Skip to main content

Advertisement

SpringerLink
Log in

Distal radioulnar joint injuries

  • Review Article
  • Published:
Indian Journal of Orthopaedics Aims and scope Submit manuscript

Abstract

Distal radioulnar joint is a trochoid joint relatively new in evolution. Along with proximal radioulnar joint, forearm bones and interosseous membrane, it allows pronosupination and load transmission across the wrist. Injuries around distal radioulnar joint are not uncommon, and are usually associated with distal radius fractures,fractures of the ulnar styloid and with the eponymous Galeazzi or Essex_Lopresti fractures. The injury can be purely involving the soft tissue especially the triangular fibrocartilage or the radioulnar ligaments.The patients usually present with ulnar sided wrist pain, features of instability, or restriction of rotation. Difficulty in carrying loads in the hand is a major constraint for these patients. Thorough clinical examination to localize point of tenderness and appropriate provocative tests help in diagnosis. Radiology and MRI are extremely useful, while arthroscopy is the gold standard for evaluation. The treatment protocols are continuously evolving and range from conservative, arthroscopic to open surgical methods. Isolated dislocation are uncommon. Basal fractures of the ulnar styloid tend to make the joint unstable and may require operative intervention. Chronic instability requires reconstruction of the stabilizing ligaments to avoid onset of arthritis. Prosthetic replacement in arthritis is gaining acceptance in the management of arthritis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Louis DS, Jebson PJ. The evolution of the distal radio-ulnar joint. Hand Clin 1998;14:155–9.

    CAS  PubMed  Google Scholar 

  2. Shaaban H, Giakas G, Bolton M, Williams R, Scheker LR, Lees VC. The distal radioulnar joint as a load-bearing mechanism-a biomechanical study. J Hand Surg Am 2004;29:85–95.

    Article  PubMed  Google Scholar 

  3. Hagert E, Hagert CG. Understanding stability of the distal radioulnar joint through an understanding of its anatomy. Hand Clin 2010;26:459–66.

    Article  PubMed  Google Scholar 

  4. Szabo RM. Distal radioulnar joint instability. Instr Course Lect 2007;56:79–89.

    PubMed  Google Scholar 

  5. 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;21:587–94.

    Article  CAS  PubMed  Google Scholar 

  6. Pirela-Cruz MA, Goll SR, Klug M, Windler D. Stress computed tomography analysis of the distal radioulnar joint: A diagnostic tool for determining translational motion. J Hand Surg Am 1991;16:75–82.

    Article  CAS  PubMed  Google Scholar 

  7. Ekenstam F. Osseous anatomy and articular relationships about the distal ulna. Hand Clin 1998;14:161–4.

    CAS  PubMed  Google Scholar 

  8. Palmer AK, Werner FW. The triangular fibrocartilage complex of the wrist—anatomy and function. J Hand Surg Am 1981;6:153–62.

    Article  CAS  PubMed  Google Scholar 

  9. Taleisnik J, Gelberman RH, Miller BW, Szabo RM. The extensor retinaculum of the wrist. J Hand Surg Am 1984;9:495–501.

    Article  CAS  PubMed  Google Scholar 

  10. Shaaban H, Giakas G, Bolton M, Williams R, Wicks P, Scheker LR, et al. The load-bearing characteristics of the forearm: Pattern of axial and bending force transmitted through ulna and radius. J Hand Surg Br 2006;31:274–9.

    Article  CAS  PubMed  Google Scholar 

  11. 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;32:438–44.

    Article  PubMed  Google Scholar 

  12. Adams BD, Berger RA. An anatomic reconstruction of the distal radioulnar ligaments for posttraumatic distal radioulnar joint instability. J Hand Surg Am 2002;27:243–51.

    Article  PubMed  Google Scholar 

  13. Iida A, Omokawa S, Akahane M, Kawamura K, Takayama K, Tanaka Y. Distal radioulnar joint stress radiography for detecting radioulnar ligament injury. J Hand Surg Am 2012;37:968–74.

    Article  PubMed  Google Scholar 

  14. Scheker LR, Belliappa PP, Acosta R, German DS. Reconstruction of the dorsal ligament of the triangular fibrocartilage complex. J Hand Surg Br 1994;19:310–8.

