Advertisement

Der Orthopäde

, Volume 47, Issue 8, pp 663–669 | Cite as

Das proximale Radioulnargelenk unter Berücksichtigung des distalen Radioulnargelenks

  • J. Oppermann
  • K. J. Burkhart
  • S. Löw
  • L. P. Müller
Leitthema

Zusammenfassung

Die Umwendbewegung des Unterarms folgt einem komplexen Zusammenspiel dreier Hauptkomponenten: dem proximalen und distalen Radioulnargelenk sowie der Membrana interossea. Verletzungen einer oder gar aller Hauptkomponenten haben enormen Einfluss auf die Integrität des Systems. Die Essex-Lopresti-Läsion stellte eine hohe Herausforderung in der klinischen Diagnostik als auch in der Therapie dar. Rekonstruktionen der Längenverhältnisse und der Stabilität sind für ein zufriedenstellendes postoperatives Ergebnis unerlässlich. Sofern eine Rekonstruktion des Radiuskopfes osteosynthetisch nicht möglich ist, sollte bei longitudinaler Instabilität eine Radiuskopfprothese implantiert werden – „overlengthening“ und/oder „oversizing“ gilt es zu vermeiden. Die Rekonstruktion bei vorliegender Ruptur der Membrana interossea sollte berücksichtig werden, ebenso die Beurteilung des distalen Radioulnargelenks bzw. des triangulären fibrokartilaginären Komplexes. Verschiedene Rekonstruktionsmöglichkeiten stehen diesbezüglich zur Verfügung.

Schlüsselwörter

Gelenkinstabilität Handgelenk Osteosynthese, Fraktur Radius Triangulärer fibrokartilaginärer Komplex 

Abkürzungen

DRUG

Distales Radioulnargelenk

LARS

„Ligament augmentation reconstruction system“

LCL

Ligamentum collaterale laterale

MCL

„Medial collateral ligament“

MI

Membrana interossea

PRUG

Proximales Radioulnargelenk

TFCC

Triangulärer fibrokartilaginärer Komplex

The proximal radioulnar joint in consideration of the distal radioulnar joint

Abstract

The movement of the forearm follows a complex interplay of three main components: the proximal and distal radioulnar joint and the interosseous membrane. Injuries to one or even all components have a huge impact on the integrity of this system. The Essex-Lopresti lesion presented a high challenge in clinical diagnostics as well as therapy. Reconstructions of the length and stability are essential for a satisfactory postoperative outcome. If a reconstruction of the radial head by osteosynthesis is not possible, a radial head prosthesis should be implanted in the case of longitudinal instability – avoiding overlapping and/or oversizing. The reconstruction of the interosseous membrane should be considered, as well as the assessment of the distal radioulnar joint and/or the triangular fibrocartilage complex. Various reconstruction options are available in this regard.

Keywords

Joint instability Wrist joint Osteosynthesis, fracture Radius Triangular fibrocartilage complex 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

