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The Impact of Coronal Alignment on Distal Radioulnar Joint Stability Following Distal Radius Fracture
Eugene Jang, MS1; Christopher J. Dy, MD, MSPH2; Samuel A. Taylor, MD2; Kathleen N. Meyers, MS2; Scott W. Wolfe, MD2
1Columbia University College of Physicians and Surgeons, New York, NY; 2Hospital for Special Surgery, New York, NY

Introduction: Malalignment of a distal radius fracture may compromise the contributions of the distal oblique bundle (DOB) of the interosseous membrane to distal radioulnar joint (DRUJ) stability. We hypothesized that anatomic reduction of coronal alignment of a distal radius fracture will decrease DRUJ displacement.
Methods: Distal radius fractures were modeled in 10 cadaveric specimens by performing a distal radius osteotomy just proximal to the base of the sigmoid notch along with an oblique ulnar styloid osteotomy. A volar plate was used to shift the distal radius fragment radially in the coronal plane. A mechanical testing apparatus applied 20N of dorsal and volar load to the distal fragment with the forearm in neutral, 60° pronation, and 60° supination. Dorsal-volar displacement of the radius relative to the fixed ulna was measured in the control state (distal radius fracture reduced and ulnar styloid anatomically fixed) and in three positions (anatomic reduction, 2mm coronal shift, 4mm coronal shift) with ulnar styloid displaced. The specimens were dissected after testing to evaluate for a distinct DOB (thickness >0.5mm). Repeated-measures ANOVA was used to compare DRUJ displacement between the testing and control states, with separate analyses for specimens with and without a distinct DOB.
Results: Mean DRUJ displacement of all specimens was significantly increased after a 2mm coronal shift of the distal fragment (p=0.038 neutral forearm rotation) versus control, but was not significantly different after a 4mm shift. Similar results were seen in pronation and supination. In the subset of specimens with a distinct DOB, a similar significant increase in DRUJ displacement after 2mm coronal shift was observed in neutral forearm rotation (p=0.02). Coronal shift did not have a significant effect on DRUJ displacement in specimens without a distinct DOB.
Conclusions: In the setting of an ulnar styloid fracture, coronal plane malalignment of the distal radial fragment is associated with increased DRUJ displacement. This result was particularly pronounced in specimens with a distinct DOB. Awareness of the importance of coronal plane alignment may aid in the prevention of DRUJ instability associated with distal radius fractures.


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