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Philip E Blazar - One of the best experts on this subject based on the ideXlab platform.
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ulnar styloid fractures associated with distal radius fractures incidence and implications for distal radioulnar Joint Instability
Journal of Hand Surgery (European Volume), 2002Co-Authors: Megan M May, Jeffrey N Lawton, Philip E BlazarAbstract:Ulnar-sided injuries of the wrist have received more attention recently for their potential negative impact on the outcome of distal radius fractures. Radiographs and medical records were retrospectively reviewed for 166 distal radius fractures treated during a 1-year interval. Distal radius fractures were classified according to the AO system, and accompanying ulnar styloid fractures were evaluated for both size and displacement. Each distal radius fracture was also evaluated for radiographic and clinical evidence of distal radioulnar Joint Instability. The distribution of ulnar styloid fractures was not random; greater than one third involved the base. All distal radius fractures complicated by distal radioulnar Joint Instability were accompanied by an ulnar styloid fracture. A fracture at the ulnar styloid's base and significant displacement of an ulnar styloid fracture were found to increase the risk of distal radioulnar Joint Instability.
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ulnar styloid fractures associated with distal radius fractures incidence and implications for distal radioulnar Joint Instability
Journal of Hand Surgery (European Volume), 2002Co-Authors: Jeffrey N Lawton, Philip E BlazarAbstract:Abstract Ulnar-sided injuries of the wrist have received more attention recently for their potential negative impact on the outcome of distal radius fractures. Radiographs and medical records were retrospectively reviewed for 166 distal radius fractures treated during a 1-year interval. Distal radius fractures were classified according to the AO system, and accompanying ulnar styloid fractures were evaluated for both size and displacement. Each distal radius fracture was also evaluated for radiographic and clinical evidence of distal radioulnar Joint Instability. The distribution of ulnar styloid fractures was not random; greater than one third involved the base. All distal radius fractures complicated by distal radioulnar Joint Instability were accompanied by an ulnar styloid fracture. A fracture at the ulnar styloid's base and significant displacement of an ulnar styloid fracture were found to increase the risk of distal radioulnar Joint Instability. (J Hand Surg 2002;27A:965-971. Copyright © 2002 by the American Society for Surgery of the Hand.)
Alexej Barg - One of the best experts on this subject based on the ideXlab platform.
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interaction of loading and ligament injuries in subtalar Joint Instability quantified by 3d weightbearing computed tomography
Journal of Orthopaedic Research, 2021Co-Authors: Arne Burssens, Nicola Krahenbuhl, Charles L Saltzman, Alexej Barg, Amy L Lenz, Kalebb Howell, Chong Zhang, Yantarat SripanichAbstract:Despite decades of research since its first description, subtalar Joint Instability remains a diagnostic enigma within the concept of hindfoot Instability. This could be attributed to current imaging techniques, which are impeded by two-dimensional measurements. Therefore, we used weightbearing CT imaging to quantify three-dimensional displacement associated with subtalar Joint Instability. Three-dimensional models were generated in seven paired cadaver specimens to compute talocalcaneal displacement after different patterns of axial load (85kg) combined with torque in internal and external rotation (10Nm). Sequential imaging was repeated in the subtalar Joint containing intact ligaments to determine reference displacement. Afterwards the interosseus talo-calcaneal ligament (ITCL) or calcaneofibular ligament (CFL) was sectioned, then the ITCL with CFL and after the ITCL, CFL with the deltoid ligament (DL). The highest translation could be detected in the dorsal direction and the highest rotation occurred in the internaldirection, when external torque was applied to the foot without load. These displacements differed significantly from the condition containing intact ligaments, with a mean difference of 1.6 mm (95% CI, 1.3 to 1.9) for dorsal translation and mean of 12.4° (95% CI, 10.1 to 14.8) for internal rotation. Clinical relevance- Our study provides a novel and non-invasive analysis to quantify subtalar Joint Instability based on three-dimensional WBCT imaging. This approach overcomes former studies using trans-osseous fixation to determine three-dimensional subtalar Joint displacement and implements an imaging device and software modalities that are readily available. Based on our findings, we recommend applying torque inexternal rotation to the foot to optimize detection of subtalar Joint Instability. This article is protected by copyright. All rights reserved.
