Patterns of subchondral bone mineralization in the distal radioulnar joint

Purpose: Studies have shown that it is possible to derive direct knowledge about the actual mechanical conditions of the wrist by analyzing the subchondral mineralization. The aim of the present study was to evaluate the distribution of the subchondral bone mineralization of the distal radioulnar joint (DRUJ) noninvasively in living subjects by using computed tomography (CT) osteoabsorptiometry to gain new information about the long-term loading conditions. Methods: Twenty-two wrist joints were investigated in 11 healthy young subjects by means of CT osteoabsorptiometry. The CT scans of the DRUJ were taken in the axial plane in neutral position of the forearm and in both maximum pronation and supination. The CT datasets of 1.5-mm sections were obtained and then transferred to an image-analyzing system. The subchondral bone plate in each section was isolated, reconstructed in 3 dimensions, and converted into a false color series. Results: The maximum subchondral bone density in the sigmoid notch of the radius was found along the distal border in all wrists. It was located dorsally in 10 wrists, palmarly in 8 wrists, and centrally in 4 wrists. The maximum bone density on the corresponding articular surface of the ulna was found dorsally in 10 cases, centrally in 8 cases, and palmarly in 4 cases. In 13 cases the maximum bone density was found in direct opposition on radius and ulna in neutral position. A statistically significant difference could not be detected in subjects with an ulna minus variance nor in those with a DRUJ angulation greater than 10°. Conclusions: Our results show that in the sigmoid notch the load is transmitted through either the dorsal or palmar parts of the joint. In contrast the maximum bone density on the side of the ulna was found dorsally and centrally. We conclude that the ulna receives the maximum load in neutral position and supination, whereas because of the dorsopalmar translation of the ulnar head the radius may lead the ulna with either its palmar or dorsal borders during pronosupination. The ligamentous apparatus, the shape of the joint, and the ulna variance, however, may influence load transmission.