Pressure distribution in the distal radioulnar joint
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The distal radioulnar joint (DRUJ) acts in concert with the proximal radioulnar joint to control forearm rotation. The DRUJ is stabilized by the triangular fibrocartilage complex (TFCC). This complex of fibrocartilage and ligaments support the joint through its arc of rotation, as well as provide a smooth surface for the ulnar side of the carpus. TFCC and DRUJ injuries are part of the common pattern of injuries we see with distal radius fractures. While much attention has been paid to the treatment of the distal radius fractures, many of the poor outcomes are due to untreated or unrecognized injuries to the DRUJ and its components.
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Objective: To compare the effect of Darrach procedure and Sauve′ Kapandji procedure on axial load transmission across the wrist joint. Methods: 8 upper extremities were taken from fresh young adult cadavers. During these experiments, 100N axial load controlled by MTS universal testing machine was applied across the wrist joint at each position, and the force through ulna was measured by means of pressure sensitive film and the calculation of the computer. The changing value of ulna load transmission was calculated. Results: After complete resection of the distal end of the ulna, ulna load transmission dropped dramatically in all of the tested wrist and forearm positions ( P 0.01). After Sauve′ Kapandji procedures, ulna load transmission dropped close to the level of the normal specimens. Conclusions: Darrach procedure resulted in DRUJ unstable and ulnar load transmission dropped dramatically, and could not accord with biomechanical requirement.
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Two cases of fresh traumatic anterior dislocation of the ulna at the distal radioulnar joint (DRUJ) are reported: one is an isolated dislocation and the other with the styloid process fracture of the ulna. In the latter arthrography of the wrist revealed the triangular fibrocartilage complex (TFCC) remained intact.Computerized tomography through DRUJ is helpful for the diagnosis of the dislocation. Closed reduction under general anaesthesia failed in both of them. At operation the intact TFCC prevented the dislocated ulna from reduction.
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