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currently used imaging options cannot accurately predict subtalar Joint Instability
Knee Surgery Sports Traumatology Arthroscopy, 2019Co-Authors: Nicola Krahenbuhl, Beat Hintermann, Maxwell W Weinberg, Nathan P Davidson, Megan K Mills, Charles L Saltzman, Alexej BargAbstract:To give a systematic overview of current diagnostic imaging options and surgical treatment for chronic subtalar Joint Instability. A systematic literature search across the following sources was performed: PubMed, ScienceDirect, and SpringerLink. Twenty-three imaging studies and 19 outcome studies were included. The Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS 2) tool was used to assess the methodologic quality of the imaging articles, while the modified Coleman Score was used to assess the methodologic quality of the outcome studies. Conventional radiographs were most frequently used to assess chronic subtalar Joint Instability. Talar tilt, anterior talar translation, and subtalar tilt were the three most commonly used measurement methods. Surgery often included calcaneofibular ligament reconstruction. Current imaging options do not reliably predict subtalar Joint Instability. Distinction between chronic lateral ankle Instability and subtalar Joint Instability remains challenging. Recognition of subtalar Joint Instability as an identifiable and treatable cause of ankle pain requires vigilant clinical investigation. Systematic Review of Level III and Level IV Studies, Level IV.
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can weightbearing computed tomography scans be used to diagnose subtalar Joint Instability a cadaver study
Journal of Orthopaedic Research, 2019Co-Authors: Nicola Krahenbuhl, Nathan P Davidson, Charles L Saltzman, Arne Burssens, Chelsea Mccarty Allen, Heath B Henninger, Alexej BargAbstract:Chronic hindfoot Instability is a frequent problem that includes the ankle and/or the subtalar Joint. While ankle Joint Instability can be diagnosed clinically, accurate assessment of the subtalar Joint remains elusive. This study's purpose was to assess the ability of weightbearing computed tomography (CT) scans to detect subtalar Joint Instability. Seven pairs of fresh frozen male cadavers (tibial plateau to toe-tip) were tested. A radiolucent frame held specimens in a plantigrade position while non-weightbearing and weightbearing CT scans (with and without torque application) were taken. First, intact ankles (Native) were scanned. Second, one specimen from each pair underwent interosseous talo-calcaneal ligament (ITCL) transection, while the contralateral underwent calcaneo-fibular ligament (CFL) transection. Third, the remaining intact ITCL or CFL was transected. Finally, the deltoid ligament was transected in all ankles. Eight radiographic measurements were performed to assess the congruency of the subtalar Joint on digitally reconstructed radiographs and single CT images. Axial loading did not impact most measurements, whereas torque did impact most measurements. Radiographic measurements performed at the subtalar Joint level were more reliable and better predictors for subtalar Joint Instability compared with measurements performed at the ankle Joint level. While torque application is crucial to identify subtalar Joint Instability, axial load application should be avoided. Measurements to assess the subtalar Joint stability should primarily be performed at the subtalar Joint level rather than at the ankle Joint level when using weightbearing CT scans. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2457-2465, 2019.
Jan Friden - One of the best experts on this subject based on the ideXlab platform.
