Pdf distal radioulnar joint druj instability is a common clinical condition but a. Of note, in 2 of these clinical studies, druj instability was reported following anatomical reduction and fixation of distal third radius fracturessupporting the concept that concomitant soft tissue injury eg, to the diom, as opposed to altered bony biomechanics, contributed to druj instability. Although instability after accurate reduction and fixation of the distal radius is relatively uncommon, it is important to evaluate druj stability after treatment of a distal radius fracture. An anatomic reconstruction of the distal radioulnar ligaments for posttraumatic distal radioulnar joint instability. Distal radioulnar joint druj instability is an important cause of ulnar sided wrist pain, often associated with distal radial fractures. May 30, 2012 untreated distal radioulnar joint druj injuries can give rise to long lasting complaints. We present the case of a 74yearold asian woman with a fourth and fifth extensor tendon rupture caused by instability of the ulnar head associated with an osteoarthritic distal. Wrist arthroplasty was used to perform ulnar distal articular cleansing and repair of. Distal radioulnar joint druj instability is a rare but disabling problem. Distal radioulnar joint injuries druj and carpal instability. Nineteen of 50 patients 38 % had druj instability after fixation of radius fractures.
Any information contained in this pdf file is automatically generated from digital. Elfar, md2 abstract distal radioulnar joint druj instability is a common clinical condition but a frequently missed diagnosis. Thus, the druj relies heavily on soft tissue structures, and instability of the joint is a common clinical problem. Clinical and nonclinical aspects of distal radioulnar joint.
Diagnosing druj instability remains a challenge since the generally accepted available clinical test, i. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. Divide ulnar sided wrist pain into acute traumatic chronic overuse chronic degenerative physical exam position patient across from you with elbow 90 and fingers toward ceiling inspection palpation lt ecufcu fovea druj. Frank dislocation of druj complete tear caused by distal radioulnarligament tears palmar or dorsal. However, delayed diagnosis or misdiagnosis has been relatively rare due to improved diagnosis and treatment. Division of only the dorsal ligament caused druj instability with supination, but the joint was stable with pronation. Jun 12, 20 the ulnar styloid is an important supportive structure for the triangular fibrocartilage complex. Jun 14, 2016 the wafer procedure requires only a limited arthrotomy of the distal radioulnar joint druj and allows direct inspection of the tfcc, debridement or repair of the tfcc, if necessary, as well as decompression of the ulnocarpal junction 1,2. Surgical techniques chronic instability of the distal. Acute dislocations of the distal radioulnar joint and distal ulna fractures brian t. In testing the druj, a distinction should be made between static and dynamic instability. The advent of arthroscopic techniques has helped to rebuild the triangular.
Dislocation of the distal radioulnar joint and injury to distal forearm are commonly encountered. Dec 30, 20 although spontaneous extensor tendon rupture often occurs in association with rheumatoid arthritis, extensor tendon rupture associated with osteoarthritis of the distal radioulnar joint has been rarely reported. The distal radioulnar joint druj provides not only supination and pronation of the forearm, but also is crucial to the grip strength and lifting capabilities of individuals. The role of radiography and computerized tomography in the diagnosis of subluxation and dislocation of the distal radioulnar joint.
Patients and methods posteroanterior pa radiographs, using a standardized tech. Chronic instability of the distal radioulnar joint t he skeletal architecture of the distal radioulnar joint druj provides minimal inherent stability. However, instability is frequently undiagnosed and the clinical and radiographic factors associated with instability are not well understood. Distal radioulnar joint subluxation or druj subluxation may also be caused due to oversupination, which means turning the palm in the upwards direction during the fall, and overpronation, which means turning the palm in downwards direction, forces resulting from the falls on the wrist or. The system allows an intraoperative choice between. Ligamentous reconstruction for posttraumatic chronic. The distal radioulnar joint druj is composed of the radius and ulna, the triangular fibrocartilage complex tfcc and the joint capsule. Distal radioulnar joint instability can result from injuries to the triangular fibrocartilage complex, an abnormal joint architecture or alterations in the radioulnar. All patients had a positive ulnar fovea sign, 15 positive provocative maneuvers as described by kleinman, 6 and druj instability. Paul brand centre for hand surgery, cmc hospital, vellore, tamil nadu, india. Outcomes of the adamsberger ligament reconstruction for the distal radioulnar joint instability in 95 consecutive cases joshua a. Radiologic evaluation of druj instability begins with conventional. Treatment of carpal instability and distal radioulnar joint instability. Associate professor director orthopaedic trauma research.