    Article  CAS  PubMed  Google Scholar 

  15. Adams BD. Distal radioulnar joint instability. In: Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH, editors. Green’s operative hand surgery. 6th ed. Philadelphia: Elsevier Churchill Livingstone; 2011. p. 523–60.

    Chapter  Google Scholar 

  16. Amrami KK, Moran SL, Berger RA, Ehman EC, Felmlee JP. Imaging the distal radioulnar joint. Hand Clin 2010;26:467–75.

    Article  PubMed  Google Scholar 

  17. Magee T. Comparison of 3-T MRI and arthroscopy of intrinsic wrist ligament and TFCC tears. AJR Am J Roentgenol 2009;192:80–5.

    Article  PubMed  Google Scholar 

  18. Bednar JM, Osterman AL. The role of arthroscopy in the treatment of traumatic triangular fibrocartilage injuries. Hand Clin 1994;10:605–14.

    CAS  PubMed  Google Scholar 

  19. Melone CP Jr, Nathan R. Traumatic disruption of the triangular fibrocartilage complex. Pathoanatomy. Clin Orthop Relat Res 1992;275:65–73.

    Google Scholar 

  20. Palmer AK. Triangular fibrocartilage complex lesions: A classification. J Hand Surg Am 1989;14:594–606.

    Article  CAS  PubMed  Google Scholar 

  21. Kovachevich R, Elhassan BT. Arthroscopic and open repair of the TFCC. Hand Clin 2010;26:485–94.

    Article  PubMed  Google Scholar 

  22. Trumble T. Radial side (1D) tears. Hand Clin 2011;27:243–54.

    Article  PubMed  Google Scholar 

  23. Yao J. All-arthroscopic repair of peripheral triangular fibrocartilage complex tears using FasT-Fix. Hand Clin 2011;27:237–42.

    Article  PubMed  Google Scholar 

  24. Yao J, Lee AT. All-arthroscopic repair of Palmer 1B triangular fibrocartilage complex tears using the FasT-Fix device. J Hand Surg Am 2011;36:836–42.

    Article  CAS  PubMed  Google Scholar 

  25. Bohringer G, Schadel-Hopfner M, Petermann J, Gotzen L. A method for all-inside arthroscopic repair of Palmer 1B triangular fibrocartilage complex tears. Arthroscopy 2002;18:211–3.

    Article  PubMed  Google Scholar 

  26. Corso SJ, Savoie FH, Geissler WB, Whipple TL, Jiminez W, Jenkins N. Arthroscopic repair of peripheral avulsions of the triangular fibrocartilage complex of the wrist: A multicenter study. Arthroscopy 1997;13:78–84.

    Article  CAS  PubMed  Google Scholar 

  27. de Araujo W, Poehling GG, Kuzma GR. New Tuohy needle technique for triangular fibrocartilage complex repair: Preliminary studies. Arthroscopy 1996;12:699–703.

    Article  PubMed  Google Scholar 

  28. Geissler WB. Arthroscopic knotless peripheral ulnar-sided TFCC repair. Hand Clin 2011;27:273–9.

    Article  PubMed  Google Scholar 

  29. Trumble TE, Gilbert M, Vedder N. Isolated tears of the triangular fibrocartilage: Management by early arthroscopic repair. J Hand Surg Am 1997;22:57–65.

    Article  CAS  PubMed  Google Scholar 

  30. Nakamura T, Sato K, Okazaki M, Toyama Y, Ikegami H. Repair of foveal detachment of the triangular fibrocartilage complex: Open and arthroscopic transosseous techniques. Hand Clin 2011;27:281–90.

    Article  PubMed  Google Scholar 

  31. Garcia-Elias M, Hagert E. Surgical approaches to the distal radioulnar joint. Hand Clin 2010;26:477–83.

    Article  PubMed  Google Scholar 

  32. Garcia-Elias M, Smith DE, Llusa M. Surgical approach to the triangular fibrocartilage complex. Tech Hand Up Extrem Surg 2003;7:134–40.

    Article  PubMed  Google Scholar 

  33. Ellanti P, Grieve PP. Acute irreducible isolated anterior distal radioulnar joint dislocation. J Hand Surg Eur Vol 2012;37:72–5.

