Distal radioulnar joint instability: current concepts of treatment

Abstract

Distal radioulnar joint (DRUJ) instability is often an underestimated or missed lesion which may entail fatal consequences. The triangular fibrocartilage complex is a biomechanically very important stabilizer of the DRUJ and guarantees unrestricted range of motion of the forearm. To detect DRUJ instability a systematic examination is of uppermost importance. The contralateral healthy arm will be used for comparison during clinical examination. X-rays are required to exclude osseous lesions or deformities. Computed tomography of both wrists in neutral forearm rotation, supination, and pronation may be necessary to verify DRUJ instability in ambiguous situations. Following a systematic clinical examination wrist and DRUJ arthroscopy detects lesions definitely. Tears of the distal radioulnar ligaments which entail DRUJ instability should be repaired preferably anatomically. Ulnar-sided ligament ruptures which cause instability are detected more often than radial-sided ones. Osseous ligament avulsions are mostly refixated osteosynthetically. Ligamentous tears of the distal radioulnar ligaments may be reconstructed using anchor suture or transosseous refixation. Secondary procedures such as tendon transplants are necessary for anatomical reconstruction in cases of unrepairable ligament tears.

Biomechanical considerations on a CT-based treatment-oriented classification in radius fractures

“…They were partly used in combination with external fixation. However, secondary dislocation still occurred [9][10][11][12][13][14], that necessitated correction and salvage procedures [15][16][17][18][19][20][21][22][23][24][25][26][27].…”

Ulnar shortening osteotomy as a treatment of symptomatic ulnar impaction syndrome after malunited distal radius fractures

“…Exclusion of other sources of ulnocarpal pain, such as pisotriquetral osteoarthritis, distal radioulnar joint (DRUJ) instability or osteoarthritis or ECU tendinitis, should be taken into consideration [58]. An examination of stability of the DRUJ compared to the contralateral side should always be performed [63].…”

Arthroscopic assisted treatment of distal radius fractures and concomitant injuries

“…• Intra-articular DRFs with an impacted central fragment to evaluate correct fragment reduction. • Intra-articular DRFs with an unstable, DRUJ for TFCC assessment [20]. • Galeazzi type DRFs with a loss of radial length of > 6 mm.…”

“…The importance of TFCC tears and DRUJ instability is explained in a separate chapter within this journal. Therefore, the authors will not discuss any details in this manuscript [20].…”