Radiographic Predictors of DRUJ Instability with Distal Radius Fractures

Abstract

Because the distal radioulnar joint (DRUJ) is an inherently unstable joint, the diagnosis and treatment of DRUJ instability is often difficult in a clinical hand surgery practice. Several soft tissue stabilizers are recognized, of which the deep limbs of the radioulnar ligament are primary stabilizers. This article discusses the predictors of DRUJ instability in distal radius fractures based on our clinical and biomechanical analyses.

Keywords

radioulnar - joint - instability - predictor

• References

• 1 Palmer AK, Werner FW. The triangular fibrocartilage complex of the wrist—anatomy and function. J Hand Surg Am 1981; 6: 153-162
• 2 Nakamura T, Takayama S, Horiuchi Y, Yabe Y. Origins and insertions of the triangular fibrocartilage complex: a histological study. J Hand Surg [Br] 2001; 26 (5) 446-454
• 3 Fujitani R, Omokawa S, Akahane M, Iida A, Ono H, Tanaka Y. Predictors of distal radioulnar joint instability in distal radius fractures. J Hand Surg Am 2011; 36 (12) 1919-1925
• 4 Richards RS, Bennett JD, Roth JH, Milne Jr K. Arthroscopic diagnosis of intra-articular soft tissue injuries associated with distal radial fractures. J Hand Surg Am 1997; 22 (5) 772-776
• 5 Kwon BC, Seo BK, Im HJ, Baek GH. Clinical and radiographic factors associated with distal radioulnar joint instability in distal radius fractures. Clin Orthop Relat Res 2012; 470 (11) 3171-3179
• 6 Bombaci H, Polat A, Deniz G, Akinci O. The value of plain X-rays in predicting TFCC injury after distal radial fractures. J Hand Surg Eur Vol 2008; 33: 322-326
• 7 May MM, Lawton JN, Blazar PE. Ulnar styloid fractures associated with distal radius fractures: incidence and implications for distal radioulnar joint instability. J Hand Surg Am 2002; 27 (6) 965-971
• 8 Kobayashi M, Garcia-Elias M, Nagy L , et al. Axial loading induces rotation of the proximal carpal row bones around unique screw-displacement axes. J Biomech 1997; 30 (11-12) 1165-1167
• 9 Moore TM, Lester DK, Sarmiento A. The stabilizing effect of soft-tissue constraints in artificial Galeazzi fractures. Clin Orthop Relat Res 1985; 194 (194) 189-194
• 10 Omori S, Moritomo H, Murase T , et al. Changes in length of the radioulnar ligament and distal oblique bundle after Colles' fracture. J Plast Surg Hand Surg 2013; 47: 409-414
• 11 Saito T, Nakamura T, Nagura T, Nishiwaki M, Sato K, Toyama Y. The effects of dorsally angulated distal radius fractures on distal radioulnar joint stability: a biomechanical study. J Hand Surg Eur Vol 2013; 38: 739-745
• 12 Nakanishi Y, Omokawa S, Shimizu T, Nakano K, Kira T, Tanaka Y. Intra-articular distal radius fractures involving the distal radioulnar joint (DRUJ): three dimensional computed tomography-based classification. J Orthop Sci 2013; 18 (5) 788-792