Dislocation Of Distal Radioulnar Joint Research Articles

Volar distal radioulnar joint dislocation: A case report and literature review

Volar distal radioulnar joint dislocation: A case report and literature review

Case report of Galeazzi like fracture associated with fracture of the scaphoid, Rolando fracture and avulsion of the inserting site of the extensor carpi ulnaris

Introduction: Galeazzi fracture is a fracture of the distal third or medial third of the ulnar shaft associated with distal radioulnar joint dislocation. These lesions can be accompanied with others lesions. Case presentation: 21 years old male victim of motorcycle slide with a Galeazzi like fracture accompanied with a fracture of the scaphoid, first and fifth metacarpal and which was treated surgically. Discussion: Galeazzi fracture present the third of the fractures of the radius, the mechanism combines axial loading with excessive rotation. It’s fracture of necessity nonsurgical treatment yields a poor result. Conclusion: for our patient the mechanism suggests an axial loading with excessive pronation trained by the handlebar of the motorcycle.

Mini-invasive Indirect Distraction in the Treatment of Neglected DRUJ Dislocations—A Novel Surgical Technique

Abstract Introduction: This study presents mini-invasive indirect distraction in the treatment of neglected distal radioulnar joint (DRUJ) dislocations as a novel surgical technique. Pure DRUJ dislocation is a rare injury caused by over rotation of the forearm. It is often undiagnosed in an acute setting. There is no consensus on the treatment of neglected dislocations. Materials and methods: We present a group of six patients with neglected pure DRUJ dislocation, treated by a single surgeon between 2012 and 2019. Results: Closed reduction was impossible in six of six patients. The indirect distraction allowed the reduction of the DRUJ in all cases with final stable DRUJ. Forearm rotation returned to normal in four patients, one patient had 50%, and another patient had 60% of the range of forearm. Mean pain dropped from 7 to 0.8 on visual analog scale. At the 2-year follow-up, the mean Disabilities of the Arm, Shoulder, and Hand score was 8 (0–37.5), and minor degenerative X-ray changes were observed in four patients. Level of evidence IV

Two-week versus four-week immobilization of stable distal radioulnar joint following surgical fixation of Galeazzi fracture-dislocations: A randomized controlled trial

BackgroundPostoperative immobilization protocols following surgical fixation of Galeazzi fracture-dislocations (GFD) in adults remain unresolved. This study aimed to compare outcomes of two different immobilization durations (two weeks versus four weeks) in terms of functional outcomes and complications. MethodsParticipants were prospectively and randomly enrolled in two-week versus four-week immobilization after plate fixation of GFD when the distal radioulnar joint (DRUJ) was reducible and stable postoperatively. Immobilization involved an above-elbow splint with the forearm in full supination. Demographic data, including age, gender, mechanism of injury, fracture characteristics, and treatment approach, were recorded. The primary outcome was the abbreviated version of the Disability of Arm, Shoulder, and Hand (DASH) scores at three months post-operation. Secondary outcomes included wrist range of motion, mean grip strength differences between injured and uninjured sides, and complications. ResultsA total of 54 participants were enrolled and randomized into two treatment groups. Demographics were similar between groups, with most participants being male, and the mean age was 35 years (range 18–65). Fractures were generally less than 10 cm. The mean DASH scores were slightly higher in the four-week immobilization group but not statistically significant (1.43 in the two-week immobilization group vs. 2.36 in the four-week immobilization group, p = 0.152). Range of motion and mean grip strength differences were similar between groups. Complication rates were also similar, with recurrent DRUJ dislocation occurring in two participants from each group. ConclusionThis study found no significant differences in functional outcomes and complications between two-week and four-week immobilization durations after plate fixation of GFD when the DRUJ was reducible and stable postoperatively. Level of evidenceTherapeutic Level I.

Management of Polytrauma Patient in a Limited Setting : A Case report

Polytrauma patients with multiple fractures present a significant challenge in limited resources settings. The application of damage control orthopedics (DCO) principles, including temporary stabilization, staged definitive fixation, and multidisciplinary collaboration, resulted in favorable outcomes for the patient. This case report describes the successful management of a polytrauma patient who sustained multiple injuries, including unstable pelvic fracture and fractures of the femur, radius, shoulder dislocation, and distal radio-ulnar joint dislocation. This report emphasizes the importance of timely intervention and resource optimization in limited settings.

