Pisotriquetral joint (PTJ) disorders are an important cause of ulnar-sided wrist pain but are often underrecognized. Ulnar variance (UV) has been associated with several wrist pathologies.
Purpose
To determine the effect of UV on PTJ in patients with trauma.
Material and Methods
A total of 143 patients (77 men, 66 women; mean age=41.64 ± 18.07 years) were included. Patients with fractures, severe and high-energy trauma, arthritic conditions, avascular necrosis, congenital deformity, bone and soft-tissue tumors, suboptimal image quality, and incorrect joint position were excluded. UV and the amount of PTJ subluxation were evaluated using coronal and sagittal computed tomography images.
Results
PTJ subluxation was divided into five grades. A statistically significant difference was found between the presence of PTJ subluxation and sex (P = 0.045). PTJ subluxation was more common in men (46.8%) than in women (30.3%). There was no significant difference between the presence of PTJ subluxation and age (P = 0.758). The patients were also divided into three groups as positive, neutral, and negative UV. A statistically significant relationship was found between the UV and presence of PTJ subluxation (P = 0.01). PTJ subluxation was significantly less in the neutral (none=51.1%, present=48.9%; P < 0.05) and negative (none=77.8%, present=22.2%; P < 0.05) groups.
Conclusion
PTJ subluxation was found to be less among the groups with neutral and negative UV in our study population. PTJ subluxation is more common in men while there is no relationship with age. UV and gender may be risk factors for PTJ subluxation by affecting force dynamics at the wrist joint.
MorauxALefebvreGPansiniV, et al. Pisotriquetral joint disorders: an under-recognized cause of ulnar side wrist pain. Skeletal Radiol2014;43:761–773.
2.
TosunOCilengirAHDirim MeteB, et al. The effect of ulnar variance on scapholunate and capitolunate angles. Acta Radiol2017;58:1358–1363.
3.
CerezalLdel PiñalFAbascalF, et al. Imaging findings in ulnar-sided wrist impaction syndromes. Radiographics2002;22:105–121.
4.
SerfatyACostaHPFoelkerCE, et al. Evaluation of ulnar variance on wrist MR imaging: is it a reliable measure?Skeletal Radiol2020;49:723–730.
5.
KoxLSJensSLaufK, et al. Well-founded practice or personal preference: a comparison of established techniques for measuring ulnar variance in healthy children and adolescents. Eur Radiol2020;30:151–162.
6.
BrunoFArrigoniFPalumboP, et al. The acutely injured wristRadiol Clin North Am2019;57:943–955.
7.
ElsaftawyA. Radiological investigation of relationship between lunate type and ulnar variance. Pol Przegl Chir2013;85:576–580.
8.
JalanDElhenceAYadavP. Measurement of ulnar variance in a regional subset of Indian population-a pilot study of 30 subjects. J Clin Diagn Res2015;9:RC05–RC08.
9.
SchuurmanAHMaasMDijkstraPF, et al. Assessment of ulnar variance: a radiological investigation in a Dutch population. Skeletal Radiol2001;30:633–638.
10.
BonzarMFirrellJCHainerM, et al. Kienböck disease and negative ulnar variance. J Bone Joint Surg Am1998;80:1154–1157.
11.
NakamuraRTanakaYImaedaT, et al. The influence of age and sex on ulnar variance. J Hand Surg Br1991;16:84–88.
12.
LarsenCFLindequistSBellstromT. Lack of correlation between ulnar variance and carpal bone angles on lateral radiographs in normal wrists. Acta Radiol1992;33:275–276.
13.
MoojenTMSnelJGRittMJ, et al. Pisiform kinematics in vivo. J Hand Surg Am2001;26:901–907.
14.
StahlSStahlASMeisnerC, et al. Critical analysis of causality between negative ulnar variance and Kienböck disease. Plast Reconstr Surg2013;132:899–909.
15.
ChaSMShinHDKimKC. Positive or negative ulnar variance after ulnar shortening for ulnar impaction syndrome: a retrospective study. Clin Orthop Surg2012;4:216–220.
16.
GreybeDBolandMRWuT, et al. A finite element model to investigate the effect of ulnar variance on distal radioulnar joint mechanics. Int J Numer Method Biomed Eng2017;33:e02790.
17.
GanLPSatkunananthamMSreedharanS, et al. Triquetral fracture with associated pisiform subluxation. Singapore Med J2015;56:e39–e41.
18.
KofmanKESchuurmanAHMulderMC, et al. The pisotriquetral joint: osteoarthritis and enthesopathy. J Hand Microsurg2014;6:18–25.
19.
