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A-0961 Distal Radioulnar Joint Instability and Injury
Greg T Pickering, Grey ED Giddins, Royal United Hospital Bath NHS Foundation Trust, Bath, UK
Thursday, June 14, 2018 · 3:36 p.m. · 08m 00s
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good afternoon uh yes i'm an integrated in this is a pickering
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isn't doing this talk he's doing my clinic beckoning and
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i'm pleased to say so on doing the talking stud so this is instability that we've measured and some uh
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thoughts on it technically
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um so yeah you jane's abilities recognise increasingly common it's complex
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by mechanics and there's been suggested that different positions is the wrist in
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for all will um tighten or loosen the d. r. u. j.
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so we do about race reading um this is the third incarnation you should have seen the first it was
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very primitive and so we're able to simulate the chemical testing of d. r. u. j. she yeah
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and we can do it in probation super nation radio non deviation
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we can't completely control for rotation of the radius related to
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the on that um and that's a limitation of this
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so that's the rig as we use it when we tested it on could obvious we previously probably set work we say that this is
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um reliable and valid so the meshes we got we think are pretty jane you in and
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they fit without the clinical measurements so we've compared them to our sounded c. t. based
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is that people down and they look very similar to the so this is to really show you what
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the data really is and then we can extract the landing points from its own the normal population
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uh the writes the same as the left on surprisingly there's a pretty consistent range
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this was in four hundred and ten limbs we've now done over five hundred
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and the ranges from four to nine millimetres okay that nines
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quite an important point okay so it's pretty consistent
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and it's pretty consistent between men and women is a little bit more in maine and we've now started measuring for on length
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'cause maintain the bigger than women and there's a degree
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proportionality so essentially most people are pretty similarly stable
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uh then we tested the positions and it has been suggested that you put your wrist into only deviation
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then that makes the d. r. u. j. less stable for that's wrong every position makes the d. r. u.
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j. more stable per nation super nation cradle deviation only
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deviation completely consistent it never changes so that's clear
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and with as we said d. r. u. j. translation correlates a little bit too just to form length
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so we then look next to patients who work clinically lacks impatience you came
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to my clinic and were clearly unstable when we looked at the is
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and we showed the the range in there on on to the armour similar
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two before it was five to eight millimetres meaner six point five and then the
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symptomatic side it was between ten and fifteen millimetres and they suggested there
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might be a little does i know where and um in fact
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it was a sort of or nothing that wasn't the continuum but we something
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we should and that's not true but this is um exactly a difference
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and then we did these testing reagan only deviation predation c. foundation and all
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of them tighten the rest so when your t. i. u. j.'s unstable
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doing something else to it will type it and therefore it makes sense to doing all the shooting else your tummy
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will tighten your wrist and so that does might we haven't actually measured that yet that's got to be done
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and then we added in a force meta and we showed that patients he was symptomatic could tolerate
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less force before they felt symptoms and tell right less maximum force on assessing the risks
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and again that's what you'd expect and then we look to destroy radio fact
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isn't just remind you the light touches reasonably clear is suggests that
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between thirty and seventy percent of patients with just two radio fractures had
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d. r. u. j. instability if you look at the popular series
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i'm i'm pleased to tell you that they're all wrong okay every single patient with
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the uh uh just to radio fracture as the o. u. j. instability
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yeah before you start running out the room to go and fix
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them all i don't think they need treatment that just unstable
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and what this implies isn't weaves done other work which says that is when you fall for this radio fracture
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you fall first on the on the side of the rest you damage the d. r. u.
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j. and then the force transmits up into the radius and you get a fracture
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i just remember that 'cause we'll talk about it subsequently will say showed whereas previously
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in the symptomatic patients actually the survey from the next one um be um
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that was their brains like the outside of the range this more clearly crosses over
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so some of these patients symptomatic aloft sound and once again
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all the positions of the wrist and forearm increases stability
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so as i say previous expensive said it's thirty to seventy percent and they're
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on what they show is is the technical assessment is not very reliable
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and we need to be measuring things but not measuring um we don't really know what
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we're talking about with a lot to radio head fractures and we showed that
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basically they run stable so if you fix the radio head they will always less they with the other side there's some
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in the normal range he did a replacement they were all in the quite unstable range and if you excise them
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they were very unstable again it may not matter symptomatic labour when your patients
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complain of wrist problems having had radio head fracture that's probably why
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so it looks like some d. r. u. j. instabilities inevitable
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following these injuries and that therefore implies that the essex
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the press deletion is not an all or nothing it's simply a continued you to go cruise please thank you
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um and then finally worked its skateboard fractures and none of them had d. r.
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u. j. instability in action uh use that that's a different mechanism of injury
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so implications i said it lies on that spectrum that
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all patients will be unstable but not symptomatic
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yeah six the press d. is probably not a continuum and what we have
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shirt and this is important is that non clinical practitioners on on x.
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but it's not very good at assessing this and may sleep people are
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not symptomatic until they're unstable about twelve millimetres that's appreciably outside all
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now does come to conclusion so lies on the spectrum 'cause notice
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the radio factors in radio head fractures but not skateboard fractures
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and all changes in wrist inform position stay belies the d. i. u. j. thank you
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ah
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oh is that we should really be why does this time is huge building um what it is
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'cause i've now to find instability and not defined instability is more translation a nine millimetres
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and that's what instability read the stable your unstable doesn't leno symptomatic
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but we now we really got three groups and we should recognise that you read the stable
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you all a symptomatic leon stable probably doesn't matter but you
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need to recognise it or you symptomatic lee unstable
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what it means is that when people staple lies than you do in adams proceed or something else
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you never make and staple all you do is you make them
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less unstable and take them into an a symptomatic unstable group
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but it's important to recognise if you try to make unstable entertained you are when you're
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not you're just deceiving itself and the patient so i think it doesn't actually yes
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