Distal Radioulnar Dislocation Research Articles

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.

Chronic Essex-Lopresti injury: a systematic review of current treatment options.

Essex-Lopresti lesion (ELL) is a severe injury. Most of ELL is recognized in chronic phase representing a therapeutic challenge for orthopaedic surgeons. The aim of this systematic review is to highlight and criticize current concepts in the surgical treatment. The search was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guideline. A comprehensive research of Pubmed database was made using the following Mesh term: ((Essex-Lopresti injury) OR (Essex Lopresti) OR (distal radio ulnar dissociation) OR (distal radio ulnar dislocation) OR (longitudinal forearm instability)). Quality assessment of each article was performed according to Coleman score by two authors. Eight full articles were included to the systematic review. Surgical treatment was differentiated in five categories according to the most common procedure reported in clinical series. The mean Coleman Score was 51.13 ± 9.76. Case series reported in the literature include a limited number of patients with chronic ELL. Currently, salvage procedure devoted to treat a wrong diagnosis and an incorrect treatment is used. Radial head replacement together with ulnar shortening osteotomy and interosseous membrane reconstruction are the most common treatments of choice, but at present, there is not yet a shared scheme of management for patients with chronic ELL. According to current literature, a case-by-case treatment must always be considered. Further investigations, with higher level of evidence, quality of study design, and number of patients, are needed to better assess clinical results and complication of each technique. IV.

Acute isolated volar dislocation of the distal radio-ulnar joint: Case report and literature review

The acute isolated distal radio-ulnar (DRU) dislocation is a rare traumatic pathology and no consensus concerning its management has been established. This case report describes an acute isolated volar DRU dislocation in a 26-year-old patient. The authors propose, based on this case and after an exhaustive review of the literature, a non-operative management for these isolated and non-complicated dislocations.

Un faux équivalent de Galeazzi chez l’enfant. À propos d’un cas

We report the case of a false Galeazzi equivalent in children. This injury is characterised by an epiphyseal detachment of the distal extremity of the ulna rather than a distal radio-ulnar dislocation. A 16-year-old patient was injured in a fall from a bike. Radiographs showed a fracture of the radial shaft with anterior angulation, together with a type II Salter-Harris epiphyseal injury at the level of the distal ulna. We were unable to perform a closed reduction under general anesthesia due to interposition of periosteum at the fracture site. Thus surgical management was the only option, which consisted of removing the offending periosteum and performing osteosynthesis of the radial shaft fracture with a plate, and the epiphyseal detachment with pins. After 10 months, we noted no bone growth disturbance, or any reduced mobility of the wrist. We will continue the follow-up to monitor bone growth disturbance of the distal extremity of the ulna.

Radiocarpal Fracture-dislocations

Radiocarpal fracture-dislocations most often are caused by high-energy trauma. These difficult, uncommon injuries involve significant soft-tissue and osseous trauma, requiring meticulous reduction and fixation. The mechanism of injury is generally a severe shear or rotational insult. Anatomically, the dislocation results in disruption of the radiocarpal ligaments and, usually, both the radial and the ulnar styloid. Understanding the anatomy of the radiocarpal joint is central to understanding the osseous and soft-tissue constraints that are disrupted with a radiocarpal dislocation. Diagnosis can be reliably made on physical examination and radiographic evaluation. Radiocarpal fracture-dislocation injuries must be differentiated from Barton fractures. Associated injuries such as open fractures, neurovascular involvement, and distal radioulnar dislocations also must be taken into account. Closed reduction can be obtained relatively easily, but open reduction and internal fixation is typically necessary to ensure accurate anatomic restoration of injured bone and ligaments.

Fractures of the radial head with distal radio-ulnar dislocation

The two cases of comminuted fracture of the radial head presented in this paper stress the importance of evaluating the distal radio-ulnar joint for dislocation when the mechanism of injury is a longitudinal compression force. Two treatment approaches are recommended for this particular type of injury. The first is reconstruction of the radial head. If reconstruction is not feasible due to severe comminution, leaving the distal radius undisturbed and accepting some distal radio-ulnar subluxation may be required. Another option, after immediate excision, could be to temporarily use a prosthesis in place of the radial head to hold the radius down until the distal joint and interosseous membrane heal and become stable.

