Assessment of Distal Radioulnar Joint Stability After Reconstruction With the Brachioradialis Wrap.

BACKGROUND: The brachioradialis (BR) wrap technique is an option to restore the stability of the distal radioulnar joint (DRUJ). The technique capitalizes on the BR's advantageous insertion point on the radial styloid and the ability of the BR to be harvested with minimal to no deficit. The tendon can then be wrapped around the radius and ulna, tunneling under the pronator quadratus and extensor compartments and secured back into its insertion to provide stability. In this cadaveric study, we used micro-computed tomography (CT) to assess the stability restored by this procedure. METHODS: Axial CT scans were taken of cadaveric specimens (n = 10) in 3 different positions (neutral, 60° pronation, and 60° supination) to establish the baseline measurements of each DRUJ. Surgical disruption of the dorsal and volar ligaments of each DRUJ then simulated a destabilizing injury and the specimens were scanned again. The specimens then underwent the BR wrap procedure and were scanned once more. Degree of ulnar subluxation with respect to the Sigmoid notch was determined using the modified radioulnar line method. RESULTS: The mean percentages of subluxation in the neutral position for the normal, injured, and reconstructed DRUJ were 22.4±4.9%, 56.2±12.9%, and 29.0±6.5%, respectively. In 60° pronation, these values were 15.4±4.7%, 53.5±15.0%, and 36.5±11.8%, respectively. In 60° supination, these values were 18.6±2.5%, 69.7±20.5%, and 31.9±8.7%, respectively. CONCLUSIONS: Values differed significantly between normal and injured conditions in all positions. No significant difference was noted between normal and reconstructed conditions, suggesting reconstruction improves DRUJ biomechanics and more closely approximates normal stability.

Bone loss following spinal cord injury in a rat model.

The current study was undertaken to follow the time course of bone loss in the proximal tibia of rats over several weeks following thoracic contusion spinal cord injury (SCI) of varying severity. It was hypothesized that bone loss would be more pronounced in the more severely injured animals, and that hindlimb weight bearing would help prevent bone loss. Twenty-six female Sprague-Dawley rats (200-225 g, 6-7 weeks old) received standard thoracic (T9) injuries at energies of 6.25, 12.5, 25, or 50 g-cm. The rats were scored weekly for hindlimb function during locomotion. At 0, 2 or 3, and 8 weeks, high-resolution micro-CT images of each right tibia were obtained. Mechanical indentation testing was done to measure the compressive strength of the cancellous bone structure. The 6.25 g-cm group showed near normal locomotion, the 12.5 and 25 g-cm groups showed the ability to frequently or occasionally generate weight-supported plantar steps, respectively, and the 50 g-cm group showed only movement without weight-supported plantar stepping. The 6.25, 12.5 and 25 g-cm groups remained at the same level of bone volume fraction (cancBV/TV=0.24±0.07), while the 50 g-cm group experienced severe bone loss (67%), resulting in significantly lower (p<0.05) bone volume fraction (cancBV/TV=0.11±0.05) at 8 weeks. Proximal tibia cancellous bone strength was reduced by approximately 50% in these severely injured rats. Instead of a linear proportionality between injury severity and bone loss, there appears to be a distinct functional threshold, marked by occasional weight-supported stepping, above which bone loss does not occur.

In vivo micro-CT scanning of a rabbit distal femur: repeatability and reproducibility.

Before in vivo micro-CT scanning can be used to investigate femoral trabecular microarchitecture over time in rabbits, its repeatability and reproducibility must be demonstrated. To accomplish this, both distal femurs of two 6-month-old New Zealand white rabbits were scanned five times each in 1 day under different conditions (repeatability). Scanning was done at 28 microm isotropic voxel size to produce five image stacks of each femur. Three operators then followed a standard image processing protocol (reproducibility) to isolate two separate cubes from each anterior femoral condyle [total n = (8 cube sites)(5 scans)(3 operators) = 120]. Bone volume fraction (BV/TV) of the eight different cube sites (sample) ranged from 0.408 to 0.501 (mean: 0.453); trabecular thickness (Tb.Th) ranged from 158.1 to 185.5 microm (mean: 168.6 microm); and trabecular separation (Tb.Sp) ranged from 179.4 to 233.1 microm (mean: 204.7 microm). Using ANOVA and the variance component method, the total process variation was +/- 14.1% of the mean BV/TV of 0.453. The sample variation was +/- 13.9% (p < 0.001), the repeatability was +/- 2.1% (p < 0.001), and the reproducibility was +/- 0.1% (p > 0.05). Results were similar for Tb.Th and Tb.Sp. Though the contribution due to repeatability was statistically significant for each of the three indices, the natural sample differences were far greater than differences caused by repeated scanning under different conditions or by different operators processing the images. These findings suggest that in vivo micro-CT scanning of rabbit distal femurs was repeatable and reproducible and can be used with confidence to measure differences in trabecular bone microarchitecture at a single location in a longitudinal study design.