Download PDF
J Wrist Surg 2020; 09(05): 417-424
DOI: 10.1055/s-0040-1713158
Scientific Article

Morphology at the Distal Radioulnar Joint: Identifying the Prevalence of Reverse Obliquity

Maureen O'Shaughnessy
1   Department of Orthopaedics, University of Kentucky, Lexington, Kentucky
,
Lauren M. Shapiro 
2   Department of Orthopaedic Surgery, Stanford University, Redwood City, California
,
Blake Schultz
2   Department of Orthopaedic Surgery, Stanford University, Redwood City, California
,
Julia Retzky
3   Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
,
Andrea K. Finlay
2   Department of Orthopaedic Surgery, Stanford University, Redwood City, California
,
Jeffrey Yao
2   Department of Orthopaedic Surgery, Stanford University, Redwood City, California
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Background Recent advances in the understanding of ulnar-sided wrist pathologies such as ulnar abutment syndrome (UAS) have brought increased attention to the anatomy of the distal radioulnar joint (DRUJ). Previous work established three anatomical variants of the sigmoid notch (parallel, oblique, and reverse oblique). The reverse oblique DRUJ poses theoretical risk of increased contact forces following ulnar shortening osteotomy, a common method of treating UAS.

Purpose As prevalence of reverse oblique morphology has been under-reported, this study aims to better define the prevalence of reverse oblique morphology in the adult population.

Methods Institutional Review Board-approved review of 1,000 radiographs over a 2-year period was performed. Demographic data and radiographic measurements were recorded (ulnar variance, notch inclination, and presence of arthritis). Correlation tests, a test of proportions, a t-test, and linear and logic regression tests were used to examine associations between ulnar variance, sigmoid inclination, sex, age, and presence of arthritis.

Results One thousand radiographs were analyzed revealing prevalence rates of: parallel—68%, oblique—26%, and reverse oblique—6%. Females were significantly more likely to have reverse inclination. No significant correlation was noted for morphology by age. Ulna positive variance was negatively correlated with reverse inclination. DRUJ arthritis was noted in 14% of patients. Higher sigmoid inclination was associated with higher odds of presence of arthritis, adjusting for sex and age. Higher incidence of arthritis was noted among patients with the oblique (20.8%) or reverse oblique (24.6%) compared with parallel (10.5%) morphology.

Conclusion This series of 1,000 radiographs demonstrates a 6% overall prevalence of reverse obliquity. This large dataset allows for better quantification of the prevalence of DRUJ morphologies and determination of correlations that have clinical implications for patients with ulnar-sided wrist pathology.

Level of Evidence This is a Level IV study.

Keywords

distal ulna - morphology - sigmoid inclination - ulnar variance - ulnar abutment syndrome - ulnar shortening osteotomy

Ethical Approval

The authors have complied the ethical standards as detailed in “Instructions to the Author” set forth by Journal of Wrist Surgery.




Publication History

Received: 09 April 2020

Accepted: 07 May 2020

Article published online:
06 July 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers
333 Seventh Avenue, New York, NY 10001, USA.

 

