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Tendon graft--ulna fixation in distal radio-ulnar joint stabilisation; biomechanical comparison of three graft-bone fixation methods.

ABSTRACT: A common distal radio-ulnar joint (DRUJ) stabilisation procedure uses a tendon graft running from the lip of the radial sigmoid notch to the ulnar fovea and through a bony tunnel to the ulnar shaft, before being wrapped round the distal ulna and sutured to itself. Such graft fixation can be challenging and requires a considerable tendon length. The graft length could be reduced by fixing the graft to the ulna using a bone anchor or interference screw. The aim of this study was to compare the strength of three distal ulna graft fixation methods (tendon wrapping and suturing, bone anchor and interference screw). Four human cadaveric ulnae were used. A tendon strip was run through a tunnel in the distal ulna and secured by: (1) wrapping round the shaft and suturing it to itself, (2) a bone anchor and (3) an interference screw in the bone tunnel. Load to failure was determined using a custom-made apparatus and an Instron machine. Maximum failure load was highest for the bone anchor fixation (99.3 +/- 23.7 N) followed by the suturing (96.2 +/- 12.1 N), and the interference screw fixation (46.9 +/- 5.6 N). There was no significant difference between the tendon suturing and bone anchor methods, but the tendon suturing was statistically significantly higher compared to the interference screw (P = 0.028). In performing anatomical stabilisation of the DRUJ fixation of the tendon graft to the distal ulna with a bone anchor provides the most secure fixation. This may make the stabilisation technique less demanding and require a smaller tendon graft.

SUBMITTER: Kalson NS

PROVIDER: S-EPMC2724616 | biostudies-other | 2009 Sep

REPOSITORIES: biostudies-other

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Project description:PurposeThe purpose of this study was to evaluate three different methods of attachment of continuous loop suspensory cortical preparation of all soft tissue central quad tendon grafts compared to a bone block control for anterior cruciate ligament reconstruction on construct displacement and load to failure.MethodsThirty-two cadaveric central quadriceps tendon (CQT) specimens were harvested, using three clinical techniques for graft fixation: cortical button alone (BTB EB), BTB cortical button with rip-stop suture (BTB RS), and continuous loop cortical button (BTB CL). A control group was also included that consisted of a bone block secured within testing clamps (BTB CON). Specimens were preloaded to 150 N. Tendons were then cyclically loaded between 50 N and 250 N for 1,000 cycles at .5 Hz. Displacement was measured at the point of fixation of the CQT after the 150 N preload, 250 N initial load and every 100th cycle. The specimens were loaded to failure after 1,000 cycles.ResultsThere was a significant increase in displacement from .32 ± .56 mm for the BTB CON to 1.91 ± 1.13 mm for the BTB RS (P = .014) and 3.85 ± 2.32 mm for the BTB CL condition (P = .023). There was no significant increase in displacement for BTB EB (P = .182). Failure occurred for all of the BTB CL and 62.5% of the BTB EB specimens within the first 50 cycles. Twenty-five percent of the BTB CON specimens and 12.5% BTB RS failed at ∼400 and 500 cycles, respectively. Similar failure loads were observed for the BTB CON and the BTB RS (446.4 ± 151.46 N vs 505.74 ± 131.41 N; P = .99) Failure testing was not feasible for the BTB CL and BTB EB preparation methods.ConclusionIn response to cyclic loading, the three all-soft tissue suspensory conditions experienced significantly greater displacement compared to the bone block controls. None of the soft-tissue conditions appeared superior when compared to each other.Clinical relevanceIt remains unknown which method of soft-tissue suspensory provides optimal fixation. As these autografts become more common, it is essential to evaluate which fixation methods provide superior outcomes.

