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J Wrist Surg 2023; 12(03): 199-204
DOI: 10.1055/s-0042-1750872
Scientific Article

Fixed Subluxation of the Distal Radioulnar Joint following Malunion of the Ulnar Styloid Process

Sophie Brackertz 
1   Department of Hand Surgery, University Hospital Balgrist, Zurich, Switzerland
,
Lisa Reissner
1   Department of Hand Surgery, University Hospital Balgrist, Zurich, Switzerland
,
Benjamin Fritz
2   Department of Radiology, University Hospital Balgrist, Zurich, Switzerland
,
Jonas Walker
3   Balgrist CARD, Research in Orthopedic Computer Science, Zurich, Switzerland
,
Ladislav Nagy
1   Department of Hand Surgery, University Hospital Balgrist, Zurich, Switzerland
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Abstract

Purpose Recent literature on significance and treatment of ulnar styloid fractures suggest that the ulnar styloid is not the central problem but the radioulnar ligaments and their impact on joint stability. However, specifically displaced ulnar styloid process fractures that secondarily heal in an ectopic position remain a rare situation for which diagnostics and treatment options remain a topic of discussion.

Methods This case series presents four patients with limited supination due to a fixed dorsal subluxation of the distal radioulnar joint (DRUJ). The reason here fore was a significant malunion of ulnar styloid fracture that was addressed by corrective ulnar styloid osteotomy. Three of these osteotomies used three-dimensional (3D) preoperative planning and patient specific guides.

Results All patients presented with a significant displacement of the malunited ulnar styloid fracture (average 32-degree rotation and 5-mm translation). In all four patients, the fixed subluxation of the ulnar head was resolved clinically and radiographically, and the forearm rotation restored after corrective osteotomy of the ulnar styloid and fixation in an anatomical position.

Conclusion This case series presents a very specific subset of patients with nonanatomically healed ulnar styloid fractures responsible for a chronic DRUJ dislocation and limited prosupination and its treatment.

Level of evidence This is a Level IV, therapeutic study.

Keywords

DRUJ subluxation - fixed pronosupination DRUJ - malunion ulnar styloid process - ulnar styloid fracture


Publication History

Received: 07 January 2022

Accepted: 12 May 2022

Article published online:
26 September 2022

© 2022. Thieme. All rights reserved.

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  • References

  • 1 Kim JK, Koh YD, Do NH. Should an ulnar styloid fracture be fixed following volar plate fixation of a distal radial fracture?. J Bone Joint Surg Am 2010; 92 (01) 1-6
    CrossrefPubMedGoogle Scholar
  • 2 Sammer DM, Shah HM, Shauver MJ, Chung KC. The effect of ulnar styloid fractures on patient-rated outcomes after volar locking plating of distal radius fractures. J Hand Surg Am 2009; 34 (09) 1595-1602
    CrossrefPubMedGoogle Scholar
  • 3 Souer JS, Ring D, Matschke S, Audige L, Marent-Huber M, Jupiter JB. AOCID Prospective ORIF Distal Radius Study Group. Effect of an unrepaired fracture of the ulnar styloid base on outcome after plate-and-screw fixation of a distal radial fracture. J Bone Joint Surg Am 2009; 91 (04) 830-838
    CrossrefPubMedGoogle Scholar
  • 4 Zenke Y, Sakai A, Oshige T, Moritani S, Nakamura T. The effect of an associated ulnar styloid fracture on the outcome after fixation of a fracture of the distal radius. J Bone Joint Surg Br 2009; 91 (01) 102-107
    CrossrefPubMedGoogle Scholar
  • 5 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
  • 6 Zimmermann R, Rudisch A, Fritz D, Gschwentner M, Arora R. [MR imaging for the evaluation of accompanying injuries in cases of distal forearm fractures in children and adolescents]. Handchir Mikrochir Plast Chir 2007; 39 (01) 60-67
    PubMedGoogle Scholar
  • 7 Oskarsson GV, Aaser P, Hjall A. Do we underestimate the predictive value of the ulnar styloid affection in Colles fractures?. Arch Orthop Trauma Surg 1997; 116 (6-7): 341-344
    CrossrefPubMedGoogle Scholar
  • 8 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
  • 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 Shaw JA, Bruno A, Paul EM. Ulnar styloid fixation in the treatment of posttraumatic instability of the radioulnar joint: a biomechanical study with clinical correlation. J Hand Surg Am 1990; 15 (05) 712-720
    CrossrefPubMedGoogle Scholar
  • 11 Wijffels M, Ring D. The influence of non-union of the ulnar styloid on pain, wrist function and instability after distal radius fracture. J Hand Microsurg 2011; 3 (01) 11-14
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Chen ACY, Chiu C-H, Weng C-J, Chang S-S, Cheng C-Y. Early and late fixation of ulnar styloid base fractures yields different outcomes. J Orthop Surg Res 2018; 13 (01) 193
    CrossrefPubMedGoogle Scholar
  • 13 Hauck RM, Skahen III J, Palmer AK. Classification and treatment of ulnar styloid nonunion. J Hand Surg Am 1996; 21 (03) 418-422
    CrossrefPubMedGoogle Scholar
  • 14 Nakamura R, Horii E, Imaeda T, Nakao E. Criteria for diagnosing distal radioulnar joint subluxation by computed tomography. Skeletal Radiol 1996; 25 (07) 649-653
    CrossrefPubMedGoogle Scholar
  • 15 Nakamura R, Horii E, Imaeda T, Tsunoda K, Nakao E. Distal radioulnar joint subluxation and dislocation diagnosed by standard roentgenography. Skeletal Radiol 1995; 24 (02) 91-94
    CrossrefPubMedGoogle Scholar
  • 16 Suzuki T, Nakamura T, Tanino Y, Obara Y, Yoshikawa Y, Iwamoto T. Acute blocking of forearm supination secondary to tearing of the triangular fibrocartilage complex. J Hand Surg Eur Vol 2020; 45 (09) 939-944
    CrossrefPubMedGoogle Scholar
  • 17 Takahashi Y, Nakamura T, Sato K, Toyama Y. Subluxation of the palmar radioulnar ligament as a cause of blocked forearm supination: a case of DRUJ locking. J Wrist Surg 2013; 2 (01) 83-86
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Feeney MS, Wentorf F, Putnam MD. Simulation of altered excursion of the pronator quadratus. J Wrist Surg 2014; 3 (03) 198-202
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Kleinman WB, Graham TJ. The distal radioulnar joint capsule: clinical anatomy and role in posttraumatic limitation of forearm rotation. J Hand Surg Am 1998; 23 (04) 588-599
    CrossrefPubMedGoogle Scholar
  • 20 Kihara H, Palmer AK, Werner FW, Short WH, Fortino MD. The effect of dorsally angulated distal radius fractures on distal radioulnar joint congruency and forearm rotation. J Hand Surg Am 1996; 21 (01) 40-47
    CrossrefPubMedGoogle Scholar
  • 21 Bronstein AJ, Trumble TE, Tencer AF. The effects of distal radius fracture malalignment on forearm rotation: a cadaveric study. J Hand Surg Am 1997; 22 (02) 258-262
    CrossrefPubMedGoogle Scholar