January 16, 2009 reading list stability of the distal radioulnar joint. Jan 01, 2006 to access the article, you may purchase it or purchase the complete back file collection here. Although common, diagnosis and treatment of druj injuries remains a challenge. Distal radioulnar joint instability radiology case. Distal radioulnar joint druj subluxationtypescauses. Mechanical testing of distal radioulnar instability repair. Laxity soft tissue is intact must be assymetricalto be significant 2. Piano key signfor instability ballottement of ulnar head, prominence of ulna 2. Disorders of the distal radioulnar joint druj are a common source of ulnarsided wrist pain.
Chronic instability following fracture of the distal radius chronic instability of the druj can undergo a trial of nonoperative management, including bracing 48. The druj brace is donned circumferentially around the distal radioulnar joint and provides adjustable compression of the proximal portion of the distal radioulnar joint that is independent of adjustable compression of the distal portion of the distal radioulnar joint, without compression of the ulnar styloid. On the true lateral view a radioulnar distance of 6mm or more, between the most dorsal cortices, indicates druj instability. Prof of orthopaedics, smch binu p thomas, raveendran sreekanth dr. Ifssh scientific committee on bone and joint injuries. Kinesio technique facilitate handwrist flexion kinesio technique utilizing a y strip start with the base over the. Chronic distal radioulnar joint instability is a painful and often disabling condition. The presence of distal radioulnar joint druj instability remains often. The role of imaging in diagnosing diseases of the distal. Surgical technique first choice druj system partial ulnar. Any druj injury can cause limitation of the range of motion, decreased strength, pain, and instability. Anatomic reconstruction of the distal radioulnar ligament. It preserves the ligamentous attachments of the tfcc to the base of the ulna styloid process and. This document was downloaded for personal use only.
Clinical and nonclinical aspects of distal radioulnar joint instability. A similar case with a simultaneous dislocation of the radial head and druj with no other injury of the arm was reported a few years ago. Orthopaedic grand rounds distal radioulnar joint bernard f. Moran, mda,b anatomy and biomechanics of the distal radioulnar joint the ulna is the fixed unit of the forearm joint, with the hand, carpus, and radius rotating around it. The osseous structure of the druj has minimal inherent stability. Radiographic and arthroscopic assessment of druj instability due to foveal avulsion of the radioulnar ligament in distal radius fractures toshiyasu nakamura, md, phd1 takuji iwamoto, md, phd1 noboru matsumura, md, phd1 kazuki sato, md, phd1 yoshiaki toyama, md, phd 1 1department of orthopaedic surgery, school of medicine, keio. In isolated posttraumatic druj instability, the most common history is a traumatic event involving a fall on the outstretched hand or a forced rotation of the wrist such as recoil from a power drill, which is followed by ulnarsided wrist swelling and pain aggravated by forearm and wrist motion. Pdf clinical and nonclinical aspects of distal radioulnar joint.
Us8398573b2 druj brace with ulnar styloid accommodation. The clinical and nonclinical aspects of distal radioulnar. Oct 29, 2014 in addition, the sigmoid notch and ulnar head must be sufficiently competent to allow the ligament restraints to function under normal tension and length. In rare circumstances, such as for druj instability, the radiologist may indicate that no reformats are necessary. The wrist was imm obilized by a splint for 3 weeks, followed by rehabilitations. The stability of the distal radioulnar joint druj is a result of both the bony structure and the integrity of the surrounding soft tissues including the triangular. Start studying ecu vs tfcc tests vs druj instability.
Reconstruction for druj instability pubmed central pmc. The mean duration from onset of symptoms to surgery was 8 months range, 2 to 24 months. The ulnar side of the wrist has often been likened to the. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Treatment of old dislocation of radioulnar joint is challenging due to development of secondary chronic instability and difficulties in restoration of joint function. The radial sigmoid notch is a shallow concavity found along the ulnar border of the radius. Clinical druj instability does not influence the longterm functional. Clinical and nonclinical aspects of distal radioulnar. New york university hospital for joint diseases, ny, ny. Instability of soft tissue partial tear leads to increased translation often caused by peripheral tears of tfcc 3.
In chronic druj instability, the dorsal translation of the ulnar head is more common than the volar one, due to radial malunion 7. Distal radioulnar joint instability introduction the distal radioulnar joint druj links the radius and ulna with the proximal radioulnar joint. Residual dorsal angulation, radial shortening and decreased radial inclination can lead to radioulnar incongruity, tfcc distortion and druj instability. Treatment of distal radioulnar joint dislocation with.
