title: Biomechanical comparison of transosseous re-fixation of the deep fibres of the distal radioulnar ligaments versus deep and superficial fibres: a cadaver study.
abstract: OBJECTIVE
  We hypothesized that the re-fixation of the deep and superficial fibres of the distal radioulnar ligaments provide improved stability compared to reconstruction of the deep fibres alone.
  
  
  METHODS
  Fourteen fresh-frozen cadaver upper extremities were used for biomechanical testing. Transosseous re-fixation of the deep fibres of the distal radioulnar ligaments alone (single mattress suture group; n = 7) was compared to the transosseous re-attachment of the deep and superficial fibres (double mattress suture group; n = 7). Cyclic load application provoked palmar translation of the radius with respect to the rigidly affixed ulna. Creep, stiffness, and hysteresis were obtained from the load-deformation curves, respectively. Testing was done in neutral forearm rotation, 60° pronation, and 60° supination.
  
  
  RESULTS
  The re-fixation techniques did not differ significantly regarding the viscoelastic parameters creep, hysteresis, and stiffness. Several significant differences of one cycle to the consecutive one within each re-fixation group could be detected especially for creep and hysteresis. No significant differences between the different forearm positions could be detected for each viscoelastic parameter.
  
  
  CONCLUSIONS
  The re-fixation techniques did not differ significantly regarding creep, hysteresis, and stiffness. This means that the additional re-attachment of the superficial fibres may not provide greater stability to the DRUJ. Bearing in mind that the study was a cadaver examination with a limited number of specimens we may suppose that the re-attachment of the superficial fibres seem to be unnecessary. A gradual decline of creep and hysteresis from first to last loading-unloading cycle is to be expected and typical of ligaments which are viscoelastic.
authors.affiliation: Department of Hand Surgery, Vulpius Klinik, Vulpiusstraße 29, 74906, Bad Rappenau, Germany. christianspies27@gmail.com.
authors.forename: Christian K
authors.initials: CK
authors.lastname: Spies
authors.affiliation: Cologne Center for Musculoskeletal Biomechanics (CCMB) Medical Faculty, University of Cologne, Joseph-Stelzmann-Str. 9, 50931, Köln, Germany.|Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933, Köln, Germany.
authors.forename: Anja
authors.initials: A
authors.lastname: Niehoff
authors.affiliation: Department of Hand Surgery, Vulpius Klinik, Vulpiusstraße 29, 74906, Bad Rappenau, Germany.|Medical Faculty Mannheim of the Ruprecht-Karls University Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Unglaub
authors.affiliation: Department of Orthopaedics and Traumatology, University Hospital Cologne, Kerpener Str. 62, 50937, Köln, Germany.
authors.forename: Lars P
authors.initials: LP
authors.lastname: Müller
authors.affiliation: Department of Orthopaedics and Traumatology, University Hospital Münster, Waldeyerstr. 1, 48129, Münster, Germany.
authors.forename: Martin F
authors.initials: MF
authors.lastname: Langer
authors.affiliation: Department of Anatomy I, Medical Faculty, University of Cologne, Kerpener Str. 62, 50937, Köln, Germany.
authors.forename: Wolfram F
authors.initials: WF
authors.lastname: Neiss
authors.affiliation: Department of Orthopaedics and Traumatology, University Hospital Cologne, Kerpener Str. 62, 50937, Köln, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Oppermann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D002102:Cadaver; D005260:Female; D006801:Humans; D008022:Ligaments / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods*; D013536:Suture Techniques; D014955:Wrist Joint / Q000503:physiopathology / Q000601:surgery*
keywords: Biomechanics; DRUJ instability; Radioulnar ligament re-fixation; Transosseous re-fixation technique