Outcome of Distal Radioulnar Joint in Galeazzi Lesions

Abstract

Objective: To evaluate clinical, radiological, and tomographic long-term evolution of the distal radioulnar joint in Galeazzi lesions treated with open reduction and internal fixation of the radius component and indirect reduction of distal radioulnar joint dislocation. Material and Methods: We retrospectively evaluated patients with Galeazzi lesions; the inclusion criteria were patients older than 18 years, treated with open reduction, and internal fixation of radial fracture and nonsurgical reduction of distal radioulnar joint dislocation, with postoperative immobilization in slight supination for 3 weeks. All cases with open reduction of the distal radioulnar joint and follow-up of less than 6 years were excluded. We evaluated pain using the visual analogue scale and Swanson scale; function was assessed by Disabilities of the Arm, Shoulder and Hand (DASH) score. Wrist range of motion—flexion-extension, lateral deviation, and pronosupination—was measured bilaterally with a manual goniometer. Bilateral grip strength was recorded with a Jamar Dynamometer. Distal radioulnar piano key sign was tested bilaterally with the wrist in neutral rotation, maximum pronation, and maximum supination to evaluate joint stability. Bilateral true anterior-posterior (AP) and lateral x-rays were taken at final follow-up; ulnar dorsal subluxation was measured with respect to the radial axis on lateral x-rays. Radial shortening was measured by taking the ulnar variance on AP x-rays. Distal radioulnar joint arthritis signs were classified following Knirk and Jupiter scale. Computed tomography (CT) scans of both wrists were taken in 3 positions—neutral rotation, supination, and pronation. On the axial slices, distal radioulnar joint subluxation was evaluated using the Mino and radioulnar ratio methods. Arthritis signs in the distal radioulnar joint were also recorded. Results: Fourteen patients met the inclusion criteria; average follow-up was 11.5 years (6-18 years). Twelve were male and the mean age at the time of lesion was 38 years (18-59). The final evaluation revealed 9 patients without pain, 3 had pain with heavy tasks, and 2 with moderate efforts. Final pain intensity according to the visual analogue scale was on average 0.3 (0-3). Average DASH was 3 (0-9). Wrist flexion-extension was 98%, lateral deviation 95%, and pronosupination 97%; grip strength was 77%, and 3 patients had piano key sign positive for instability, but none produced pain. All these measurements were recorded comparative to the contralateral wrist. Final lateral x-rays showed one patient with dorsal radioulnar subluxation. However, CT scans showed no cases of distal radioulnar joint subluxation. The average final ulnar variance was 0 mm on the injured side and −0.5 mm on the contralateral wrist. Six patients had radiologic arthritis grade II and 2 had grade I. The remaining 6 patients had no signs of arthritis either in x-rays or CT scans. Conclusions: Clinical and radiological long-term results showed a stable distal radioulnar joint. Even when almost half of the patients had arthritic changes in the distal radioulnar joint on the lesion side, they had no significant clinical repercussions, giving a painless joint with an excellent range of motion.