J Korean Soc Surg Hand.  2014 Jun;19(2):70-78. 10.12790/jkssh.2014.19.2.70.

Acute Dislocation of Distal Radioulnar Joint

• Han SH
• Lee HJ

• KMID: 2097612
• DOI: http://doi.org/10.12790/jkssh.2014.19.2.70

Abstract

Traumatic injuries of the distal radioulnar joint (DRUJ) is important problem that requires special consideration for treatment to prevent disability arising from failure to the diagnosis, treatment, and rehabilitation. Stability of the DRUJ is provided by a combination of bony and soft tissue architecture. The bony architecture of the DRUJ account for only 20% of the DRUJ stability and soft tissues including triangular fibrocartilage complex (TFCC), pronator quadratus, and interosseous membrane give major role on the stability. TFCC is generally accepted as the most essential soft tissue stabilizer of the DRUJ. Acute dislocation of DRUJ injury is commonly associated with forearm fractures but it occurs as an isolated injury even though it is relatively rare. DRUJ injury is the one of main source of chronic wrist pain, instability and the focus of this article is on acute dislocation injury of DRUJ and their management.

Keyword

Distal radioulnar joint; Acute dislocation

MeSH Terms

Diagnosis
Dislocations*
Forearm
Joints*
Membranes
Rehabilitation
Triangular Fibrocartilage
Wrist

Figure

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  Fig. 1. (A) Dorsal side of distal radioulnar joint (DRUJ) and dorsal radioulnar ligament. (B) Coronal section of DRUJ and triangular fibrocartilage complex.

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  Fig. 2. (A) Dorsal protruded ulnar head. (B) Limitation of supination of the injured right side. (C) Posterior dislocation of the ulnar head on the lateral radiograph.

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  Fig. 3. Sequence of reduction and repair of impinged triangular fibrocartilage complex.

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  Fig. 4. (A) Distal radioulnar joint dislocation with prominent ulnar head and supination limitation. (B) Open reduction and repair of injured triangular fibrocartilage complex and capsule. (C) Reduced ulnar head and regained supination.

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  Fig. 5. (A) Displaced large fragment of ulnar styloid. (B) Reduction and fixation of the fragment and reduced distal radioulnar joint.

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  Fig. 6. (A, B) Galeazzi injury: fracture on the distal shaft of radius with distal radioulnar joint dislocation.

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  Fig. 7. (A) Multiple fractures with distal radioulnar joint (DRUJ) dissociation. (B) Union of fractures and stable DRUJ after open reduction and fixation. (C) Recovery of forearm and wrist motion.

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  Fig. 8. (A, B) Stable fixation of distal radius fracture and remained instability of distal radioulnar joint.

Reference

References

1. Aulicino PL, Siegel JL. Acute injuries of the distal radioulnar joint. Hand Clin. 1991; 7:283–93.

2. Bruckner JD, Alexander AH, Lichtman DM. Acute dislocations of the distal radioulnar joint. Instr Course Lect. 1996; 45:27–36.

3. Murray PM, Adams JE, Lam J, Osterman AL, Wolfe S. Disorders of the distal radioulnar joint. Instr Course Lect. 2010; 59:295–311.

4. Henry MH. Management of acute triangular fibrocartilage complex injury of the wrist. J Am Acad Orthop Surg. 2008; 16:320–9.

5. Carlsen BT, Dennison DG, Moran SL. Acute dislocations of the distal radioulnar joint and distal ulna fractures. Hand Clin. 2010; 26:503–16.

6. Garrigues GE, Sabesan V, Aldridge JM 3rd. Acute distal radioulnar joint instability. J Surg Orthop Adv. 2008; 17:262–6.

7. Lichtman DM, Joshi A. Acute injuries of the distal radioulnar joint and triangular fibrocartilage complex. Instr Course Lect. 2003; 52:175–83.

8. Mulford JS, Axelrod TS. Traumatic injuries of the distal radioulnar joint. Orthop Clin North Am. 2007; 38:289–97.

9. Mikic ZD. Treatment of acute injuries of the triangular fibrocartilage complex associated with distal radioulnar joint instability. J Hand Surg Am. 1995; 20:319–23.

10. Nicolaidis SC, Hildreth DH, Lichtman DM. Acute injuries of the distal radioulnar joint. Hand Clin. 2000; 16:449–59.

11. Szabo RM. Distal radioulnar joint instability. Instr Course Lect. 2007; 56:79–89.

12. Kim JK, Yi JW, Jeon SH. The effect of acute distal radioulnar joint laxity on outcome after volar plate fixation of distal radius fractures. J Orthop Trauma. 2013; 27:735–9.

13. Kim JP, Park MJ. Clinical assessment of the distal radioulnar joint instability after treatment of intra-articular fractures of the distal radius using computed tomography. J Korean Orthop Assoc. 2005; 40:252–9.