The role of radiography and computerized tomography in the diagnosis of subluxation and dislocation of the distal radioulnar joint

Mino, David E.; Palmer, Andrew K.; Levinsohn, E. Mark

doi:10.1016/s0363-5023(83)80046-x

Cited by 203 publications

(60 citation statements)

References 9 publications

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“…Secure positioning is essential in this respect. Projection of the pisiform bone over the distal part of the scaphoid indicates a pure lateral view [34,35]. …”

Section: Radiologic Evaluationmentioning

confidence: 99%

Clinical and Non-Clinical Aspects of Distal Radioulnar Joint Instability

Wijffels¹,

Brink²,

Schipper³

2012

TOORTHJ

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Untreated distal radioulnar joint (DRUJ) injuries can give rise to long lasting complaints. Although common, diagnosis and treatment of DRUJ injuries remains a challenge. The articulating anatomy of the distal radius and ulna, among others, enables an extensive range of forearm pronosupination movements. Stabilization of this joint is provided by both intrinsic and extrinsic stabilizers and the joint capsule. These structures transmit the load and prevent the DRUJ from luxation during movement. Several clinical tests have been suggested to determine static or dynamic DRUJ stability, but their predictive value is unclear. Radiologic evaluation of DRUJ instability begins with conventional radiographs in anterioposterior and true lateral view. If not conclusive, CT-scan seems to be the best additional modality to evaluate the osseous structures. MRI has proven to be more sensitive and specific for TFCC tears, potentially causing DRUJ instability. DRUJ instability may remain asymptomatic. Symptomatic DRUJ injuries treatment can be conservative or operative. Operative treatment should consist of restoration of osseous and ligamenteous anatomy. If not successful, salvage procedures can be performed to regain stability.

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“…Secure positioning is essential in this respect. Projection of the pisiform bone over the distal part of the scaphoid indicates a pure lateral view [34,35]. …”

Section: Radiologic Evaluationmentioning

confidence: 99%

Clinical and Non-Clinical Aspects of Distal Radioulnar Joint Instability

Wijffels¹,

Brink²,

Schipper³

2012

TOORTHJ

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“…Bilateral comparison enables assessment of the individual's normal ulnar variance on the uninjured side. Ultrasound, CT, and MRI have been shown to provide accurate information regarding the integrity of the interosseous membrane and confirmation of congruency of the distal radioulnar joint (Mino et al 1983, Starch and Dabezies 2001, Wallace 2002). …”

Section: Discussionmentioning

confidence: 99%

Radial shortening following a fracture of the proximal radius

Duckworth

Watson

Will³

et al. 2011

Acta Orthopaedica

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Background and purposeThe Essex-Lopresti lesion is thought to be rare, with a varying degree of disruption to forearm stability probable. We describe the range of radial shortening that occurs following a fracture of the proximal radius, as well as the short-term outcome in these patients.Patients and methodsOver an 18-month period, we prospectively assessed all patients with a radiographically confirmed proximal radial fracture. Patients noted to have ipsilateral wrist pain at initial presentation underwent bilateral radiography to determine whether there was disruption of the distal radio-ulnar joint suggestive of an Essex-Lopresti lesion. Outcome was assessed after a mean of 6 (1.5–12) months using clinical and radiographic results, including the Mayo elbow score (MES) and the short musculoskeletal function assessment (SMFA) questionnaire. One patient with a Mason type-I fracture was lost to follow-up after initial presentation.Results60 patients had ipsilateral wrist pain at the initial assessment of 237 proximal radial fractures. Radial shortening of ≥ 2mm (range: 2–4mm) was seen in 22 patients (mean age 48 (19–79) years, 16 females). The most frequent mechanism of injury was a fall from standing height (10/22). 21 fractures were classified as being Mason type-I or type-II, all of which were managed nonoperatively. One Mason type-III fracture underwent acute radial head replacement. Functional outcome was assessed in 21 patients. We found an excellent or good MES in 18 of the 20 patients with a Mason type-I or type-II injury.InterpretationThe incidence of the Essex-Lopresti lesion type is possibly under-reported as there is a spectrum of injuries, and subtle disruptions often go unidentified. A full assessment of all patients with a proximal radial fracture is required in order to identify these injuries, and the index of suspicion is raised as the complexity of the fracture increases.

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“…Verkippungen aus der seitlichen Projektion von bereits 10° lassen keine zuverlässige Aussage mehr über eine Subluxation bzw. Dislokation im DRUG zu [35]. …”

Section: Handgelenk Im Streng Seitlichen Strahlengangunclassified

“…Zahlreiche Auswertungsmethoden für das computertomographische schnittbildgende Verfahren wurden veröffentlicht [24,30,35,38,39,40,41]. Die radioulnare Quotientenmethode hat sich im klinischen Alltag als praktikables Verfahren bewährt [3,39].…”

Section: Computertomographische Diagnostikunclassified

Instability of the distal radioulnar joint

Spies¹,

Prommersberger

Langer

et al. 2015

Unfallchirurg

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Injuries of the triangular fibrocartilage complex (TFCC) may be fatal to the distal radioulnar joint (DRUJ). This structure is one of the crucial stabilizers and guarantees unrestricted pronosupination of the forearm. A systematic examination is mandatory to diagnose DRUJ instability reliably. A clinical examination in comparison to the contralateral side is obligatory. Plain radiographs are required to exclude osseous lesions or deformities. Computed tomography of both wrists in neutral, pronation and supination is necessary to verify DRUJ instability in ambiguous situations. Based on a systematic examination wrist and DRUJ arthroscopy identify lesions clearly. Injuries of the radioulnar ligaments which entail DRUJ instability, should be reconstructed preferably anatomically. Ulnar-sided TFCC lesions may often cause DRUJ instability. Osseous ligament avulsions are mostly treated osteosynthetically. Ligament tears may be refixated using anchor or transosseous sutures. Tendon transplants are necessary for an anatomical reconstruction in cases of irreparable ruptures.

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The role of radiography and computerized tomography in the diagnosis of subluxation and dislocation of the distal radioulnar joint

Cited by 203 publications

References 9 publications

Clinical and Non-Clinical Aspects of Distal Radioulnar Joint Instability

Clinical and Non-Clinical Aspects of Distal Radioulnar Joint Instability

Radial shortening following a fracture of the proximal radius

Instability of the distal radioulnar joint

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