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patients with triangular fibrocartilage complex injuries and distal radioulnar Joint Instability have reduced rotational torque in the forearm
Journal of Hand Surgery (European Volume), 2016Co-Authors: Jonny K Andersson, Peter Axelsson, J Stromberg, Jon Karlsson, Jan FridenAbstract:A total of 20 patients scheduled for wrist arthroscopy, all with clinical signs of rupture to the triangular fibrocartilage complex and distal radioulnar Joint Instability, were tested pre-operatively by an independent observer for strength of forearm rotation. During surgery, the intra-articular pathology was documented by photography and also subsequently individually analysed by another independent hand surgeon. Arthroscopy revealed a type 1-B injury to the triangular fibrocartilage complex in 18 of 20 patients. Inter-rater reliability between the operating surgeon and the independent reviewer showed absolute agreement in all but one patient (95%) in terms of the injury to the triangular fibrocartilage complex and its classification. The average pre-operative torque strength was 71% of the strength of the non-injured contralateral side in pronation and supination. Distal radioulnar Joint Instability with an arthroscopically verified injury to the triangular fibrocartilage complex is associated with a s...
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distal radio ulnar Joint Instability in children and adolescents after wrist trauma
Journal of Hand Surgery (European Volume), 2014Co-Authors: Jonny K Andersson, Jon Karlsson, Tommy Lindau, Jan FridenAbstract:This study retrospectively evaluated the medical records and radiographs of patients younger than aged 25 that were referred for a second opinion due to ulnar-sided wrist pain and persistent distal radio-ulnar (DRU) Joint Instability. We identified 85 patients with a major wrist trauma before the age of 18. Median age at trauma was 14 years. Median time between trauma and diagnosis of DRUJ Instability was 3 years. Sixty-seven patients (79%) had sustained a fracture at the initial trauma. The two most common skeletal injuries related to the DRUJ Instability were Salter–Harris type II fractures (24%) and distal radius fractures (19%). In 19 patients (22%), the secondary DRUJ Instability was caused by malunion or growth arrest. Eighteen patients (21%) had no fracture; in spite of this, they presented with subsequent symptomatic DRUJ Instability. Fourteen of these 18 patients had a triangular fibrocartilage complex (TFCC) tear, confirmed by arthroscopy, open surgery, or magnetic resonance imaging. In conclusi...
Jonny K Andersson - One of the best experts on this subject based on the ideXlab platform.
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patients with triangular fibrocartilage complex injuries and distal radioulnar Joint Instability have reduced rotational torque in the forearm
Journal of Hand Surgery (European Volume), 2016Co-Authors: Jonny K Andersson, Peter Axelsson, J Stromberg, Jon Karlsson, Jan FridenAbstract:A total of 20 patients scheduled for wrist arthroscopy, all with clinical signs of rupture to the triangular fibrocartilage complex and distal radioulnar Joint Instability, were tested pre-operatively by an independent observer for strength of forearm rotation. During surgery, the intra-articular pathology was documented by photography and also subsequently individually analysed by another independent hand surgeon. Arthroscopy revealed a type 1-B injury to the triangular fibrocartilage complex in 18 of 20 patients. Inter-rater reliability between the operating surgeon and the independent reviewer showed absolute agreement in all but one patient (95%) in terms of the injury to the triangular fibrocartilage complex and its classification. The average pre-operative torque strength was 71% of the strength of the non-injured contralateral side in pronation and supination. Distal radioulnar Joint Instability with an arthroscopically verified injury to the triangular fibrocartilage complex is associated with a s...
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distal radio ulnar Joint Instability in children and adolescents after wrist trauma
Journal of Hand Surgery (European Volume), 2014Co-Authors: Jonny K Andersson, Jon Karlsson, Tommy Lindau, Jan FridenAbstract:This study retrospectively evaluated the medical records and radiographs of patients younger than aged 25 that were referred for a second opinion due to ulnar-sided wrist pain and persistent distal radio-ulnar (DRU) Joint Instability. We identified 85 patients with a major wrist trauma before the age of 18. Median age at trauma was 14 years. Median time between trauma and diagnosis of DRUJ Instability was 3 years. Sixty-seven patients (79%) had sustained a fracture at the initial trauma. The two most common skeletal injuries related to the DRUJ Instability were Salter–Harris type II fractures (24%) and distal radius fractures (19%). In 19 patients (22%), the secondary DRUJ Instability was caused by malunion or growth arrest. Eighteen patients (21%) had no fracture; in spite of this, they presented with subsequent symptomatic DRUJ Instability. Fourteen of these 18 patients had a triangular fibrocartilage complex (TFCC) tear, confirmed by arthroscopy, open surgery, or magnetic resonance imaging. In conclusi...