Réorientation de la glène radiale dans la déformation de Madelung par ostéotomie cunéiforme avec retournement

A technique of cuneiform osteotomy of the distal end of the radius is presented. It was used in three female patients with Madelung's deformity (two bilateral cases and one unilateral case). A wedge of bone was harvested in situ from the metaphysis, then returned and replaced in situ. This technique, performed through the Henry's approach, combines closing wedge osteotomy on the longer radial cortices with opening wedge osteotomy on the shorter radial cortices. The biplane osteotomy, which provides the bony wedge, involves the entire width of the metaphysis and is performed with an oscillating saw. Once the wedge is reversed and replaced, stabilization is obtained with an anterior plate. In all five cases the forward subluxation of the carpus was reduced as well as the distal radioulnar dislocation through the backward projection of the epiphysis. The reversed cuneiform osteotomy brings new possibilities of reorienting the radial articular surface and its technical mastery allows for accurate correction of severe deformities.

Luxation radio-carpienne: À propos d’une série de 12 cas et revue de la literature

Purpose of the study Radiocarpal dislocation is an uncommon entity in traumatology. Proper management depends on the type of dislocation and the presence of concomitant injury. The purpose of this study was to detail the pathogenesis of radiocarpal dislocation and describe its complications and treatment. Material and methods Twelve radiocarpal dislocations were reviewed retrospectively. Nine were associated with multiple trauma. For this review, physical examination was performed to determine the functional status, presence of pain, joint motion, and grip force. The Green and O’Brien score as modified by Cooney was used to assess function. Grip force was measured with a Jamar dynamometer and weighted by the non-dominant/dominant ratio. Dumontier and Moneim classifications were used to define different types of radiocarpal dislocation. Radiological evaluation was based on anteroposterior (ulnar and radial inclination) and lateral views of the wrist. Results Dorsal displacement was observed for nine dislocations. All were associated with fractures (eleven fractures of the lateral cuneal process and eight fractures of the styloid process). Other associated injuries were distal radioulnar dislocation and intracarpal sprains (two scapholunate and two lunotriquetral). There were three median nerve compressions which all regressed without sequelae. Ten patients were treated by styloradial osteosynthesis alone and two patients by capsule-ligament suture via an anterior approach. Pinning was used to stabilize the two lunotriquetral injuries and the one neglected radioulnar dislocation. Results At last follow-up (mean 46.2 months), the overall functional outcome was satisfactory. The Green and O’Brien (modified by Cooney) score was excellent for one patient, fair for eight, and mediocre for three (75% satisfactory results). Distal radioulnar degeneration developed in the patient who had a neglected radioulnar dislocation. Three cases of radiocarpal degeneration were observed in patients with neglected scapholunate sprains whose wrist was symptomatic at last follow-up. Discussion Radiocarpal dislocation is associated with intracarpal fracture and/or injury. Intracarpal injury must be treated in order to limit the risk of future degeneration. Pure radiocarpal dislocation (or in association with a minimal fracture of the styloid) should be treated surgically, irrespective of the approach, in order to achieve capsule-ligament suture. Other radiocarpal dislocations can be simply reduced with osteosynthesis of associated fractures. Intracarpal and/or distal radioulnar lesions must be stabilized. Osteosynthesis or capsule-ligament suture must be achieved to obtain a satisfactory clinical result.

Posterior radiocarpal fracture-dislocation (eight case reports)

The Authors report a retrospective series of eight cases of posterior radiocarpal fracture-dislocation. Average age of patients was 32 years (23/54), with a male predominance (7 men and a woman). Injury was often due to a fall on the hand in extension from an elevated place (5/8). The wrist in back of fork is the characteristic deformity. Diagnosis was confirmed by AP and lateral views of the wrist. Radial styloïd fracture, posterior dislocation of the carpus and posterior rim avulsion were constant. Ulnar styloïd fracture was present in half of the cases and distal radio-ulnar dislocation in two cases. Four patients were treated conservatively and four surgically. Whatever the treatment choice, results are satisfactory at a short follow-up. The two patients presenting a distal radio-ulnar dislocation resulted in a bad result.

The Classic

Mr. Essex-Lopresti (Fig. 1) was trained at the London Hospital and qualified in 1937. After several resident appointments, he joined the Royal Army Medical Corps serving as a surgical specialist in an airborne division. As a result of this experience, he was able to give a comprehensive report on the injuries associated with 20,777 parachute jumps made by men in the Sixth British Airborne Division, one of the first such reports. 1 A paper on the open wound in trauma followed.2 At the end of World War II, he went back to the Birmingham Accident Hospital where he reorganized the postgraduate training program. He was recognized as an outstanding young surgeon and was awarded a Hunterian Professorship. His Hunterian Lecture delivered at the Royal College of Surgeons on March 6, 1951 has been chosen as the Classic article for this Symposium. Although Essex-Lopresti is remembered eponymically for his cases of radial head fracture associated with distal radioulnar dislocations, i.e. Essex-Lopresti's fracture,3 his Classic for this Symposium is on fractures of the os calcis. Mr. Essex-Lopresti was a talented and energetic young surgeon whose death at the age of 35 cut short a promising career.

