Download PDF
CC BY-NC-ND 4.0 · J Hand Microsurg 2021; 13(03): 123-131
DOI: 10.1055/s-0041-1730886
Review Article

Distal Radioulnar Joint Instability and Associated Injuries: A Literature Review

Sohail Qazi
1   Department of Orthopaedic Surgery, Temple University Hospital, Philadelphia, Pennsylvania, United States
,
David Graham
2   Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
,
Steven Regal
2   Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
,
Peter Tang
2   Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
,
Jon E. Hammarstedt
2   Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

The distal radioulnar joint (DRUJ) allows supination and pronation of the distal forearm and wrist, an integral motion in everyday human activity. DRUJ injury and chronic instability can be a significant source of morbidity in patients’ lives. Although often linked with distal radius fractures, DRUJ injury may occur in a variety of other upper extremity injuries, as well as an isolated pathology. Diagnosis of this injury requires the clinician to have a high index of suspicion and low threshold for clinical testing and further imaging of the DRUJ. The purpose of this article is to provide a review on DRUJ anatomy and biomechanics, to discuss common diagnostic and treatment modalities, and to identify common injuries associated with DRUJ instability.

Keywords

DRUJ - instability - anatomy - biomechanics


Publication History

Article published online:
19 June 2021

© 2021. Society of Indian Hand & Microsurgeons. All rights reserved. Thieme Medical and Scientific