Jeffrey N Lawton - One of the best experts on this subject based on the ideXlab platform.
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ulnar styloid fracture with distal radioulnar Joint Instability
2016Co-Authors: Nikhil R Oak, Caroline N Wolfe, Jeffrey N LawtonAbstract:A distal radius fracture with associated ulnar styloid fracture may place the patient at higher risk for distal radioulnar Joint (DRUJ) Instability. With anatomical reduction and volar plate fixation of the distal radius fracture, the ulnar styloid fracture is often indirectly reduced and the DRUJ remains stable. It has been shown that ulnar styloid fractures or its nonunion does not affect the outcome with adequate reduction and fixation of the distal radius fracture. However, large ulnar styloid base fractures or displacement over 2 mm may require open reduction and fixation of the ulnar styloid fracture to achieve DRUJ stability due to proximity of major DRUJ stabilizing ligaments. DRUJ Instability may lead to chronic pain, decreased range of motion, and need for further salvage procedures for relief. The most important guiding principle is to evaluate DRUJ stability following distal radius fixation routinely to determine whether or not to address concomitant ulnar styloid fracture. If the DRUJ remains stable after anatomical fixation of the distal radius, ulnar styloid fixation is rarely required. If the DRUJ remains unstable, we would recommend open reduction and internal fixation of ulnar styloid fracture to achieve stability and reduce the risk of long-term problems.
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ulnar styloid fractures associated with distal radius fractures incidence and implications for distal radioulnar Joint Instability
Journal of Hand Surgery (European Volume), 2002Co-Authors: Megan M May, Jeffrey N Lawton, Philip E BlazarAbstract:Ulnar-sided injuries of the wrist have received more attention recently for their potential negative impact on the outcome of distal radius fractures. Radiographs and medical records were retrospectively reviewed for 166 distal radius fractures treated during a 1-year interval. Distal radius fractures were classified according to the AO system, and accompanying ulnar styloid fractures were evaluated for both size and displacement. Each distal radius fracture was also evaluated for radiographic and clinical evidence of distal radioulnar Joint Instability. The distribution of ulnar styloid fractures was not random; greater than one third involved the base. All distal radius fractures complicated by distal radioulnar Joint Instability were accompanied by an ulnar styloid fracture. A fracture at the ulnar styloid's base and significant displacement of an ulnar styloid fracture were found to increase the risk of distal radioulnar Joint Instability.
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ulnar styloid fractures associated with distal radius fractures incidence and implications for distal radioulnar Joint Instability
Journal of Hand Surgery (European Volume), 2002Co-Authors: Jeffrey N Lawton, Philip E BlazarAbstract:Abstract Ulnar-sided injuries of the wrist have received more attention recently for their potential negative impact on the outcome of distal radius fractures. Radiographs and medical records were retrospectively reviewed for 166 distal radius fractures treated during a 1-year interval. Distal radius fractures were classified according to the AO system, and accompanying ulnar styloid fractures were evaluated for both size and displacement. Each distal radius fracture was also evaluated for radiographic and clinical evidence of distal radioulnar Joint Instability. The distribution of ulnar styloid fractures was not random; greater than one third involved the base. All distal radius fractures complicated by distal radioulnar Joint Instability were accompanied by an ulnar styloid fracture. A fracture at the ulnar styloid's base and significant displacement of an ulnar styloid fracture were found to increase the risk of distal radioulnar Joint Instability. (J Hand Surg 2002;27A:965-971. Copyright © 2002 by the American Society for Surgery of the Hand.)
