Distal radioulnar joint disruption


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



  • 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


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


  • Outpatient with ortho followup

See Also


  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.