J. Oppermann, K. J. Burkhart, S. Löw und L. P. Müller geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Literatur

  1. 1.
    Adams BD, Berger RA (2002) An anatomic reconstruction of the distal radioulnar ligaments for posttraumatic distal radioulnar joint instability. J Hand Surg Am 27:243–251CrossRefPubMedGoogle Scholar
  2. 2.
    Ahrens C, Unglaub F, Bruckner T et al (2014) Midterm functional outcome after dorsal capsular imbrication for posttraumatic instability of the distal radioulnar joint. Arch Orthop Trauma Surg 134:1633–1639CrossRefPubMedGoogle Scholar
  3. 3.
    Birkbeck DP, Failla JM, Hoshaw SJ et al (1997) The interosseous membrane affects load distribution in the forearm. J Hand Surg Am 22:975–980CrossRefPubMedGoogle Scholar
  4. 4.
    Bowers WH (1985) Distal radioulnar joint arthroplasty: the hemiresection-interposition technique. J Hand Surg Am 10:169–178CrossRefPubMedGoogle Scholar
  5. 5.
    Breen TF, Jupiter JB (1989) Extensor carpi ulnaris and flexor carpi ulnaris tenodesis of the unstable distal ulna. J Hand Surg Am 14:612–617CrossRefPubMedGoogle Scholar
  6. 6.
    Brin YS, Palmanovich E, Bivas A et al (2014) Treating acute Essex-Lopresti injury with the TightRope device: a case study. Tech Hand Up Extrem Surg 18:51–55CrossRefPubMedGoogle Scholar
  7. 7.
    Burkhart KJ, Mattyasovszky SG, Runkel M et al (2010) Mid- to long-term results after bipolar radial head arthroplasty. J Shoulder Elbow Surg 19:965–972CrossRefPubMedGoogle Scholar
  8. 8.
    Chien HY, Chen AC, Huang JW et al (2010) Short- to medium-term outcomes of radial head replacement arthroplasty in posttraumatic unstable elbows: 20 to 70 months follow-up. Chang Gung Med J 33:668–678PubMedGoogle Scholar
  9. 9.
    Cohn M, Glait SA, Sapienza A et al (2014) Radiocapitellar joint contact pressures following radial head arthroplasty. J Hand Surg Am 39:1566–1571CrossRefPubMedGoogle Scholar
  10. 10.
    Del Gaudio T, Haerle M (2016) Arthroscopic partial resection of the ulnar head for ulnocarpal decompression. Oper Orthop Traumatol 28:263–269CrossRefPubMedGoogle Scholar
  11. 11.
    Doornberg JN, Linzel DS, Zurakowski D et al (2006) Reference points for radial head prosthesis size. J Hand Surg Am 31:53–57CrossRefPubMedGoogle Scholar
  12. 12.
    Drake ML, Farber GL, White KL et al (2010) Restoration of longitudinal forearm stability using a suture button construct. J Hand Surg Am 35:1981–1985CrossRefPubMedGoogle Scholar
  13. 13.
    Duckworth AD, Watson BS, Will EM et al (2011) Radial shortening following a fracture of the proximal radius. Acta Orthop 82:356–359CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Duckworth AD, Wickramasinghe NR, Clement ND et al (2014) Radial head replacement for acute complex fractures: what are the rate and risks factors for revision or removal? Clin Orthop Relat Res 472:2136–2143CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Gaspar MP, Kane PM, Pflug EM et al (2016) Interosseous membrane reconstruction with a suture-button construct for treatment of chronic forearm instability. J Shoulder Elbow Surg 25:1491–1500CrossRefPubMedGoogle Scholar
  16. 16.
    Gaspar MP, Kearns KA, Culp RW et al (2018) Single- versus double-bundle suture button reconstruction of the forearm interosseous membrane for the chronic Essex-Lopresti lesion. Eur J Orthop Surg Traumatol 28(3):409.  https://doi.org/10.1007/s00590-017-2051-4 CrossRefPubMedGoogle Scholar
  17. 17.
    Gausepohl T (2015) Essex-Lopresti-Verletzungen – Instabilitätseinschätzung und Therapie des distalen Radioulnargelenks. Trauma Berufskr 16:231–236CrossRefGoogle Scholar