BeckersAKoebkeJ. Mechanical strain at the pisotriquetral joint. Clin Anat1998;11:320–326.
20.
HelalB. Chronic overuse injuries of the piso-triquetral joint in racquet game players. Br J Sports Med1978;12:195–198.
21.
ShulmanBSRettigMSapienzaA. Management of pisotriquetral instability. J Hand Surg Am2018;43:54–60.
22.
PevnyTRayanGMEgleD. Ligamentous and tendinous support of the pisiform: anatomic and biomechanical study. J Okla State Med Assoc1995;88:205–210.
23.
YamaguchiSViegasSFPattersonRM. Anatomic study of the pisotriquetral joint: ligament anatomy and cartilagenous change. J Hand Surg Am1998;23:600–606.
24.
TheumannNHPfirrmannCWChungCB, et al. Pisotriquetral joint: assessment with MR imaging and MR arthrography. Radiology2002;222:763–770.
25.
VasilasA. Roentgen aspect of injuries to the pisiform bone and pisotriquetral joint. J Bone Joint Surg1960;42:1317–1328.
26.
SugiyamaYNaitoKObataH, et al. Does pisiform subluxation affect the postoperative outcomes in a cohort of patients with distal radius fractures?Ann Med Surg (Lond)2018;35:73–75.
27.
ChaeHDYooHJHongSH, et al. Assessment of pisotriquetral misalignment with magnetic resonance imaging: is it associated with trauma?Eur Radiol2017;27:3033–3041.
28.
BlumAGZabelJPKohlmannR, et al. Pathologic conditions of the hypothenar eminence: evaluation with multidetector CT and MR imaging. Radiographics2006;26:1021–1044.
29.
ConeROSzaboRResnickD, et al. Computed tomography of the normal soft tissues of the wristInvest Radiol1983;18:546–551.
30.
KomuraSYokoiTNonomuraH, et al. Incidence and characteristics of carpal fractures occurring concurrently with distal radius fractures. J Hand Surg Am2012;37:469–476.
31.
JamesonBHRayanGMAckerRE. Radiographic analysis of pisotriquetral joint and pisiform motion. J Hand Surg Am2002;27:863–869.
32.
AmaralLClaessensALFerreirinhaJ, et al. Does ulnar variance change with age and what is the influence of training and biological characteristics in this change? A short-term longitudinal study in Portuguese artistic gymnasts. Clin J Sport Med2014;24:429–434.
33.
ChenWSWangJW. Ageing does not affect ulnar variance: an investigation in Taiwan. J Hand Surg Eur Vol2008;33:797–799.
34.
SandersonPLCameronICHoltGR, et al. Ulnar variance and age. J Hand Surg Br1997;22:21–24.
35.
SayitETanrivermis SayitABagirM, et al. Ulnar variance according to gender and side during aging: an analysis of 600 wrists. Orthop Traumatol Surg Res2018;104:865–869.
36.
FreedmanDMEdwardsGSJrWillemsMJ, et al. Right versus left symmetry of ulnar variance. A radiographic assessment. Clin Orthop Relat Res1998;354:153–158.
37.
GelbermanRHSalamonPBJuristJM, et al. Ulnar variance in Kienböck’s disease. J Bone Joint Surg Am1975;57:674–676.
38.
PalmerAKGlissonRRWernerFW. Ulnar variance determination. J Hand Surg Am1982;7:376–379.
39.
ColemanDABlairWFShurrD. Resection of the radial head for fracture of the radial head. Long-term follow-up of seventeen cases. J Bone Joint Surg Am1987;69:385–392.
40.
LainoDKPetchprapaCNLeeSK. Ulnar variance: correlation of plain radiographs, computed tomography, and magnetic resonance imaging with anatomic dissection. J Hand Surg Am2012;37:90–97.
41.
ShimJIImJHLeeJY, et al. Changes in ulnar variance after a triangular fibrocartilage Complex tear. J Wrist Surg2019;8:30–36.
42.
de VriesJSouerJSZurakowskiD, et al. Measurement of ulnar variance on uncalibrated digital radiographic images. Hand (N Y)2010;5:267–272.
43.
ThuysbaertGRingburgAPetroniliaS, et al. Measurement of ulnar variance and radial inclination on X-rays of healed distal radius fractures. With the axis of the distal radius or ulna?Acta Orthop Belg2015;81:308–314.
44.
KrederHJHanelDPMcKeeM, et al. X-ray film measurements for healed distal radius fractures. J Hand Surg1996;21-A:31–39.
45.
GoldfarbCAStraussNLWallLB, et al. Defining ulnar variance in the adolescent wrist: measurement technique and interobserver reliability. J Hand Surg Am2011;36:272–277.
