Distal radioulnar joint disruption

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Background

  • Seen with intra-articular or distal radial shaft fractures or both bone fracture

Clinical Features

  • Easy to miss due to concomitant injuries
  • Painful pronation or supination of wrist/forearm, possible crepitus
  • Prominent or displaced ulnar styloid

Differential Diagnosis

Distal radius fractures

Evaluation

Imaging

  • PA
    • Narrowing and overlap of distal radioulnar joint
  • Lateral
    • Volar or dorsal displacement of ulna (which is usually centered/overlapping the radius)
    • Requires a true lateral to avoid a false positive result
  • Consider forearm radiographs to evaluate for Galeazzi fracture-dislocation and Essex Lopresti

Radiographic signs of instability[1]

  • Radial shortening
  • Fracture of the sigmoid notch of radius
  • Fracture of ulnar styloid base with >2mm displacement

Management

  • Dorsal dislocation
    • Immobilize wrist in supination
  • Volar dislocation
    • Immobilize wrist in pronation

Disposition

See Also

References

  1. ↑ German C. Hand and wrist emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.