; 41: 135-140
        • Moriya T.
        • Aoki M.
        • Iba K.
        • Ozasa Y.
        • Wada T.
        • Yamashita T.
        Effect of triangular ligament tears on distal radioulnar joint instability and evaluation of three clinical tests: a biomechanical study.
        J Hand Surg Eur Vol. 2009; 34: 219-223
        • King G.J.
        • McMurtry R.Y.
        • Rubenstein J.D.
        • Ogston N.G.
        Computerized tomography of the distal radioulnar joint: correlation with ligamentous pathology in a cadaveric model.
        J Hand Surg Am. 1986; 11: 711-717
        • Metz V.M.
        • Gilula L.A.
        Imaging techniques for distal radius fractures and related injuries.
        Orthop Clin North Am. 1993; 24: 217-228
        • Park M.J.
        • Kim J.P.
        Reliability and normal values of various computed tomography methods for quantifying distal radioulnar joint translation.
        J Bone Joint Surg Am. 2008; 90: 145-153
        • Kataoka T.
        • Moritomo H.
        • Omokawa S.
        • Iida A.
        • Murase T.
        • Sugamoto K.
        Ulnar variance: its relationship to ulnar foveal morphology and forearm kinematics.
        J Hand Surg Am. 2012; 37: 729-735
        • Akhbari B.
        • Shah K.N.
        • Morton A.M.
        • et al.
        Biomechanics of the distal radioulnar joint during in vivo forearm pronosupination.
        J Wrist Surg. 2021; 10: 208-215
        • Kim J.P.
        • Park M.J.
        Assessment of distal radioulnar joint instability after distal radius fracture: comparison of computed tomography and clinical examination results.
        J Hand Surg Am. 2008; 33: 1486-1492
        • Spies C.K.
        • Langer M.
        • Müller L.P.
        • Oppermann J.
        • Unglaub F.
        Distal radioulnar joint instability: current concepts of treatment.
        Arch Orthop Trauma Surg. 2020; 140: 639-650
        • Auzias P.
        • Camus E.J.
        • Moungondo F.
        • Van Overstraeten L.
        Arthroscopic-assisted 6U approach for foveal reattachment of triangular fibrocartilage complex with an anchor: clinical and radiographic outcomes at 4 years' mean follow-up.
        Hand Surg Rehabil. 2020; 39: 193-200
        • Pan C.C.
        • Lin Y.M.
        • Lee T.S.
        • Chou C.H.
        Displacement of the distal radioulnar joint of clinically symptom-free patients.
        Clin Orthop Relat Res. 2003; 415: 148-156
        • Lester B.
        • Halbrecht J.
        • Levy I.M.
        • Gaudinez R.
        Press test” for office diagnosis of triangular fibrocartilage complex tears of the wrist.
        Ann Plast Surg. 1995; 35: 41-45
        • Hess F.
        • Farshad M.
        • Sutter R.
        • Nagy L.
        • Schweizer A.
        A novel technique for detecting instability of the distal radioulnar joint in complete triangular fibrocartilage complex lesions.
        J Wrist Surg. 2012; 1: 153-158
        • Yamaguchi S.
        • Beppu M.
        • Matsushita K.
        • Takahashi K.
        The carpal stretch test at the scapholunate joint.
        J Hand Surg Am. 1998; 23: 617-625
        • Lawand A.
        • Foulkes G.D.
        The “clenched pencil” view: a modified clenched fist scapholunate stress view.
        J Hand Surg Am. 2003; 28 (discussion 419): 414-418
        • Mino D.E.
        • Palmer A.K.
        • Levinsohn E.M.
        The role of radiography and computerized tomography in the diagnosis of subluxation and dislocation of the distal radioulnar joint.
        J Hand Surg Am. 1983; 8: 23-31
        • Atzei A.
        New trends in arthroscopic management of type 1-B TFCC injuries with DRUJ instability.
        J Hand Surg Eur Vol. 2009; 34: 582-591
        • DeLong E.R.
        • DeLong D.M.
        • Clarke-Pearson D.L.
        Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach.
        Biometrics. 1988; 44: 837-845
        • Scheker L.R.
        • Belliappa P.P.
        • Acosta R.
        • German D.S.
        Reconstruction of the dorsal ligament of the triangular fibrocartilage complex.
        J Hand Surg Br. 1994; 19: 310-318

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