    Article  CAS  PubMed  Google Scholar 

  34. Bruckner JD, Alexander AH, Lichtman DM. Acute dislocations of the distal radioulnar joint. Instr Course Lect 1996;45:27–36.

    CAS  PubMed  Google Scholar 

  35. Kleinman WB. Distal radius instability and stiffness: Common complications of distal radius fractures. Hand Clin 2010;26:245–64.

    Article  PubMed  Google Scholar 

  36. Geissler WB, Fernandez DL, Lamey DM. Distal radioulnar joint injuries associated with fractures of the distal radius. Clin Orthop Relat Res 1996;327:135–46.

    Article  Google Scholar 

  37. Pogue DJ, Viegas SF, Patterson RM, Peterson PD, Jenkins DK, Sweo TD, et al. Effects of distal radius fracture malunion on wrist joint mechanics. J Hand Surg Am 1990;15:721–7.

    Article  CAS  PubMed  Google Scholar 

  38. 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;78:357–65.

    Article  CAS  PubMed  Google Scholar 

  39. Carlsen BT, Dennison DG, Moran SL. Acute dislocations of the distal radioulnar joint and distal ulna fractures. Hand Clin 2010;26:503–16.

    Article  PubMed  Google Scholar 

  40. 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;36:1919–25.

    Article  PubMed  Google Scholar 

  41. 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;Suppl 108:3+.

    Google Scholar 

  42. 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;92:1–6.

    Article  PubMed  Google Scholar 

  43. Souer JS, Ring D, Matschke S, Audige L, Marent-Huber M, Jupiter JB. 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;91:830–8.

    Article  PubMed  Google Scholar 

  44. Sasao S, Beppu M, Kihara H, Hirata K, Takagi M. An anatomical study of the ligaments of the ulnar compartment of the wrist. Hand Surg 2003;8:219–26.

    Article  PubMed  Google Scholar 

  45. Scheer JH, Adolfsson LE. Pathomechanisms of ulnar ligament lesions of the wrist in a cadaveric distal radius fracture model. Acta Orthop 2011;82:360–4.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Hauck RM, Skahen J 3rd, Palmer AK. Classification and treatment of ulnar styloid nonunion. J Hand Surg Am 1996;21:418–22.

    Article  CAS  PubMed  Google Scholar 

  47. Rettig ME, Raskin KB. Galeazzi fracture-dislocation: A new treatment-oriented classification. J Hand Surg Am 2001;26:228–35.

    Article  CAS  PubMed  Google Scholar 

  48. Mikic ZD. Galeazzi fracture-dislocations. J Bone Joint Surg Am 1975;57:1071–80.

    Article  CAS  PubMed  Google Scholar 

  49. Bruckner JD, Lichtman DM, Alexander AH. Complex dislocations of the distal radioulnar joint. Recognition and management. Clin Orthop Relat Res 1992;275:90–103.

    Google Scholar 

  50. Essex-Lopresti P. Fractures of the radial head with distal radio-ulnar dislocation; report of two cases. J Bone Joint Surg Br 1951;33B:244–7.

    Article  CAS  PubMed  Google Scholar 

  51. Edwards GS Jr, Jupiter JB. Radial head fractures with acute distal radioulnar dislocation. Essex-Lopresti revisited. Clin Orthop Relat Res 1988;234:61–9.

    Google Scholar 

  52. Adams BD. Effects of radial deformity on distal radioulnar joint mechanics. J Hand Surg Am 1993;18:492–8.

    Article  CAS  PubMed  Google Scholar 

  53. Kim JK, Yun YH, Kim DJ, Yun GU. Comparison of united and nonunited fractures of the ulnar styloid following volar-plate fixation of distal radius fractures. Injury 2011;42:371–5.

    Article  PubMed  Google Scholar 

  54. Adams BD, Lawler E. Chronic instability of the distal radioulnar joint. J Am Acad Orthop Surg 2007;15:571–5.

    Article  PubMed  Google Scholar 

  55. Kakar S, Carlsen BT, Moran SL, Berger RA. The management of chronic distal radioulnar instability. Hand Clin 2010;26:517–28.

    Article  PubMed  Google Scholar 

  56. Fulkerson JP, Watson HK. Congenital anterior subluxation of the distal ulna. A case report. Clin Orthop Relat Res 1978;131:179–82.