Chronic isolated distal radioulnar dislocation in child a case report

Chronic isolated distal radioulnar dislocation in child a case report

Dorsal Dislocation of the Distal Radioulnar Joint Secondary to Plastic Deformation of the Ulna

An unusual case of an unstable dorsal, distal radioulnar dislocation secondary to plastic deformation of the ulna is presented. The etiology and pathomechanics of this rare injury are reviewed.

Treatment of Old Distal Radioulnar Dislocation: A Preliminary Report

Treatment of Old Distal Radioulnar Dislocation: A Preliminary Report

Radial Head Fractures with Acute Distal Radioulnar Dislocation

Seven adults with displaced radial head fractures had concurrent dislocation of the distal radioulnar joint. Because support of the radius was lost at both the elbow and wrist, proximal migration of the radius from 5 to 10 mm occurred. Different types of fractures were classified to designate the best method of restoring radial length to prevent chronic wrist pain and stiffness. Type I fractures had large displaced radial head fragments with minimal or no comminution and amenable to interfragmentary fixation. Type II fractures had severe comminution requiring radial head excision and prosthetic replacement. Type III were old injuries with irreducible proximal migration of the radius managed by ulnar shortening and radial head prosthetic replacement. There were three Type I, two Type II, and two Type III fractures. Results of treatment were graded as 3, excellent; 2, good; 1, fair; and 1, poor. The three excellent results were in patients in which restoration of radial length was achieved within one week of injury. Suboptimal results occurred in the remaining four patients when definitive surgery was delayed four to ten weeks. The poor result was in a patient treated only by radial head excision and who refused further surgery. Recommendations include meticulous clinical and roentgenographic examination of the distal radioulnar joint in all patients with displaced radial head fractures. Preservation of the radial head with anatomic reduction and rigid internal fixation is preferred, but radial head replacement may be necessary in cases with extensive comminution. Radial head excision alone, though contraindicated, may be restructured by ulnar shortening and radial head prosthetic replacement.

Opération de Kapandji-Sauvé: Techniques et indications dans les affections non rhumatismales

The Kapandji-Sauvé operation consists in the arthrodesis of the distal radioulnar joint surmounted with a segmentary resection of the lower ulna. This technique may be used not only in rheumatoid dislocations of the distal radioulnar joint instead of the resection of the distal end of the ulna (Moore-Darrach) but also in traumatic diseases such as dislocations, sprains, chronical instabilities of this joint and stiffness secondary to Colles fractures. Two techniques are described, following the original one proposed in 1936. The first one (Technique I) indicated to chronical instabilities secondary to sprains and distal radioulnar dislocations. In this case, the ulnar head is in right situation at the sigmoid notch level and may be blocked at this place with two screws in mid position of prono-supination. The gap between the two extremities of the ulna must be filled by the pronator quadratus to avoid bony reconstruction. The second one (Technique II) is especially designed for the limitations of the prono-supination motion after Colles fractures, with shortening of the radius which causes an incongruency of the distal radioulnar joint and a positive ulnar variance. In this case it is necessary to lift up the ulnar head before blocking it in the sigmoid notch. A proceeding doing this automatically is described. Technique I was used in three cases and Technique II in four. In all cases the range of the prono-supination motion was normal in three to six weeks. The pains disappeared except a slight one when holding a load in supination position and when resting the hand unsteadily. The stability of the wrist was recovered allowing to unwind screw caps and to turn door knobs.

Radioulnar dislocation : Foster R. J. and Hansen S. T. (1985) Management of acute distal radioulnar dislocations associated with radial shaft substance loss. J. Hand Surg.10A, 72

Radioulnar dislocation : Foster R. J. and Hansen S. T. (1985) Management of acute distal radioulnar dislocations associated with radial shaft substance loss. J. Hand Surg.10A, 72

Management of acute distal radioulnar dislocations associated with radial shaft substance loss

In patients with distal radioulnar dislocations that are associated with a loss of radial shaft substance, the use of an external distractor that is applied to the distal radial fragment and the proximal ulnar shaft allows proper reduction of distal radioulnar articulation. The pins should be placed close to a joint so that the holes left after the pins are removed do not act as diaphyseal stress risers. The position is maintained by appropriate internal fixation and bone grafting of the radius. In cases where the bone is severely crushed and internal fixation cannot be applied, the external distractor may be converted to an external fixator.