Distal radioulnar joint disruption: Difference between revisions

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==Background==
==Background==
*Seen w/ intra-articular or distal radial shaft fractures or both bone fracture
*Seen with intra-articular or [[distal radius fractures|distal radial shaft fractures]] or [[Radia ulna fracture|both bone fracture]]


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


==Differential Diagnosis==
===Radiographic signs of instability<ref name="Hand and wrist emergencies">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.</ref>===
{{Distal radius fracture DDX}}
*Radial shortening
*Fracture of the sigmoid notch of radius
*Fracture of ulnar styloid base with >2mm displacement


==Management==
==Management==
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*Volar dislocation
*Volar dislocation
**Immobilize wrist in pronation
**Immobilize wrist in pronation
==Disposition==
*Outpatient with ortho followup


==See Also==
==See Also==
*[[Distal radius fractures]]
*[[Distal radius fractures]]


==Source==
==References==
*Tintinalli
<references/>


[[Category:Orthopedics]]
[[Category:Orthopedics]]

Latest revision as of 16:30, 27 October 2017

Background

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

Distal radius fracture eponyms

Eponyms Description
Barton's Fracture-dislocation of radiocarpal joint (with intra-articular fracture involving the volar or dorsal lip)
Chauffer's Fracture of radial styloid
Colles' Dorsally displaced, extra-articular fracture
Die-punch Depressed fracture of the lunate fossa (articular surface)
Smith's Volar displaced, extra-articular fracture

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

  • Outpatient with ortho followup

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.