Rotational forearm motion occurs at the distal ra dioulnar joint druj and proximal radioulnar joint pruj at the elbow. The druj instability was treated with ligament reconstruction as described by fulkerson and watson. The distal radioulnar joint druj is important for rotation of the forearm and stability of the ulnar wrist. Treatment of distal radioulnar joint dislocation with sponta. Elbow dislocation with ipsilateral galeazzi fracture. Distal radioulnar joint instability is a common, but frequently missed, clinical condition that typically occurs in the setting of associated distal radius and ulnar styloid fractures. Pdf instability of the distal radioulnar joint druj. This report describes three cases of patients complained about inability to extend their little fingers. The distal radioulnar joint druj is classified as a uniaxial synovial pivot joint between the convex head of the ulna and the concave ulnar notch of the radius. Pdf distal radioulnar joint instability researchgate. Dynamic ct assessment of distal radioulnar instability. Distal ulna hook plate fixation for unstable distal ulna.
The most common cause for druj instability is a distal radius fracture. Clinical and radiographic factors associated with distal. Pdf untreated distal radioulnar joint druj injuries can give rise to long lasting. The articulating anatomy of the distal radius and ulna, among others, enables an extensive range of forearm pronosupination movements.
Computed tomography has emerged as a valuable tool in assessing the integrity of the druj, and the roles of additional imaging modalities continue to be explored. Introduction although our understanding of human anatomy has grown rapidly, the distal radioulnar joint druj remains. An update on sl instability druj instability distal radius fractures slac and snac barcelona spain july 12. Using 11 freshfrozen cadaver specimens, instability of the distal radioulnar joint druj during passive wrist motion was measured by motion analysis and three clinical tests ulnocarpal stress. Will the untreated ulnar styloid fracture influence the.
Patients and methods we treated 17 wrists 8 male, 9 female. Stability of the ulna shaft is obtained by suturing the sheath. If the requisition mentions scaphoid or navicular, then also reformat in the 4th plane, the oblique sagittal plane d. Static instability is defined as laxity of the druj with a nonrotating distal radius, as compared to the unaffected side. Pictorial essay imaging findings of the distal radioulnar joint in trauma. The distal radioulnar joint is a complex structure necessary for forearm motion and force transmission across the wrist.
Druj instability can also manifest as an isolated injury and is occasionally seen in the context of druj arthritis. Moran, md1,3 1department of orthopedic surgery, mayo clinic, rochester, minnesota. These cases can have other causes of ulnarsided wrist pain that may mimic or coexist with druj instability. We conceive that this new external fixation method would become an alternative treat. The druj is transfixed by a screw but is not formally exposed and fused, the periosteum of the distal ulna is not excised, and the pronator quadratus is not advanced into the pseudarthrosis. The role of imaging in diagnosing diseases of the distal radioulnar joint, triangular fibrocartilage complex, and distal ulna radiographic diagnosis of tarsal coalition julia r. Lee, md2, narges rahimi, md3, shervin rashidinia, md4, and john c. In the situation of an ulnar positive variance, an ulnar shortening procedure should be considered in order to offload the axial loads through the tfcc. Sectioning of all these soft tissues around the joint leads to signi.
Using this approach, we found no association with the location of the fracture on the radius with instability of the druj. Occupational therapy perspective on rehabilitation for. Fortunately, our understanding of the anatomy, joint mechanics, and pathophysiology of this area has increased greatly in recent years, making resolution of many of these problems feasible. Ulnar variance as a predictor of persistent instability.
Distal radioulnar joint injuries druj and carpal instability slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. The integra first choice druj system provides instrumentation for both a partial and a modular ulnar head replacement. Abstract background instability of the distal radioulnar joint druj is a complication that can. It is necessary to check the osseous anatomy in patients with. Posttraumatic rotation deficit of the forearm, including. Druj motion is primarily rotational, but there are components of axial and translational motion that occur during loading and rotation. Treatment options for acute distal radioulnar joint. A direct radiographic sign that indicates druj instability, is widening of the distal radioulnar space on the ap radiograph, relative to the unaffected side.
Ecu vs tfcc tests vs druj instability flashcards quizlet. Locked volar distal radioulnar joint dislocation pdf free. At months followup, the patient has regained full flexion and extension of elbow. The gold standard of diagnosis of druj instability was any intervention casting in supination, pinning, direct repair, etc for druj instability after radial fixation in the operating room or late instability. Stable central tears without druj instability have excellent pain relief with debridement. Simultaneous dislocation of the radial head and distal radio. Druj instability is often underappreciated both clinically and radiologically, leading. Chronic distal radioulnar joint instability dorsal, palmar, or bidirectional instability. Traumatic injuries of the distal radioulnar joint pdf free. Extensor tendon rupture caused by instability of the ulnar. Druj instability after fixation of radial shaft fractures occurs more often than previous studies demonstrated 6.
