Dataset Information

Imaging Findings of the Distal Radio-Ulnar Joint in Trauma.

ABSTRACT: Traumatic lesions of the distal radio-ulnar joint (DRUJ) occur frequently in conjunction with fractures of the distal radius. They are a common cause of pain and limited range of motion after distal radial fractures. Due to the complex anatomy they are however often ignored or underappreciated. Distal radial fractures and luxations of the DRUJ often disturb the normal curvature of the radial notch and cause damage to the cartilage of this joint. The growth of the radius may be disrupted, resulting in a positive ulnar variance, and possibly give rise to complications such as ulnar abutment and motion restriction. Ulnar styloid fractures - sometimes barely visible on plain film - may give rise to symptomatic bony pseudarthrosis, dislocation and laceration of the tendon of the m. extensor carpi ulnaris and a rare posttraumatic deformity of the ulnar epiphysis. Also the possibility of lesions at the adjacent triangular fibrocartilage complex and the joint capsule should be kept in mind. This paper presents a pictorial review of the complex functional anatomy and pathologic conditions of this joint and emphasises why the DRUJ should be evaluated independently and thoroughly. The merit of each imaging modality is mentioned. A correction article relating to Fig. 2 and Fig. 27 can be found here: http://dx.doi.org/10.5334/jbr-btr.966.

SUBMITTER: Mespreuve M

PROVIDER: S-EPMC6032773 | biostudies-other | 2015 Sep

REPOSITORIES: biostudies-other

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Imaging Findings of the Distal Radio-Ulnar Joint in Trauma.

Mespreuve M M Vanhoenacker F F Verstraete K K

Journal of the Belgian Society of Radiology 20150915 1

Traumatic lesions of the distal radio-ulnar joint (DRUJ) occur frequently in conjunction with fractures of the distal radius. They are a common cause of pain and limited range of motion after distal radial fractures. Due to the complex anatomy they are however often ignored or underappreciated. Distal radial fractures and luxations of the DRUJ often disturb the normal curvature of the radial notch and cause damage to the cartilage of this joint. The growth of the radius may be disrupted, resulti ...[more]

PMID: 30039059

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Project description:RationaleHabitual volar dislocation of the ulnar head with a locked distal radioulnar joint (DRUJ) is a rare complication after distal radius fracture. We present a case of habitual volar dislocation of the ulnar head in a woman with a dorsally displaced malunited distal radius fracture.Patient concernsA 72-year-old woman presented with occasional painful locking of the forearm in full supination. She had fractured the left distal radius in a fall 6 months previously. The fracture had been treated non-surgically with wrist immobilization in a long and short arm cast for 6 weeks. Physical examination showed no swelling of the left hand. The wrist locked when the forearm was fully supinated, and the patient was not able to pronate her forearm without reducing the ulna by pressing the left ulna down toward the DRUJ. She experienced sharp pain during the reduction procedure and pronation of the left forearm. The affected wrist had 91% motion compared with the contralateral wrist.DiagnosisRadiography and computed tomography showed 28° dorsally angulated malunion of the distal radius and ulnar head subluxation with respect to the radius. Magnetic resonance imaging revealed disruption of the ulnar-side triangular fibrocartilage complex (TFCC) from the ulna fovea.InterventionsThe patient desired surgery to address the painful click during full supination of her left wrist and the limitations in her activities of daily living. Corrective osteotomy of the distal radius and arthroscopic repair of the ulnar-side tear of the TFCC were performed. The TFCC was arthroscopically repaired to the ulnar fovea to stabilize the DRUJ.OutcomesAt 1 year postoperatively, radiography showed complete union of the radius. The affected side had 97% wrist motion compared with the contralateral wrist and a full range of forearm rotation without pain or clicking. The grasp strength was 100% compared with the normal wrist.LessonsMalunited distal radius fracture with concomitant TFCC injury can result in habitual volar dislocation of the ulnar head due to severely dorsally angulated malunion of the radius and avulsion of the ulnar-side TFCC from the ulna fovea. This condition required corrective osteotomy plus TFCC repair.

Dataset Information

Imaging Findings of the Distal Radio-Ulnar Joint in Trauma.

Publications

Imaging Findings of the Distal Radio-Ulnar Joint in Trauma.

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