Morphology at the Distal Radioulnar Joint: Identifying the Prevalence of Reverse Obliquity

Background  Recent advances in the understanding of ulnar-sided wrist pathologies such as ulnar abutment syndrome (UAS) have brought increased attention to the anatomy of the distal radioulnar joint (DRUJ). Previous work established three anatomical variants of the sigmoid notch (parallel, oblique, and reverse oblique). The reverse oblique DRUJ poses theoretical risk of increased contact forces following ulnar shortening osteotomy, a common method of treating UAS. Purpose  As prevalence of reverse oblique morphology has been under-reported, this study aims to better define the prevalence of reverse oblique morphology in the adult population. Methods  Institutional Review Board-approved review of 1,000 radiographs over a 2-year period was performed. Demographic data and radiographic measurements were recorded (ulnar variance, notch inclination, and presence of arthritis). Correlation tests, a test of proportions, a t -test, and linear and logic regression tests were used to examine associations between ulnar variance, sigmoid inclination, sex, age, and presence of arthritis. Results  One thousand radiographs were analyzed revealing prevalence rates of: parallel-68%, oblique-26%, and reverse oblique-6%. Females were significantly more likely to have reverse inclination. No significant correlation was noted for morphology by age. Ulna positive variance was negatively correlated with reverse inclination. DRUJ arthritis was noted in 14% of patients. Higher sigmoid inclination was associated with higher odds of presence of arthritis, adjusting for sex and age. Higher incidence of arthritis was noted among patients with the oblique (20.8%) or reverse oblique (24.6%) compared with parallel (10.5%) morphology. Conclusion  This series of 1,000 radiographs demonstrates a 6% overall prevalence of reverse obliquity. This large dataset allows for better quantification of the prevalence of DRUJ morphologies and determination of correlations that have clinical implications for patients with ulnar-sided wrist pathology. Level of Evidence  This is a Level IV study.