  18. 18.
    Goldberg I, Peylan J, Yosipovitch Z (1986) Late results of excision of the radial head for an isolated closed fracture. J Bone Joint Surg Am 68:675–679CrossRefPubMedGoogle Scholar
  19. 19.
    Hackl M, Andermahr J, Staat M et al (2017) Suture button reconstruction of the central band of the interosseous membrane in Essex-Lopresti lesions: a comparative biomechanical investigation. J Hand Surg Eur Vol 42:370–376CrossRefPubMedGoogle Scholar
  20. 20.
    Hausmann JT, Vekszler G, Breitenseher M et al (2009) Mason type-I radial head fractures and interosseous membrane lesions—a prospective study. J Trauma 66:457–461CrossRefPubMedGoogle Scholar
  21. 21.
    Hui FC, Linscheid RL (1982) Ulnotriquetral augmentation tenodesis: a reconstructive procedure for dorsal subluxation of the distal radioulnar joint. J Hand Surg Am 7:230–236CrossRefPubMedGoogle Scholar
  22. 22.
    Iida A, Omokawa S, Akahane M et al (2012) Distal radioulnar joint stress radiography for detecting radioulnar ligament injury. J Hand Surg Am 37:968–974CrossRefPubMedGoogle Scholar
  23. 23.
    Itamura J, Roidis N, Mirzayan R et al (2005) Radial head fractures: MRI evaluation of associated injuries. J Shoulder Elbow Surg 14:421–424CrossRefPubMedGoogle Scholar
  24. 24.
    Kam CC, Jones CM, Fennema JL et al (2010) Suture-button construct for interosseous ligament reconstruction in longitudinal radioulnar dissociations: a biomechanical study. J Hand Surg Am 35:1626–1632CrossRefPubMedGoogle Scholar
  25. 25.
    Kessler I, Hecht O (1970) Present application of the Darrach procedure. Clin Orthop Relat Res 72:254–260PubMedGoogle Scholar
  26. 26.
    Kim JP, Park MJ (2008) Assessment of distal radioulnar joint instability after distal radius fracture: comparison of computed tomography and clinical examination results. J Hand Surg Am 33:1486–1492CrossRefPubMedGoogle Scholar
  27. 27.
    Kleinman WB (2007) Stability of the distal radioulna joint: biomechanics, pathophysiology, physical diagnosis, and restoration of function what we have learned in 25 years. J Hand Surg Am 32:1086–1106CrossRefPubMedGoogle Scholar
  28. 28.
    Laumonerie P, Reina N, Ancelin D et al (2017) Mid-term outcomes of 77 modular radial head prostheses. Bone Joint J 99-B:1197–1203CrossRefPubMedGoogle Scholar
  29. 29.
    Mcginley JC, Hopgood BC, Gaughan JP et al (2003) Forearm and elbow injury: the influence of rotational position. J Bone Joint Surg 85-A:2403–2409CrossRefGoogle Scholar
  30. 30.
    Minami A, Suzuki K, Suenaga N et al (1995) Hemiresection-interposition arthroplasty for osteoarthritis of the distal radioulnar joint. Int Orthop 19:35–39CrossRefPubMedGoogle Scholar
  31. 31.
    Neuhaus V, Christoforou DC, Kachooei AR et al (2015) Radial head prosthesis removal: a retrospective case series of 14 patients. Arch Bone Jt Surg 3:88–93PubMedPubMedCentralGoogle Scholar
  32. 32.
    Ochman S, Wieskotter B, Langer M et al (2017) High-resolution MRI (3T-MRI) in diagnosis of wrist pain: is diagnostic arthroscopy still necessary? Arch Orthop Trauma Surg 137:1443–1450CrossRefPubMedGoogle Scholar
  33. 33.
    Osterman AL, Terrill RG (1991) Arthroscopic treatment of TFCC lesions. Hand Clin 7:277–281PubMedGoogle Scholar
  34. 34.
    Palmer AK, Werner FW (1981) The triangular fibrocartilage complex of the wrist—anatomy and function. J Hand Surg Am 6:153–162CrossRefPubMedGoogle Scholar
  35. 35.
    Park MJ, Kim JP (2008) Reliability and normal values of various computed tomography methods for quantifying distal radioulnar joint translation. J Bone Joint Surg Am 90:145–153CrossRefPubMedGoogle Scholar