  • References

  • 1 Friedman SL, Palmer AK, Short WH, Levinsohn EM, Halperin LS. The change in ulnar variance with grip. J Hand Surg Am 1993; 18 (04) 713-716
    CrossrefPubMedGoogle Scholar
  • 2 Palmer AK, Glisson RR, Werner FW. Ulnar variance determination. J Hand Surg Am 1982; 7 (04) 376-379
    CrossrefPubMedGoogle Scholar
  • 3 Gil JA, Kakar S. Hand and wrist injuries in tennis players. Curr Rev Musculoskelet Med 2019; 12 (02) 87-97
    CrossrefPubMedGoogle Scholar
  • 4 Palmer AK, Werner FW. Biomechanics of the distal radioulnar joint. Clin Orthop Relat Res 1984; (187) 26-35
    PubMedGoogle Scholar
  • 5 Minami A, Kato H. Ulnar shortening for triangular fibrocartilage complex tears associated with ulnar positive variance. J Hand Surg Am 1998; 23 (05) 904-908
    CrossrefPubMedGoogle Scholar
  • 6 Tatebe M, Nakamura R, Horii E, Nakao E. Results of ulnar shortening osteotomy for ulnocarpal impaction syndrome in wrists with neutral or negative ulnar variance. J Hand Surg [Br] 2005; 30 (02) 129-132
    CrossrefPubMedGoogle Scholar
  • 7 Tolat AR, Stanley JK, Trail IA. 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 (05) 587-594
    CrossrefPubMedGoogle Scholar
  • 8 Tolat AR, Sanderson PL, De Smet L, Stanley JK. The gymnast's wrist: acquired positive ulnar variance following chronic epiphyseal injury. J Hand Surg [Br] 1992; 17 (06) 678-681
    CrossrefPubMedGoogle Scholar
  • 9 Sagerman SD, Zogby RG, Palmer AK, Werner FW, Fortino MD. Relative articular inclination of the distal radioulnar joint: a radiographic study. J Hand Surg Am 1995; 20 (04) 597-601
    CrossrefPubMedGoogle Scholar
  • 10 Deshmukh SC, Shanahan D, Coulthard D. Distal radioulnar joint incongruity after shortening of the ulna. J Hand Surg [Br] 2000; 25 (05) 434-438
    CrossrefPubMedGoogle Scholar
  • 11 Garcia-Elias M, Pitágoras T, Gilabert-Senar A. Relationship between joint laxity and radio-ulno-carpal joint morphology. J Hand Surg [Br] 2003; 28 (02) 158-162
    CrossrefPubMedGoogle Scholar
  • 12 Baek GH, Lee HJ, Gong HS. et al. Long-term outcomes of ulnar shortening osteotomy for idiopathic ulnar impaction syndrome: at least 5-years follow-up. Clin Orthop Surg 2011; 3 (04) 295-301
    CrossrefPubMedGoogle Scholar
  • 13 Nishiwaki M, Nakamura T, Nagura T, Toyama Y, Ikegami H. Ulnar-shortening effect on distal radioulnar joint pressure: a biomechanical study. J Hand Surg Am 2008; 33 (02) 198-205
    CrossrefPubMedGoogle Scholar
  • 14 Miura T, Firoozbakhsh K, Cheema T, Moneim MS, Edmunds M, Meltzer S. Dynamic effects of joint-leveling procedure on pressure at the distal radioulnar joint. J Hand Surg Am 2005; 30 (04) 711-718
    CrossrefPubMedGoogle Scholar
  • 15 Heiss-Dunlop W, Couzens GB, Peters SE, Gadd K, Di Mascio L, Ross M. Comparison of plain X-rays and computed tomography for assessing distal radioulnar joint inclination. J Hand Surg Am 2014; 39 (12) 2417-2423
    CrossrefPubMedGoogle Scholar
  • 16 Hollevoet N, Verdonk R, Van Maele G. The influence of articular morphology on non-traumatic degenerative changes of the distal radioulnar joint. A radiographic study. J Hand Surg [Br] 2006; 31 (02) 221-225
    CrossrefPubMedGoogle Scholar
  • 17 Ross M, Wiemann M, Peters SE, Benson R, Couzens GB. The influence of cartilage thickness at the sigmoid notch on inclination at the distal radioulnar joint. Bone Joint J 2017; 99-B (03) 369-375
    CrossrefPubMedGoogle Scholar