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Kim JK, Yi JW, Jeon SH. The effect of acute distal radioulnar joint laxity on outcome after volar plate fixation of distal radius fractures. J Orthop Trauma 2013; 27 (12) 735-739
    CrossrefPubMedGoogle Scholar
  • 2 Lindau T, Hagberg L, Adlercreutz C, Jonsson K, Aspenberg P. Distal radioulnar instability is an independent worsening factor in distal radial fractures. Clin Orthop Relat Res 2000; 376: 229-235
    CrossrefPubMedGoogle Scholar
  • 3 Wijffels MM, Krijnen P, Schipper IB. Clinical DRUJ instability does not influence the long-term functional outcome of conservatively treated distal radius fractures. Eur J Trauma Emerg Surg 2017; 43 (02) 227-232
    CrossrefPubMedGoogle Scholar
  • 4 Wolfe SW, Pederson WC, Hotchkiss RN, Kozin SH, Cohen MS. Green’s Operative Hand Surgery: Expert Consult: Online and Print. Philadelphia, PA: Elsevier Health Sciences 2010
  • 5 Carlsen BT, Dennison DG, Moran SL. Acute dislocations of the distal radioulnar joint and distal ulna fractures. Hand Clin 2010; 26 (04) 503-516
    CrossrefPubMedGoogle Scholar
  • 6 Palmer AK, Werner FW. Biomechanics of the distal radioulnar joint. Clin Orthop Relat Res 1984; 187: 26-35
    CrossrefPubMedGoogle Scholar
  • 7 af F Ekenstam, Hagert CG. Anatomical studies on the geometry and stability of the distal radio ulnar joint. Scand J Plast Reconstr Surg 1985; 19 (01) 17-25
    CrossrefPubMedGoogle Scholar
  • 8 Tolat AR, Stanley JK, Trail IA. A cadaveric study of the anatomy and stability of the distal radioulnar joint in the coronal and transverse planes. J Hand Surg [Br] 1996; 21 (05) 587-594
    CrossrefPubMedGoogle Scholar
  • 9 Stuart PR, Berger RA, Linscheid RL, An KN. The dorsopalmar stability of the distal radioulnar joint. J Hand Surg Am 2000; 25 (04) 689-699
    CrossrefPubMedGoogle Scholar
  • 10 Gofton WT, Gordon KD, Dunning CE, Johnson JA, King GJW. Soft-tissue stabilizers of the distal radioulnar joint: an in vitro kinematic study. J Hand Surg Am 2004; 29 (03) 423-431
    CrossrefPubMedGoogle Scholar
  • 11 Kihara H, Short WH, Werner FW, Fortino MD, Palmer AK. The stabilizing mechanism of the distal radioulnar joint during pronation and supination. J Hand Surg Am 1995; 20 (06) 930-936
    CrossrefPubMedGoogle Scholar
  • 12 Palmer AK, Werner FW. The triangular fibrocartilage complex of the wrist–anatomy and function. J Hand Surg Am 1981; 6 (02) 153-162
    CrossrefPubMedGoogle Scholar
  • 13 Ward LD, Ambrose CG, Masson MV, Levaro F. The role of the distal radioulnar ligaments, interosseous membrane, and joint capsule in distal radioulnar joint stability. J Hand Surg Am 2000; 25 (02) 341-351
    CrossrefPubMedGoogle Scholar
  • 14 af Ekenstam F. Anatomy of the distal radioulnar joint. Clin Orthop Relat Res 1992; 275: 14-18
    PubMedGoogle Scholar
  • 15 Schuind F, An KN, Berglund L. et al. The distal radioulnar ligaments: a biomechanical study. J Hand Surg Am 1991; 16 (06) 1106-1114
    CrossrefPubMedGoogle Scholar
  • 16 Johnson RK. Stabilization of the distal ulna by transfer of the pronator quadratus origin. Clin Orthop Relat Res 1992; 275: 130-132
    CrossrefPubMedGoogle Scholar
  • 17 Johnson RK, Shrewsbury MM. The pronator quadratus in motions and in stabilization of the radius and ulna at the distal radioulnar joint. J Hand Surg Am 1976; 1 (03) 205-209
    CrossrefPubMedGoogle Scholar
  • 18 Stuart PR. Pronator quadratus revisited. J Hand Surg [Br] 1996; 21 (06) 714-722
    CrossrefPubMedGoogle Scholar
  • 19 Moritomo H, Noda K, Goto A, Murase T, Yoshikawa H, Sugamoto K. Interosseous membrane of the forearm: length change of ligaments during forearm rotation. J Hand Surg Am 2009; 34 (04) 685-691
    CrossrefPubMedGoogle Scholar
  • 20 Watanabe H, Berger RA, Berglund LJ, Zobitz ME, An K-N. Contribution of the interosseous membrane to distal radioulnar joint constraint. J Hand Surg Am 2005; 30 (06) 1164-1171
    CrossrefPubMedGoogle Scholar
  • 21 Gofton WT, Gordon KD, Dunning CE, Johnson JA, King GJW. Comparison of distal radioulnar joint reconstructions using an active joint motion simulator. J Hand Surg Am 2005; 30 (04) 733-742
    CrossrefPubMedGoogle Scholar
  • 22 Szabo RM. Distal radioulnar joint instability. Instr Course Lect 2007; 56: 79-89
    PubMedGoogle Scholar
  • 23 Neumann JA, Kirkendall DT. III CTM. Sports Medicine for the Orthopedic Resident. Singapore: World Scientific Publishing Company 2016