  36. 36.
    Phadnis J, Watts AC (2016) Longitudinal instability of the forearm. Orthopäde 45:861–869CrossRefPubMedGoogle Scholar
  37. 37.
    Pike JM, Athwal GS, Faber KJ et al (2009) Radial head fractures—an update. J Hand Surg Am 34:557–565CrossRefPubMedGoogle Scholar
  38. 38.
    Pillukat T, Fuhrmann R, Windolf J et al (2016) The volar locking plate for extension fractures of the distal radius. Oper Orthop Traumatol 28:47–63 (quiz 64)CrossRefPubMedGoogle Scholar
  39. 39.
    Pirela-Cruz MA, Goll SR, Klug M et al (1991) Stress computed tomography analysis of the distal radioulnar joint: a diagnostic tool for determining translational motion. J Hand Surg Am 16:75–82CrossRefPubMedGoogle Scholar
  40. 40.
    Rabinowitz RS, Light TR, Havey RM et al (1994) The role of the interosseous membrane and triangular fibrocartilage complex in forearm stability. J Hand Surg Am 19:385–393CrossRefPubMedGoogle Scholar
  41. 41.
    Ring D, Quintero J, Jupiter JB (2002) Open reduction and internal fixation of fractures of the radial head. J Bone Joint Surg 84-A:1811–1815CrossRefPubMedGoogle Scholar
  42. 42.
    Schmauss D, Pohlmann S, Lohmeyer JA et al (2016) Clinical tests and magnetic resonance imaging have limited diagnostic value for triangular fibrocartilaginous complex lesions. Arch Orthop Trauma Surg 136:873–880CrossRefPubMedGoogle Scholar
  43. 43.
    Schmelzer-Schmied N (2016) Arthroscopic refixation of TFCC by bone screw anchor. Oper Orthop Traumatol 28:251–262CrossRefPubMedGoogle Scholar
  44. 44.
    Shepard MF, Markolf KL, Dunbar AM (2001) Effects of radial head excision and distal radial shortening on load-sharing in cadaver forearms. J Bone Joint Surg Am 83-A:92–100CrossRefPubMedGoogle Scholar
  45. 45.
    Soubeyrand M, Ciais G, Wassermann V et al (2011) The intra-operative radius joystick test to diagnose complete disruption of the interosseous membrane. J Bone Joint Surg Br 93:1389–1394CrossRefPubMedGoogle Scholar
  46. 46.
    Spies CK, Muller LP, Oppermann J et al (2014) Instability of the distal radioulnar joint—an overview of clinical and radiological procedures regarding their efficacies. Handchir Mikrochir Plast Chir 46:137–150CrossRefPubMedGoogle Scholar
  47. 47.
    Spies CK, Muller LP, Unglaub F et al (2014) Anatomical transosseous fixation of the deep and superficial fibers of the radioulnar ligaments. Arch Orthop Trauma Surg 134:1783–1788CrossRefPubMedGoogle Scholar
  48. 48.
    Spies CK, Niehoff A, Unglaub F et al (2016) Biomechanical comparison of transosseous re-fixation of the deep fibres of the distal radioulnar ligaments versus deep and superficial fibres: a cadaver study. Int Orthop 40:315–321CrossRefPubMedGoogle Scholar
  49. 49.
    Spies CK, Prommersberger KJ, Langer M et al (2015) Instability of the distal radioulnar joint: treatment options for ulnar lesions of the triangular fibrocartilage complex. Unfallchirurg 118:701–717CrossRefPubMedGoogle Scholar
  50. 50.
    Stabile KJ, Pfaeffle J, Saris I et al (2005) Structural properties of reconstruction constructs for the interosseous ligament of the forearm. J Hand Surg Am 30:312–318CrossRefPubMedGoogle Scholar
  51. 51.
    Szabo RM (2006) Distal radioulnar joint instability. J Bone Joint Surg Am 88:884–894CrossRefPubMedGoogle Scholar
  52. 52.
    Tay SC, Tomita K, Berger RA (2007) The “ulnar fovea sign” for defining ulnar wrist pain: an analysis of sensitivity and specificity. J Hand Surg Am 32:438–444CrossRefPubMedGoogle Scholar
