Dislocation of the distal radioulnar joint is a rare injury pattern. There is little in the English literature describing this injury and even less to direct treatment. We present the case of a patient with an irreducible dislocation of the distal radioulnar joint and discuss the pathoanatomy and operative treatment. In addition, we describe a novel radiographic and clinical finding of an ulnar impaction fracture, which we equate to the Hill-Sachs lesion noted in the humeral head following dislocation of the shoulder. Our patient was informed that data concerning the case would be submitted for publication. Aforty-year-old, right-hand dominant man presented to the emergency department immediately following a work-related injury. The patient had pain in the right wrist and lack of forearm rotation. In an attempt to catch a bag of cement that was thrown down from a truck, he struck the dorsum of the right wrist, which was supporting the 50-lb bag, against the right knee. The patient had no medical or surgical history that was relevant to the injury, nor had he sustained any previous injuries to the right forearm, wrist, or hand. On physical examination, the patient was only able to rotate the forearm between 30° and 80° with the right wrist held in a position of supination. There was loss of the dorsal prominence of the ulnar head, which was instead palpable on the volar side. The wrist was moderately swollen, tender to palpation, and painful with attempted pronation. The patient had no elbow or forearm pain. The skin and the neurovascular function, specifically including ulnar nerve function, were intact. Initial radiographs were made. The posteroanterior radiograph demonstrated an overlap of the radius and ulna at the distal radioulnar joint (Fig. 1-A), and a true lateral radiograph demonstrated volar displacement of the ulna with respect to …
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