  • 18 von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. ; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 2008; 61 (04) 344-349
    CrossrefPubMedGoogle Scholar
  • 19 Coleman DA, Blair WF, Shurr D. Resection of the radial head for fracture of the radial head. Long-term follow-up of seventeen cases. J Bone Joint Surg Am 1987; 69 (03) 385-392
    CrossrefPubMedGoogle Scholar
  • 20 De Smet L. Ulnar variance: facts and fiction review article. Acta Orthop Belg 1994; 60 (01) 1-9
    PubMedGoogle Scholar
  • 21 af Ekenstam F. Anatomy of the distal radioulnar joint. Clin Orthop Relat Res 1992; (275) 14-18
    PubMedGoogle Scholar
  • 22 Knirk JL, Jupiter JB. Intra-articular fractures of the distal end of the radius in young adults. J Bone Joint Surg Am 1986; 68 (05) 647-659
    CrossrefPubMedGoogle Scholar
  • 23 Statistical RCT. RA Language and Environment for, Computing. Vienna: R Foundation for Statistical Computing; 2018
    Google Scholar
  • 24 RStudio Team. RStudio: Integrated Development for R. Boston, MU: RStudio, Inc.; 2016
    Google Scholar
  • 25 Nakamura R, Tanaka Y, Imaeda T, Miura T. The influence of age and sex on ulnar variance. J Hand Surg [Br] 1991; 16 (01) 84-88
    CrossrefPubMedGoogle Scholar
  • 26 D'Hoore K, De Smet L, Verellen K, Vral J, Fabry G. Negative ulnar variance is not a risk factor for Kienböck's disease. J Hand Surg Am 1994; 19 (02) 229-231
    CrossrefPubMedGoogle Scholar
  • 27 Bonzar M, Firrell JC, Hainer M, Mah ET, McCabe SJ. Kienböck disease and negative ulnar variance. J Bone Joint Surg Am 1998; 80 (08) 1154-1157
    CrossrefPubMedGoogle Scholar
  • 28 Fortems Y, De Smet L, Dauwe D, Stoffelen D, Deneffe G, Fabry G. Incidence of cartilaginous and ligamentous lesions of the radio-carpal and distal radio-ulnar joint in an elderly population. J Hand Surg [Br] 1994; 19 (05) 572-575
    CrossrefPubMedGoogle Scholar
  • 29 Sanderson PL, Cameron IC, Holt GR, Stanley D. Ulnar variance and age. J Hand Surg [Br] 1997; 22 (01) 21-24
    CrossrefPubMedGoogle Scholar
  • 30 Chen WS, Wang JW. Ageing does not affect ulnar variance: an investigation in Taiwan. J Hand Surg Eur Vol 2008; 33 (06) 797-799
    CrossrefPubMedGoogle Scholar
  • 31 van Leeuwen WF, Oflazoglu K, Menendez ME, Ring D. Negative ulnar variance and Kienböck disease. J Hand Surg Am 2016; 41 (02) 214-218
    CrossrefPubMedGoogle Scholar
  • 32 Schuind FA, Linscheid RL, An KN, Chao EY. A normal data base of posteroanterior roentgenographic measurements of the wrist. J Bone Joint Surg Am 1992; 74 (09) 1418-1429
    CrossrefPubMedGoogle Scholar
  • 33 Kristensen SS, Thomassen E, Christensen F. Ulnar variance determination. J Hand Surg [Br] 1986; 11 (02) 255-257
    CrossrefPubMedGoogle Scholar
  • 34 Jung JM, Baek GH, Kim JH, Lee YH, Chung MS. Changes in ulnar variance in relation to forearm rotation and grip. J Bone Joint Surg Br 2001; 83 (07) 1029-1033
    CrossrefPubMedGoogle Scholar
  • 35 U.S. Census Bureau QuickFacts. Palo Alto city, California; United States. Accessed May 15, 2019 at: https://www.census.gov/quickfacts/fact/table/paloaltocitycalifornia,US/PST045218
    PubMed
  • 36 Laino DK, Petchprapa CN, Lee SK. Ulnar variance: correlation of plain radiographs, computed tomography, and magnetic resonance imaging with anatomic dissection. J Hand Surg Am 2012; 37 (01) 90-97
    CrossrefPubMedGoogle Scholar
  • 37 Steyers CM, Blair WF. Measuring ulnar variance: a comparison of techniques. J Hand Surg Am 1989; 14 (04) 607-612
    CrossrefPubMedGoogle Scholar