    Google Scholar 

  57. Purisa H, Sezer I, Kabakas F, Tuncer S, Erturer E, Yazar M. Ligament reconstruction using the Fulkerson-Watson method to treat chronic isolated distal radioulnar joint instability: Short-term results. Acta Orthop Traumatol Turc 2011;45:168–74.

    Article  PubMed  Google Scholar 

  58. Dy CJ, Ouellette EA, Makowski AL. Extensor retinaculum capsulorrhaphy for ulnocarpal and distal radioulnar instability: The Herbert sling. Tech Hand Up Extrem Surg 2009;13:19–22.

    Article  PubMed  Google Scholar 

  59. Stanley D, Herbert TJ. The Swanson ulnar head prosthesis for post-traumatic disorders of the distal radio-ulnar joint. J Hand Surg Br 1992;17:682–8.

    Article  CAS  PubMed  Google Scholar 

  60. Hui FC, Linscheid RL. Ulnotriquetral augmentation tenodesis: A reconstructive procedure for dorsal subluxation of the distal radioulnar joint. J Hand Surg Am 1982;7:230–6.

    Article  CAS  PubMed  Google Scholar 

  61. Scheker LR, Ozer K. Ligamentous stabilization of the distal radioulnar joint. Tech Hand Up Extrem Surg 2004;8:239–46.

    Article  PubMed  Google Scholar 

  62. Feldon P, Terrono AL, Belsky MR. Wafer distal ulna resection for triangular fibrocartilage tears and/or ulna impaction syndrome. J Hand Surg Am 1992;17:731–7.

    Article  CAS  PubMed  Google Scholar 

  63. Feldon P, Terrono AL, Belsky MR. The “wafer” procedure. Partial distal ulnar resection. Clin Orthop Relat Res 1992;275:124–9.

    Google Scholar 

  64. Milch H. Cuff resection of the ulna for malunited Colles’ fracture. J Bone Joint Surg 1941;23:311–3.

    Google Scholar 

  65. Darrach W. Partial excision of lower shaft of the ulna for deformity following Colles’s fracture. Ann Surg 1913;57:53–7.

    Google Scholar 

  66. Watson HK, Brown RE. Ulnar impingement syndrome after Darrach procedure: Treatment by advancement lengthening osteotomy of the ulna. J Hand Surg Am 1989;14(2 Pt 1):302–6.

    Article  Google Scholar 

  67. Lluch A. The Sauve-Kapandji procedure: Indications and tips for surgical success. Hand Clin 2010;26:559–72.

    Article  PubMed  Google Scholar 

  68. Breen TF, Jupiter JB. Extensor carpi ulnaris and flexor carpi ulnaris tenodesis of the unstable distal ulna. J Hand Surg Am 1989;14:612–7.

    Article  CAS  PubMed  Google Scholar 

  69. Tsai TM, Stilwell JH. Repair of chronic subluxation of the distal radioulnar joint (ulnar dorsal) using flexor carpi ulnaris tendon. J Hand Surg Br 1984;9:289–94.

    Article  CAS  PubMed  Google Scholar 

  70. Sauve’ L, Kapandji, M. Nouvelle technique de traitement chirurgical des luxations recidivantes isolees de l’extremite inferieure du cubitus. J Chirurgie 1936;47:589–94.

    Google Scholar 

  71. Bowers WH. Distal radioulnar joint arthroplasty: The hemiresection-interposition technique. J Hand Surg Am 1985;10:169–78.

    Article  CAS  PubMed  Google Scholar 

  72. Scheker LR. Implant arthroplasty for the distal radioulnar joint. J Hand Surg Am 2008;33:1639–44.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Dr. Paul Brand Centre for Hand Surgery, CMC Hospital, Vellore, Tamil Nadu, India

    Binu P. Thomas (Professor & Head) & Raveendran Sreekanth

Authors
  1. Binu P. Thomas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Raveendran Sreekanth
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Binu P. Thomas.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Thomas, B.P., Sreekanth, R. Distal radioulnar joint injuries. IJOO 46, 493–504 (2012). https://doi.org/10.4103/0019-5413.101031

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/0019-5413.101031

Key words

Search

Navigation