The distal radioulnar joint after distal radial fractures: when and how do we need to treat pain, stiffness or instability?

Abstract

The importance of distal radioulnar joint problems associated with distal radial fractures is recognized increasingly. But there remains considerable disagreement about how to treat these problems both acutely and chronically. This review outlines the knowledge about the natural history of ulnar-sided wrist problems with distal radials fractures. In particular, the recent increased understanding of the almost inevitable joint instability associated with distal radial fractures is highlighted, including the unreliability of clinical assessment and hence why there has been so much misunderstanding. Provided there is reasonable bony alignment, most ulnar-sided wrist problems can be treated non-operatively initially (typically for over a year) in anticipation of substantial improvement with time. The exception is early marked subluxation of the distal radioulnar joint (DRUJ) blocking forearm rotation, which needs urgent (typically closed) reduction.

A proposed paradigm shift in the management of distal radius fractures

“… 19 Admittedly, reduced pronosupination (particularly supination) can occur after DRFs due to the above-mentioned reasons, but most patients regain sufficient functional range of motion over time. 20 There is no clear consensus on how best to address these issues and it is reasonable to start with standard conservative treatment strategies, such as activity modifications, splints or straps, analgesics and physiotherapy. A variety of surgical management options, depending on the aetiology, have been introduced over time without clear superiority of the available techniques.…”

“…A variety of surgical management options, depending on the aetiology, have been introduced over time without clear superiority of the available techniques. 20 …”

Analyzing the reduction quality of the distal radioulnar joint after closed K-wire transfixation in a cadaver model: is supination or neutral position superior?

“…Yet controversy remains as to whether it should be done in supination or neutral position. [ 1 , 7 , 8 , 10 , 25 – 36 ].…”

“…Distal radioulnar joint (DRUJ) instability is a common and challenging injury [1]. Although they occur in up to 10-40% of distal radius fractures (DRF) clinical diagnosis is still often missed, and chronic ulnar-sided pain and impaired function occur [2][3][4][5][6].…”

“…Yet controversy remains as to whether it should be done in supination or neutral position. [1,7,8,10,[25][26][27][28][29][30][31][32][33][34][35][36].…”