  • 24 Seo KN, Park MJ, Kang HJ. Anatomic reconstruction of the distal radioulnar ligament for posttraumatic distal radioulnar joint instability. Clin Orthop Surg 2009; 1 (03) 138-145
    CrossrefPubMedGoogle Scholar
  • 25 Tay SC, Tomita K, Berger RA. The “ulnar fovea sign” for defining ulnar wrist pain: an analysis of sensitivity and specificity. J Hand Surg Am 2007; 32 (04) 438-444
    CrossrefPubMedGoogle Scholar
  • 26 Friedman SL, Palmer AK. The ulnar impaction syndrome. Hand Clin 1991; 7 (02) 295-310
    CrossrefPubMedGoogle Scholar
  • 27 Nakamura R, Horii E, Imaeda T, Nakao E, Kato H, Watanabe K. The ulnocarpal stress test in the diagnosis of ulnar-sided wrist pain. J Hand Surg [Br] 1997; 22 (06) 719-723
    CrossrefPubMedGoogle Scholar
  • 28 Lester B, Halbrecht J, Levy IM, Gaudinez R. “Press test” for office diagnosis of triangular fibrocartilage complex tears of the wrist. Ann Plast Surg 1995; 35 (01) 41-45
    CrossrefPubMedGoogle Scholar
  • 29 Sachar K. Ulnar-sided wrist pain: evaluation and treatment of triangular fibrocartilage complex tears, ulnocarpal impaction syndrome, and lunotriquetral ligament tears. J Hand Surg Am 2008; 33 (09) 1669-1679
    CrossrefPubMedGoogle Scholar
  • 30 Hahn P, Wolf MB, Unglaub F. Bilateral test for potential subluxation of the DRUJ. Arch Orthop Trauma Surg 2013; 133 (10) 1459-1461
    CrossrefPubMedGoogle Scholar
  • 31 Mino DE, Palmer AK, Levinsohn EM. Radiography and computerized tomography in the diagnosis of incongruity of the distal radio-ulnar joint. A prospective study. J Bone Joint Surg Am 1985; 67 (02) 247-252
    CrossrefPubMedGoogle Scholar
  • 32 Yang Z, Mann FA, Gilula LA, Haerr C, Larsen CF. Scaphopisocapitate alignment: criterion to establish a neutral lateral view of the wrist. Radiology 1997; 205 (03) 865-869
    CrossrefPubMedGoogle Scholar
  • 33 Lo IK, MacDermid JC, Bennett JD, Bogoch E, King GJ. The radioulnar ratio: a new method of quantifying distal radioulnar joint subluxation. J Hand Surg Am 2001; 26 (02) 236-243
    CrossrefPubMedGoogle Scholar
  • 34 Park MJ, Kim JP. Reliability and normal values of various computed tomography methods for quantifying distal radioulnar joint translation. J Bone Joint Surg Am 2008; 90 (01) 145-153
    CrossrefPubMedGoogle Scholar
  • 35 Chhabra A, Soldatos T, Thawait GK. et al. Current perspectives on the advantages of 3-T MR imaging of the wrist. Radiographics 2012; 32 (03) 879-896
    CrossrefPubMedGoogle Scholar
  • 36 Lee RKL, Griffith JF, Ng AWH, Nung RCH, Yeung DKW. Wrist traction during MR arthrography improves detection of triangular fibrocartilage complex and intrinsic ligament tears and visibility of articular cartilage. AJR Am J Roentgenol 2016; 206 (01) 155-161
    CrossrefPubMedGoogle Scholar
  • 37 Bruckner JD, Lichtman DM, Alexander AH. Complex dislocations of the distal radioulnar joint. Recognition and management. Clin Orthop Relat Res 1992; 275: 90-103
    CrossrefPubMedGoogle Scholar
  • 38 Albert MJ, Engber WD. Dorsal dislocation of the distal radioulnar joint secondary to plastic deformation of the ulna. J Orthop Trauma 1990; 4 (04) 466-469
    CrossrefPubMedGoogle Scholar
  • 39 Hanel DP, Scheid DK. Irreducible fracture-dislocation of the distal radioulnar joint secondary to entrapment of the extensor carpi ulnaris tendon. Clin Orthop Relat Res 1988; 234: 56-60
    CrossrefPubMedGoogle Scholar
  • 40 Rose-Innes AP. Anterior dislocation of the ulna at the inferior radio-ulnar joint. Case report, with a discussion of the anatomy of rotation of the forearm. J Bone Joint Surg Br 1960; 42-B: 515-521
    CrossrefPubMedGoogle Scholar
  • 41 Buterbaugh GA, Palmer AK. Fractures and dislocations of the distal radioulnar joint. Hand Clin 1988; 4 (03) 361-375
    CrossrefPubMedGoogle Scholar
  • 42 Hui FC, Linscheid RL. Ulnotriquetral augmentation tenodesis: a reconstructive procedure for dorsal subluxation of the distal radioulnar joint. J Hand Surg Am 1982; 7 (03) 230-236
    CrossrefPubMedGoogle Scholar
  • 43 Heiple KG, Freehafer AA, Van’T Hof A. Isolated traumatic dislocation of the distal end of the ulna or distal radio-ulnar joint. J Bone Joint Surg Am 1962; 44-A: 1387-1394
    CrossrefPubMedGoogle Scholar
  • 44 Geissler WB, Freeland AE, Savoie FH, McIntyre LW, Whipple TL. Intracarpal soft-tissue lesions associated with an intra-articular fracture of the distal end of the radius. J Bone Joint Surg Am 1996; 78 (03) 357-365