Project description:IntroductionGiven the absence of a satisfying plate system to deal with multifragmentary or subcapital distal ulnar fractures, the Distal Ulna Locking Plate (DUL, I.T.S. GmbH, Graz, Austria) could become a useful treatment option. This study aimed to evaluate the results of this anatomically pre-contoured plate regarding patients with unstable or displaced distal ulnar fractures.MethodsIn a prospective clinical trial, 20 patients (18 female, two male; mean age 70 years (24-91 years)) with unstable or displaced distal ulna fractures between December 2010 and August 2015 were analyzed. All patients were treated with open reduction and internal fixation using the DUL. They were evaluated at three follow-up appointments at 3, 6 and 12 months postoperatively regarding their bone healing, ulnar variance (UV), range of motion (ROM) and grip strength. Patient related outcomes were measured using the Disability of the Arm, Shoulder and Hand (DASH), the Patient Rated Wrist Evaluation (PRWE) questionnaires, and the Visual Analogue Scale (VAS). The results after one year were compared to the outcome of the healthy contralateral side.ResultsAll fractures treated with open reduction and internal fixation using the Distal Ulna Locking Plate healed within 6 months and showed stable ulnar variances after surgery. ROM (rotational plane 81.1 ± 9.0°, sagittal plane 55.1 ± 14.6°, frontal plane 33.0 ± 9.4°) and grip strength (18.7 ± 7.1 N) at the follow-up after 12 month had similar values compared with the uninjured side. The mean DASH score (36.4 ± 29.0), the PRWE-score (14.5 ± 27.0), and the VAS (at rest 0.5 ± 1.1, during activity 1.2 ± 2.4) after one year had no significant difference to the uninjured side. The surgeon's overall satisfaction rate regarding plate handling reached 81.8%.ConclusionStabilization of unstable distal ulna fractures using the DUL restores nearly normal anatomy and function. Its pre-countered design, volar placement, and enhanced stability present a satisfying plate system.Trial registration The trial was retrospectively Registered at www.Clinicaltrialsgov on 16 December 2021 (Trial Registration Number: NCT05329012).

Project description:Optimal acute management of the highly comminuted distal ulna head/neck fracture sustained in conjunction with an unstable distal radius fracture requiring operative fixation is not well established. The purpose of the present study was to determine the clinical, radiographic, and functional outcomes following acute primary distal ulna resection for comminuted distal ulna fractures performed in conjunction with the operative fixation of unstable distal radius fractures. Between 2000 and 2007, 11 consecutive patients, mean age 62 years (range, 30-75) were treated for concomitant closed, comminuted, unstable fractures of the distal radius and ulna metaphysis. All 11 patients underwent distal ulna resection through a separate dorsal ulnar incision with ECU tenodesis following surgical fixation of the distal radius fracture. According to the Q modifier of the Comprehensive Classification of Fractures, there were six comminuted fractures of the ulnar neck (Q3) and five fractures of the head/neck (Q5). Operative fixation of the distal radius fracture included volar plate fixation in four patients and spanning external fixation with supplemental percutaneous Kirschner wires in seven patients. At a mean of 42 months (range, 18-61 months) postoperatively, clinical, radiographic, and wrist-specific functional outcome with the modified Gartland and Werley wrist score were evaluated. At latest follow-up, mean wrist range of motion measured 53 degrees flexion (range, 35-60 degrees), 52 degrees extension (range, 30-60 degrees), 81 degrees pronation (range, 75-85 degrees), and 77 degrees supination (range, 70-85 degrees). Mean grip strength measured 90% of the contralateral, uninjured extremity (range, 50-133%). No patient had distal ulna instability. Final radiographic assessment demonstrated restoration of distal radius articular alignment. According to the system of Gartland and Werley as modified by Sarmiento, there were seven excellent and four good results. No patient has required a secondary surgical procedure. Acute primary distal ulna resection yields satisfactory clinical, radiographic, and functional results in appropriately selected patients and represents a reliable alternative to open reduction and internal fixation when anatomic restoration of the distal ulna/sigmoid notch cannot be achieved. Primary distal ulna resection with distal radius fracture fixation may help avoid secondary procedures related to distal ulna fixation or symptomatic post-traumatic distal radioulnar joint arthrosis.

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Tendon graft--ulna fixation in distal radio-ulnar joint stabilisation; biomechanical comparison of three graft-bone fixation methods.

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