Intra-Articular Injury Associated with Distal Radius Fracture

Hyun Sik Gong; Kee Jeong Bae; Goo Hyun Baek

doi:10.4055/jkoa.2013.48.2.157

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Gong, Bae, and Baek: Intra-Articular Injury Associated with Distal Radius Fracture

Symposium

Treatment of Distal Radius Fracture and Combined Injuries

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2013; 48(2): 157-164.

Published online: 25 April 2013

DOI: https://doi.org/10.4055/jkoa.2013.48.2.157

Intra-Articular Injury Associated with Distal Radius Fracture

Hyun Sik Gong, M.D., Ph.D., Kee Jeong Bae, M.D., Goo Hyun Baek, M.D., Ph.D.

Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea.

Correspondence to: Hyun Sik Gong, M.D., Ph.D. Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro, 173beon-gil, Bundang-gu, Seongnam 463-707, Korea. TEL: +82-31-787-7198, FAX: +82-31-787-4056, hsgong@snu.ac.kr

Received 31 January 2013 Revised 6 February 2013 Accepted 7 February 2013

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Distal radius fractures are commonly associated with intra-articular injuries such as carpal ligament injuries and triangular fibrocartilage complex (TFCC) injuries. Such injuries occurring in elderly patients with a low-energy distal radius fracture can be treated successfully with cast immobilization and do not usually lead to clinical problems. However, despite healing of the fracture, some intra-articular injuries, especially in active patients with a high-energy fracture, can result in persistent pain and disability. In addition, the current trend of internal fixation and early use of the wrist may actually increase instability due to inadequate healing of the ligament injuries. Due to a lack of typical symptoms and physical findings in acute fracture settings, detection of these injuries is not easy. Arthroscopic examination, as well as radiographs and intraoperative fluoroscopic findings, are useful in detection of carpal ligament injuries. Complete ruptures of intercarpal interosseous ligaments warrant temporary interosseous fixation using K-wires. In TFCC injuries, distal radioulnar joint (DRUJ) instability should be assessed after anatomical reduction and fixation of a distal radius fracture. Operative treatments such as open or arthroscopic repair of TFCC to the fovea can guarantee greater stability of the DRUJ. For optimal results, early detection and appropriate treatment of intra-articular injuries associated with distal radius fractures is critical.

Keywords: wrist injuries, radius fractures, carpal joints, triangular fibrocartilage

Figures and Tables

Figure 1

Scapho-lunate interosseous ligament injury associated with a distal radius fracture. (A) The initial radiograph showed an increase in the scapho-lunate distance. (B) The post-reduction radiograph showed a manually reduced radius fracture, which was immobilized with a cast. (C) Radiograph taken three weeks later showed scapho-lunate dissociation and displacement of the radial styloid fragment. Due to the lack of early treatment, open reduction of the fracture and repair of the dorsal interosseous ligament was necessary. (D) One year after open repair of the dorsal interosseous ligament and dorsal plate fixation of the radius, a normal scapho-lunate gap was observed, although the scaphoid appeared to be flexed.

Figure 2

Triangular fibrocartilage complex injury associated with a distal radius fracture. (A) The preoperative radiograph showed an intra-articular comminuted fracture of the distal radius and an ulnar styloid tip fracture. Intraoperative stress testing after fixing the radius revealed increased instability of the distal radioulnar joint, compared with the normal side. (B) Through the ulnar approach protecting the dorsal cutaneous branch of the ulnar nerve, the distal radioulnar ligament insertion that avulsed from the fovea was exposed (asterisk). (C) After trans-osseous repair of the radioulnar ligament to the fovea using pull-out sutures, the distal radioulnar joint stability was immediately recovered.

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