Anatomic and Biomechanical Study of the Forearm Interosseous Membrane, Distal Oblique Bundle, and Triangular Fibrocartilage Complex: Role in Galeazzi Fracture Dislocation

The purpose of this study was to measure distal radioulnar joint (DRUJ) dislocation and radioulnar displacement associated with sequential sectioning of the different bands of the interosseous membrane and triangular fibrocartilage complex in the simulation of a Galeazzi fracture dislocation. Twelve fresh-frozen cadaver forearms were dissected. We examined the anatomy and function of the forearm interosseous membrane. Each forearm was then mounted onto a biomechanical wrist and forearm device. In the control group, radial osteotomy was performed and the degree of DRUJ displacement with progressive loads was measured. In addition to radial osteotomy, in group 1, the central band (CB) was sectioned; in group 2, the CB, distal membranous portion of the interosseous membrane, and distal oblique bundle were sectioned; and in group 3, the CB, distal membranous portion of the interosseous membrane, distal oblique bundle, and triangular fibrocartilage complex were sectioned. The radioulnar displacement (mm) at 25 N, 50 N, and 75 N was recorded. In group 1, applying progressive loads resulted in an average DRUJ displacement of 4.3, 5.9, and 7.9 mm, respectively. In group 2, the displacement was 5.2, 5.7, and 6.9 mm, respectively. In group 3, the displacement was 6.2, 8.1, and 9.9 mm, respectively. Our study showed a correlation between increase in the load applied to the same injury and the degree of displacement (P= .001). In group 3, the degree of DRUJ displacement was statistically increased compared to the other groups (P= .04). Migration of the radius under loads implies disruption of both the CB and triangular fibrocartilage complex. The distal oblique bundle by itself does not seem to have a relevant role in radioulnar displacement at the DRUJ. This study provides insights into the interosseous membrane and stability of the DRUJ, which can contribute to a better understanding of Galeazzi fracture-dislocations.

Late Distal Radio-Ulnar Joint Instability after Childhood Distal Forearm Fracture

Introduction: Paediatric distal radius fractures are considered benign, and associated ulnar styloid injury is mostly ignored. Although a significant portion evolves to non-union, only a minority present associated complications such as ulnar pain, ulnocarpal abutment, or distal radio-ulnar instability. Distal radio-ulnar dislocations are rare and point to failure of the stabilizing mechanisms of this joint, warranting urgent reduction. Case Report: 18-years old male presents to the emergency department with a volar distal radio-ulnar joint dislocation after a twisting motion of the left wrist. Patient was submitted to urgent closed reduction under general anesthesia and cast immobilization, and surgical repair of ulnar styloid non-union and triangular fibrocartilage complex tear was performed 1 week later. At 6 months follow up the patient as achieved pain free full mobility without instability. Conclusion: The triangular fibrocartilage complex and distal radio-ulnar joint may be affected by seemingly benign injuries, later presenting with acute complications. Fracture and subsequent non-union of the ulnar styloid in the setting of a distal radius fracture is common and underdiagnosed, but clinical significance of and optimal treatment of this injury are still undefined.

Fixed Subluxation of the Distal Radioulnar Joint following Malunion of the Ulnar Styloid Process.

Purpose Recent literature on significance and treatment of ulnar styloid fractures suggest that the ulnar styloid is not the central problem but the radioulnar ligaments and their impact on joint stability. However, specifically displaced ulnar styloid process fractures that secondarily heal in an ectopic position remain a rare situation for which diagnostics and treatment options remain a topic of discussion. Methods This case series presents four patients with limited supination due to a fixed dorsal subluxation of the distal radioulnar joint (DRUJ). The reason here fore was a significant malunion of ulnar styloid fracture that was addressed by corrective ulnar styloid osteotomy. Three of these osteotomies used three-dimensional (3D) preoperative planning and patient specific guides. Results All patients presented with a significant displacement of the malunited ulnar styloid fracture (average 32-degree rotation and 5-mm translation). In all four patients, the fixed subluxation of the ulnar head was resolved clinically and radiographically, and the forearm rotation restored after corrective osteotomy of the ulnar styloid and fixation in an anatomical position. Conclusion This case series presents a very specific subset of patients with nonanatomically healed ulnar styloid fractures responsible for a chronic DRUJ dislocation and limited prosupination and its treatment. Level of evidence This is a Level IV, therapeutic study.