    CrossrefPubMedGoogle Scholar
  • 45 Lindau T, Adlercreutz C, Aspenberg P. Peripheral tears of the triangular fibrocartilage complex cause distal radioulnar joint instability after distal radial fractures. J Hand Surg Am 2000; 25 (03) 464-468
    CrossrefPubMedGoogle Scholar
  • 46 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 (06) 965-971
    CrossrefPubMedGoogle Scholar
  • 47 Morrissy RT, Nalebuff EA. Dislocation of the distal radioulnar joint: anatomy and clues to prompt diagnosis. Clin Orthop Relat Res 1979; 144: 154-158
    PubMedGoogle Scholar
  • 48 Melone Jr CP, Nathan R. Traumatic disruption of the triangular fibrocartilage complex. Pathoanatomy. Clin Orthop Relat Res 1992; 275: 65-73
    PubMedGoogle Scholar
  • 49 Roysam GS. The distal radio-ulnar joint in Colles’ fractures. J Bone Joint Surg Br 1993; 75 (01) 58-60
    CrossrefPubMedGoogle Scholar
  • 50 Stoffelen D, De Smet L, Broos P. The importance of the distal radioulnar joint in distal radial fractures. J Hand Surg [Br] 1998; 23 (04) 507-511
    CrossrefPubMedGoogle Scholar
  • 51 Thomas BP, Sreekanth R. Distal radioulnar joint injuries. Indian J Orthop 2012; 46 (05) 493-504
    CrossrefPubMedGoogle Scholar
  • 52 Frykman G. Fracture of the distal radius including sequelae–shoulder-hand-finger syndrome, disturbance in the distal radio-ulnar joint and impairment of nerve function. A clinical and experimental study. Acta Orthop Scand 1967; 108-3
    PubMedGoogle Scholar
  • 53 Mikic ZD. Treatment of acute injuries of the triangular fibrocartilage complex associated with distal radioulnar joint instability. J Hand Surg Am 1995; 20 (02) 319-323
    CrossrefPubMedGoogle Scholar
  • 54 Nakamura R, Horii E, Imaeda T, Nakao E, Shionoya K, Kato H. Ulnar styloid malunion with dislocation of the distal radioulnar joint. J Hand Surg [Br] 1998; 23 (02) 173-175
    CrossrefPubMedGoogle Scholar
  • 55 Adams BD, Samani JE, Holley KA. Triangular fibrocartilage injury: a laboratory model. J Hand Surg Am 1996; 21 (02) 189-193
    CrossrefPubMedGoogle Scholar
  • 56 Galeazzi R. Di una particolare sindrome traumatica dello scheletro dell’ avambraccio. Atti e memorie della Società lombarda di chirurgia 1934;2:663–666. Available at: https://ci.nii.ac.jp/naid/10016117871/. Last accessed on May 20, 2021
    PubMed
  • 57 Rettig ME, Raskin KB. Galeazzi fracture-dislocation: a new treatment-oriented classification. J Hand Surg Am 2001; 26 (02) 228-235
    CrossrefPubMedGoogle Scholar
  • 58 Alexander AH, Lichtman DM. Irreducible distal radioulnar joint occurring in a Galeazzi fracture - case report. J Hand Surg Am 1981; 6 (03) 258-261
    CrossrefPubMedGoogle Scholar
  • 59 Cetti NE. An unusual cause of blocked reduction of the Galeazzi injury. Injury 1977; 9 (01) 59-61
    CrossrefPubMedGoogle Scholar
  • 60 Itoh Y, Horiuchi Y, Takahashi M, Uchinishi K, Yabe Y. Extensor tendon involvement in Smith’s and Galeazzi’s fractures. J Hand Surg Am 1987; 12 (04) 535-540
    CrossrefPubMedGoogle Scholar
  • 61 Jenkins NH, Mintowt-Czyz WJ, Fairclough JA. Irreducible dislocation of the distal radioulnar joint. Injury 1987; 18 (01) 40-43
    CrossrefPubMedGoogle Scholar
  • 62 Paley D, Rubenstein J, McMurtry RY. Irreducible dislocation of distal radial ulnar joint. Orthop Rev 1986; 15 (04) 228-231
    Google Scholar
  • 63 Giannoulis FS, Sotereanos DG. Galeazzi fractures and dislocations. Hand Clin 2007; 23 (02) 153-163, v
    CrossrefPubMedGoogle Scholar
  • 64 Essex-Lopresti P. Fractures of the radial head with distal radio-ulnar dislocation; report of two cases. J Bone Joint Surg Br 1951; 33B (02) 244-247
    CrossrefPubMedGoogle Scholar
  • 65 Edwards Jr GS, Jupiter JB. Radial head fractures with acute distal radioulnar dislocation. Essex-Lopresti revisited. Clin Orthop Relat Res 1988; 234: 61-69
    PubMedGoogle Scholar
  • 66 Trousdale RT, Amadio PC, Cooney WP, Morrey BF. Radio-ulnar dissociation. A review of twenty cases. J Bone Joint Surg Am 1992; 74 (10) 1486-1497
    CrossrefPubMedGoogle Scholar
  • 67 Schuind FA, Linscheid RL, An KN, Chao EY. A normal data base of posteroanterior roentgenographic measurements of the wrist. J Bone Joint Surg Am 1992; 74 (09) 1418-1429
    CrossrefPubMedGoogle Scholar
  • 68 Smith AM, Urbanosky LR, Castle JA, Rushing JT, Ruch DS. Radius pull test: predictor of longitudinal forearm instability. J Bone Joint Surg Am 2002; 84 (11) 1970-1976
    CrossrefPubMedGoogle Scholar