The differences with our case is that a in our case the radial head was displaced purely anteriorly and not anterolateraly as in their case and b after the reduction, in our case the radial head was. Functional bracing, which has been tested in a cadaveric model 47, can be used for patients who do not wish to have surgery, but most patients prefer surgical treatment. The druj can be approached from 3 sides with a refined dorsal approach retaining a robust retinaculardorsal capsular layer preferred by most surgeons. Incidence and implications for druj instability may et al. Local examination and xray revealed chronic ulnar joint dislocation. Reconstruction of druj instability clinics in orthopedic surgery vol. Olecranon fractures non operative non displaced fractures immobilisation in 4590 degrees of flexion, for 3 weeks, then mobilise operative. Compression is maintained by hook and loop fasteners. Imaging findings of the distal radioulnar joint in trauma. If you continue browsing the site, you agree to the use of cookies on this website. Listing a study does not mean it has been evaluated by the u. Surgical technique first choice druj system partial. Chronic instability of the distal radioulnar joint orthobullets.
The purpose of this study is to evaluate the effect of an untreated ulnar styloid fracture on the outcome of unstable. Chronic instability of the distal radioulnar joint. The ulnar side of the wrist has often been likened to the lower back because of the difficulties involved in establish ing a specific diagnosis for pain at both sites and therefore in prescrib ing an effective treatment plan. Outcomes of the adams berger ligament reconstruction for. Distal radioulnar joint problems and treatment options. Acute druj instability is rather difficult to evaluate clinically due to the swelling and deformity around the wrist joint. Ligamentous reconstruction for posttraumatic chronic instability of. In general, acute peripheral tears should be repaired. Feb 21, 2015 distal radioulnar joint injuries druj and carpal instability 1.
In this paper, we described our arthroscopic repair technique for ulnar tfcc tear. We also clinically validated previously described predictors of distal radioulnar joint instability, which included a fracture line within 7. Distal radioulnar joint subluxation or partial dislocation is caused by falling down on outstretched hands. Sep 01, 2012 distal radioulnar joint instability was confirmed by a finding of more than 8 mm of palmardorsal translation of the ulna relative to the radius.
Distal radioulnar joint druj instability is an important cause of ulnar sided. The effect of distal radius fracture location on distal. Aadohkssh nursing symposium arthroplasty of ulna head. Oct 30, 2015 treatment options for acute distal radioulnar joint instability druj the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Many recent cadaver and arthroscopic studies have elucidated its exact anatomy and function. Berger10 reported the clinical results of a procedure in which a tendon graft was passed through near the normal anatomic attachment site of the volar and dorsal distal.
The full text of this article is available in pdf format. Treatment options for acute distal radioulnar joint instability druj the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Anatomy and biomechanics of the distal radioulnar joint. Distal radioulnar joint injuries presented by dr sunil poonia, pgt, orthopaedics, smch moderated by dr s. It is necessary to check the osseous anatomy in patients with chronic palmar dislocation. Clinical suspicion of druj instability is strengthened with a history of wrist trauma, pain, and limited motion with supination and pronation. Ligament reconstruction vs capsulorraphy christopher dy1, anne ouelette 1, annalena makowski, dena mohnani 3,2, ali malik, loren latta1,2,3 1orthopaedics and rehabilitation, university of miami, miami, fl. Axial ct or mri scan in different positions of rotation allows for evaluation of the radioulnar subluxation ratio, which presently appears to be the most reliable parameter to quantify druj translation 14. This chapter will discuss the relevant anatomy and pathophysiology of druj instability, along with the rationale and technique for different treatment options. In this case, we treated him with a new external fixation method and had achieved a satisfactory radiographic and functional outcome after 2 years since the operation. Acute dislocations of the distal radioulnar joint and.
Disorders of the distal radioulnar joint are a major source of ulnarsided wrist pain. Original article a new external fixation method in colles. Radiographs can be of additional value, although obtaining true lateral views is difficult and radiographs do not depict the dynamic process of. However, it remains inconclusive whether or not a fractured ulnar styloid should be fixed in an unstable distal radius fracture drf with a stable distal radioulnar joint druj. Distal radioulnar joint druj instability is an important cause of ulnarsided wrist pain in distal radius fractures. To determine the druj instability, the examiners thumb pushed the distal ulna into forearm supination and pronation. Distal radioulnar joint instability with dorsal ulnar dislocation.