Case report: Isolated acute dorsal distal radioulnar joint (DRUJ) dislocation.

IntroductionIsolated acute distal radioulnar joint (DRUJ) dislocation is a rare injury that should be early recognized and treated promptly to avoid the limitation and disability associated with delayed diagnosis and management.Case presentationWe present a patient with a traumatic dorsal isolated DRUJ dislocation who was successfully treated with a closed reduction and k-wire pinning along with cast immobilization.DiscussionPrevious reports of distal radioulnar joint dislocation have described the mechanics of this injury as well as a guidance to diagnosis and treatment. Closed reduction, stabilization of wrist joint, and early mobilization of elbow joint can help in preserving the joint function and a faster recovery.ConclusionClosed reduction under general anesthesia, DRUJ stabilization by k-wire pinning, and above elbow casting can be successful in most cases. We recommend an early transition to below elbow cast to encourage early elbow range of motion and prevent joint stiffness.

Management of chronic palmar distal radio-ulnar joint (DRUJ) dislocation of wrist: A case report on young gymnast with one year follow up

Background: A palmar dislocation of distal radio-ulnar joint (DRUJ) is rare and causes gross functional restriction of pronation. It is certainly major cosmetic concern for the patient as keeps the forearm supinated because of dislocation. Usually, such injuries are caused due to high velocity trauma and fall on supinated hand. The literature is sparse on the management of palmar dislocation of DRUJ. Materials and Methods: We present a case report on the management of chronic palmar dislocation in a 27-year-old professional gymnast trainer with 1-year follow-up. We describe the surgical technique of open reduction by palmar approach and reconstruction of triangular fibrocartilage complex ligament by suture anchor. The post-operative rehabilitation protocol is also mentioned in detail. Results: The patient has 80° pronation and painless wrist range of movements at 1-year follow-up. She is able to perform all activities of daily living though not confident in weight bearing on affected wrist. Conclusion: As per our knowledge, this is described for the 1st time about the management of chronic palmar DRUJ case in young gymnast. The restricted pronation is important sign of palmar DRUJ dislocation. The return of pronation gives immense satisfaction to the patient.

Minimally invasive stabilization of an isolated dorsal distal radioulnar joint dislocation using a suture button suspension system

Minimally invasive stabilization of an isolated dorsal distal radioulnar joint dislocation using a suture button suspension system

157 Non-Surgical Management of an Acute Isolated Volar Dislocation of the Distal Radio-Ulnar Joint

Abstract Isolated distal radio-ulnar joint dislocations are rare and commonly missed on radiographs. A young male presented with severe pain and deformity of the left wrist, following a collision whilst playing rugby. This was easily diagnosed using plain radiographs, and the initial attempted reduction methods in the Emergency Department failed. The patient was subsequently anaesthetised in theatre, yet reduction by an accepted method of palmar to dorsal pressure over the interosseous membrane with simultaneous distraction of the wrist failed. A further attempt to manipulate the dislocated ulnar head was successful, with the same force applied whilst the wrist was maximally flexed and pronated – thereby avoiding an open reduction. The patient was asymptomatic at final follow-up, over one year later. This technique has not previously been described in the literature and may be used in similar injuries in the future.

Application of Suspension Fixation with Button Plates for Patients with Distal Radioulnar Joint Dislocation: A Case Series.