  53. 53.
    Tejwani SG, Markolf KL, Benhaim P (2005) Reconstruction of the interosseous membrane of the forearm with a graft substitute: a cadaveric study. J Hand Surg Am 30:326–334CrossRefPubMedGoogle Scholar
  54. 54.
    Tolat AR, Stanley JK, Trail IA (1996) A cadaveric study of the anatomy and stability of the distal radioulnar joint in the coronal and transverse planes. J Hand Surg 21:587–594CrossRefGoogle Scholar
  55. 55.
    Trousdale RT, Amadio PC, Cooney WP et al (1992) Radio-ulnar dissociation. A review of twenty cases. J Bone Joint Surg Am 74:1486–1497CrossRefPubMedGoogle Scholar
  56. 56.
    Tsai PC, Paksima N (2009) The distal radioulnar joint. Bull NYU Hosp Jt Dis 67:90–96PubMedGoogle Scholar
  57. 57.
    Tunnerhoff HG, Langer M (2014) Arthroscopic repair for ulnar-sided tears of the TFCC. Handchir Mikrochir Plast Chir 46:286–294CrossRefPubMedGoogle Scholar
  58. 58.
    Unglaub F, Manz S, Bruckner T et al (2013) Dorsal capsular imbrication for dorsal instability of the distal radioulnar joint. Oper Orthop Traumatol 25:609–614CrossRefPubMedGoogle Scholar
  59. 59.
    Van Glabbeek F, Van Riet RP, Baumfeld JA et al (2004) Detrimental effects of overstuffing or understuffing with a radial head replacement in the medial collateral-ligament deficient elbow. J Bone Joint Surg 86-A:2629–2635CrossRefPubMedGoogle Scholar
  60. 60.
    Van Hoecke E, Van De Vijver A, Van Glabbeek F et al (2016) Long term results after bipolar radial head arthroplasty. Acta Orthop Belg 82:382–388PubMedGoogle Scholar
  61. 61.
    Van Schoonhoven J (2016) Arthroskopische Operationen am Handgelenk. Oper Orthop Traumatol 28:231–232CrossRefPubMedGoogle Scholar
  62. 62.
    Venouziou AI, Papatheodorou LK, Weiser RW et al (2014) Chronic Essex-Lopresti injuries: an alternative treatment method. J Shoulder Elbow Surg 23:861–866CrossRefPubMedGoogle Scholar
  63. 63.
    Wechsler RJ, Wehbe MA, Rifkin MD et al (1987) Computed tomography diagnosis of distal radioulnar subluxation. Skeletal Radiol 16:1–5CrossRefPubMedGoogle Scholar
  64. 64.
    Wegmann K, Engel K, Burkhart KJ et al (2014) Sequence of the Essex-Lopresti lesion—a high-speed video documentation and kinematic analysis. Acta Orthop 85:177–180CrossRefPubMedPubMedCentralGoogle Scholar
  65. 65.
    Wegmann K, Lamsfuss J, Ries C et al (2015) Identification of overlengthening after replacement of the radial head with a bipolar prosthesis. Arch Orthop Trauma Surg 135:1669–1674CrossRefPubMedGoogle Scholar
  66. 66.
    Weiss AP, Hastings H 2nd (1992) The anatomy of the proximal radioulnar joint. J Shoulder Elbow Surg 1:193–199CrossRefPubMedGoogle Scholar
  67. 67.
    Wijffels M, Brink P, Schipper I (2012) Clinical and non-clinical aspects of distal radioulnar joint instability. Open Orthop J 6:204–210CrossRefPubMedPubMedCentralGoogle Scholar
  68. 68.
    Zwingmann J, Bode G, Hammer T et al (2015) Radial head prosthesis after radial head and neck fractures – current literature and quality of evidence. Acta Chir Orthop Traumatol Cech 82:177–185PubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  • J. Oppermann
    • 1
    • 2
  • K. J. Burkhart
    • 3
  • S. Löw
    • 4
  • L. P. Müller
    • 1
    • 2
  1. 1.Klinik und Poliklinik für Orthopädie und UnfallchirurgieUniversität zu KölnKölnDeutschland
  2. 2.Cologne Center for Musculoskeletal Biomechanics, Medical FacultyUniversity of CologneKölnDeutschland
  3. 3.ARCUS KlinikenPforzheimDeutschland
  4. 4.Praxis für Handchirurgie und UnfallchirurgieBad MergentheimDeutschland

Personalised recommendations