Treatment of Distal Radioulnar Joint Injuries Associated with a Distal Radius Fracture

Ki-Bum Choi; Sung-Woo Huh; Seong-Eun Kim; Jung-Woo Lee; Seok-Whan Song; Seung-Koo Rhee

doi:10.0000/jkssh.2012.17.4.147

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Choi, Huh, Kim, Lee, Song, and Rhee: Treatment of Distal Radioulnar Joint Injuries Associated with a Distal Radius Fracture

Original Article

Journal of the Korean Society for Surgery of the Hand

Journal of the Korean Society for Surgery of the Hand 2012; 17(4): 147-152.

Published online: 31 December 2012

DOI: https://doi.org/10.0000/jkssh.2012.17.4.147

Treatment of Distal Radioulnar Joint Injuries Associated with a Distal Radius Fracture

Ki-Bum Choi, Sung-Woo Huh, Seong-Eun Kim, Jung-Woo Lee, Seok-Whan Song, Seung-Koo Rhee

Department of Orthopedic Surgery, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.

Correspondence to: Seung-Koo Rhee. Department of Orthopedic Surgery, Yeouido St. Mary's Hospital, The Catholic University of Korea, 10 yuksam-ro, Yeongdeungpo-gu, Seoul 150-713, Korea. TEL: +82-2-3779-1192, FAX: +82-2-783-0252, skrhee@catholic.ac.kr

Received 10 May 2012 Revised 14 September 2012 Accepted 21 September 2012

(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

Purpose

Distal radius fractures involving distal radioulnar joint (DRUJ) are common. After the fracture treatment, pain on the ulnar side of wrist, limitation of forearm rotation and instabilities can be remained. The purpose of this study was to address the importance of anatomical reduction for DRUJ injuries.

Methods

Of 115 cases with a distal radius fracture involving DRUJ, 61 cases involving sigmoid notch of the radius or having a ulnar styloid process base fracture were evaluated. At an average of six months follow-up, their final outcomes were investigated using radiologic findings, functional disabilities of the arm, shoulder and hand (DASH) and visual analogue scale (VAS) pain scores and wrist motion of pronation/supination.

Results

Satisfied radiologic reduction rate was 73.8%(45/61) in average, which was most favorable in external fixator group (82.4%, 28/34). The mean functional DASH score was 29.0 points and mean VAS for pain was 5.0. The mean range of wrist motions for pronation/supination was 59.5°/55.7°.

Conclusion

Distal radius fractures involving DRUJ should be classified into the basic categories of unstable distal radius fracture, and immediate anatomical reduction is needed by operative treatment to avoid painful forearm rotation.

Keywords: Distal radioulnar joint injuries

Figures and Tables

Fig. 1

(A) Radiographs of a 45-year-old male patient show distal radius fracture involving ulnar side of radius. (B) Computed tomography shows the fracture extends to distal radioulnar joint line. (C) Anatomical reduction was performed using external fixator and K-wires. (D) At 6 months follow-up, radiograph shows anatomically-reduced state. Painless full wrist range of motion was obtained.

Fig. 2

(A) Radiographs of a 30-year-old male patient show the fracture line extending distal radioulnar joint and a fracture of distal ulna. (B) Anatomical reduction was performed using K-wires and mini-Acutrak screw. (C) At 4 month follow-up, radiograph shows anatomically-reduced state.

Table 1

Clinical end results

VAS: visual analogue scale for pain, DASH: disabilities of the arm, shoulder and hand, ROM: range of motion, Radiologic good results: neutral varian, more than 0° of volar inclination or 5° of radial inclination, less than 2 mm of joint incongruity, no diastasis or subluxation of distal radioulnar joint and no non-union of ulnar styloid process comparing with opposite wrist X-rays.

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