ObjectiveThe aim of the present study was to assess the effect of suspension fixation with button plates on the reconstruction of the distal radioulnar joint dislocation (DRUJ).MethodsThis was a case series of six patients (two men and four women) who underwent suspension fixation with button plates for DRUJ dislocation between January 2015 and May 2017. Physical examination, radiography, MRI, functional activity of the wrist joint, grip strength of the wrist joint, Garland–Werley wrist score, Mayo wrist score, and visual analog scale (VAS) score were used to evaluate the effect of this procedure. All patients were followed up every 3 months. The evaluation time point was 12 months after the operation. Comparisons of the functional indexes of wrist function before and after the operation were performed using paired statistical tests.ResultsThe mean range of motion of the affected limb was 70° at forearm pronation and 75° at forearm supination. The subjective assessments and tests of the motor function of the wrist showed improvement after surgery. The Garland–Werley wrist score was 13.50 ± 2.66 preoperatively, the Mayo wrist score was 56.67 ± 18.35, and the VAS score was 4.83 ± 1.17. The Garland–Werley wrist score was 2.83 ± 1.33 postoperatively at 12 months, the Mayo wrist score was 87.5 ± 6.89, and the VAS score was 0.50 ± 0.55. At 12 months, the Garland–Werley wrist score, the Mayo wrist score, and the VAS score showed significant improvements when compared with those before surgery (P = 0.000, P = 0.003, and P = 0.000, respectively). Radiographic examination revealed that the internal fixation device was in place, and no dislocation of the DRUJ could be observed. None of the patients had internal fixation device removal or re‐dislocation of the DRUJ. None of the patients had re‐dislocation of the DRUJ. No secondary ulnar or radial fractures and nerve injury were reported during and after surgery. No tumor recurrence was observed in patients with giant cell tumors of the tendon sheath. No loosening and displacement of screws were reported.ConclusionThe new method of suspension fixation with button plates for the surgical reconstruction of a DRUJ dislocation is simple, with minimal trauma, and maintains the stability of the DRUJ without the need for intra‐articular or extra‐articular reconstruction of the ligament. Furthermore, it allows early functional exercise and achieves satisfactory postoperative functional recovery.

Isolated Volar Distal Radioulnar Joint Dislocation, a Very Rare and Easily Missed Injury.

Background: Isolated distal radioulnar joint (DRUJ) dislocations without associated fracture are very rare entities. A few mechanisms of injury were reported in the literature with dorsal(posterior) dislocation being more common than the volar (palmar, anterior) dislocation.
 Case report: A 26-year-old male, manual laborer presented to our emergency department (ED) 24 hours post-self-inflected injury with right wrist pain, deformity, and decreased range of motion (ROM). The physical examination showed bruising over the dorsal ulnar side of the wrist, loss of the ulnar styloid bony prominence, abnormal volar fullness of the wrist, and gutter deformity on the dorsal aspect of the distal forearm and wrist. The diagnosis was confirmed by comparative radiographs which were followed by closed reduction and immobilization in the below-elbow cast in pronation for 4 weeks.
 Conclusion: Timely accurate diagnosis and conservative treatment with favorable outcome necessitate a proper history on the mechanism of injury with a thorough physical examination, accurate radiographic positioning, and true lateral view.

Clinical, functional and radiological outcomes of volar locked plating of distal radius fracture: A prospective study

Background: The fracture of lower end radius is the most common fracture of the upper extremity encountered in practice and constitutes 10 to 20% of all the fractures and 75% of all forearm fractures. In spite of various new advances, closed reduction and cast immobilization has been the mainstay of treatment of these fractures, but malunion of fracture and subluxation /dislocation of distal radioulnar joint resulting in poor functional and cosmetic results is the usual outcome. Recently, the volar locked plate osteosynthesis is considered as the “gold standard” in treatment of ‘unstable’ distal radius fractures. The present study proposed to evaluate the role of volar locking plate fixation in the management of intra-articular and extra-articular volar fractures of distal end radius and to evaluate the clinical, functional and radiological outcomes.Aim and Objectives: To study the improvement in clinical, functional and radiological outcomes of volar locked plate fixation in a distal end radius fracture.Materials and Methods: A prospective study was undertaken in a Tertiary Hospital from September 2016 to September 2018, 30 patients (age >20 yrs) with volar fracture of lower end of radius i.e. AO types A 2.3, B 3.1, B 3.2, B 3.3 operated with volar locked plating. The patients were followed up at 2nd, 6th, 12th and 24th postoperative weeks. Radiological & clinical, functional outcomes were assessed by using Stewart score & PRWE (Patient–rated wrist evaluation questionnaire) score respectively. Data collected of these 30 patients were statistically analysed using ANOVA chi – square test.Results: Clinical and Functional outcome by Patient Rated Wrist Evaluation scoring system shows maximum no. of patients come in Good and Excellent grading i.e. 17(56.7%) and 8(26.7%) out of 30 patients, along with this 1(3.3%) Fair and 4(13.3%) Poor result. Radiological outcome by Stewart I scoring system is Maximum no. of cases shows Good and Excellent results i.e. 20(66.7%) and 6(20%) out of 30 patients. With this 1(3.3%) Fair and 3(10%) Poor result.Conclusion: Open reduction and internal fixation with volar locked plating has satisfactory functional and radiological outcome with minimal complications and thus it is an excellent modality to treat volar fractures of distal end radius.

Closed reduction of volar distal radio-ulnar joint dislocation

Closed reduction of volar distal radio-ulnar joint dislocation

Isolated volar ulnar dislocation: case report and literature review

Isolated ulnar head dislocation is a rare and frequently misdiagnosed clinical entity. To our knowledge, few cases of volar ulnar dislocation have been reported in literature and a well-defined treatment does not exist. This case report describes the management of an acute isolated volar ulna dislocation in a 64-year-old patient. We also performed a systematic review of the available English literature in order to evaluate management of volar ulna dislocation. Among 86 eligible articles, 13 were included and fully evaluated. Isolated distal radioulnar joint (DRUJ) dislocation with only ligamentous involvement are uncommon injuries. If diagnosis is uncertain and X-ray are not informative, further imaging with CT or MRI can be performed because it is mandatory to recognise these lesions and to manage them properly. The first step is to reduce the DRUJ dislocation. The second is to evaluate the stability of the joint. If multidirectional instability is noted, direct repair of the ligament or Triangular Fibrocartilaginous Complex (TFCC) is indicated. Management of the acute lesion initially consists of an attempt of closed reduction, but if closed reduction is impossible in our opinion the only option is to restore the normal anatomy of the DRUJ with operative treatment. Herein, we summarise the available evidence on this lesion, based on this case and after a systematic review of the literature. We propose operative management for this lesion, with open reduction and reconstruction of ligaments to allow a rapid functional recovery and to avoid secondary complications.

Case Report of Distal Radioulnar Joint and Posterior Elbow Dislocation.

Distal radioulnar joint dislocation, DRUJ, DRUJ dislocation, elbow dislocation, orthopedics, ortho, upper extremity, wrist injury, elbow injury, closed reduction.

Percutaneous Suspensory Stabilization of Chronic Distal Radioulnar Joint (DRUJ) Dislocation Using an Adjustable Loop Endobutton Construct: Case Report.

Chronic distal radioulnar joint (DRUJ) dislocation has been treated historically with complex osteotomies and reconstructive procedures, often resulting in intractable stiffness and loss of function. It is desirable to use a technique of fixation that will not only restore the wrist biomechanics but also be cosmetically appealing to the individual. We present a novel technique of reduction and fixation of a chronically dislocated DRUJ in a 26-year-old male using a minimally invasive approach, with successful restoration of DRUJ function and no postoperative complications.

Subtle Essex-Lopresti, what the literature teaches us illustrated by 2 case reports.

Subtle Essex-Lopresti Lesion (ELL) is a rare slow onset longitudinal forearm instability that can presents with subnormal initial radiographs and can easily be missed for the inattentive eye. We reviewed the literature about the subtle ELL illustrated by the report of 2 cases with initially isolated radial neck fractures that turned out to be a subtle ELL pattern. The subtle ELL defined by normal or subnormal initial plain radiographs is usually an association of a slight rupture of the 3 longitudinal stability elements of the forearm being a proximal radius fracture, an inter osseous membrane (IOM) rupture and a distal radio ulnar joint dislocation. These subtle alterations that are often missed worsen with time as do their prognosis making it an emergency to diagnose them and treat them as soon as possible. If diagnosis can involve ultrasound and MRI, the most important key is the initial clinical examination and plain radiographs that has both to be repeated in a short period of time. Among the treatment options, for the acute diagnosis, treatment is similar to usual ELL. As for the missed ones, the proximal radius being usually healed with little displacement can be treated with an ulnar osteotomy alone with good results or associated with IOM reconstruction. Subtle ELL is a rare condition but heavy of consequences for the patients that must be known diagnosed and treated as early as possible by upper extremity surgeons even if there is not a consensual treatment which asks for more research about that subject.