Introduction Definition distal 1/3 radius shaft fx AND associated distal radioulnar joint (DRUJ) injury Incidence of DRUJ instability if radial fracture is <7.5 cm from articular surface unstable in 55% if radial fracture is >7.5 cm from articular surface unstable in 6% Mechanism direct wrist trauma typically dorsolateral aspect fall onto outstretched hand with forearm in pronation Anatomy DRUJ sigmoid notch found along ulnar border of distal radius is a shallow concavity for the articulating ulnar head volar and dorsal radioulnar ligaments function as the primary stabilizers of the DRUJ most stable in supination Classification OTA classification of radius/ulna included under subgroups and qualifications OTA classification of radius/ulna 22-A2.3 Radius/ulna, diaphyseal, simple fracture of radius with dislocation of DRUJ 22-A3.3 Radius/ulna, diaphyseal, simple fracture of both bones (distal zone radius) with dislocation of DRUJ 22-B2.3 radius/ulna, diaphyseal, wedge fracture of radius with dislocation of DRUJ 22-B3.3 radius/ulna, diaphyseal, wedge of both bones with dislocation of DRUJ Presentation Symptoms pain, swelling, deformity Physical exam point tenderness over fracture site ROM test forearm supination and pronation for instability DRUJ stress causes wrist or midline forearm pain Imaging Radiographs recommended views AP and lateral views of forearm, elbow, and wrist findings signs of DRUJ injury ulnar styloid fx widening of joint on AP view dorsal or volar displacement on lateral view radial shortening (≥5mm) Treatment Operative ORIF of radius with reduction and stabilization of DRUJ indications all cases, as anatomic reduction of DRUJ is required acute operative treatment far superior to late reconstruction Surgical Techniques ORIF of radius approach volar (Henry) approach to radius plate fixation perform anatomic plate fixation of radial shaft radial bow must be restored/maintained Reduction & stabilization of DRUJ approach dorsal capsulotomy reduction technique immobilization in supination (6 weeks) indicated if DRUJ stable following ORIF of radius percutaneous pin fixation indicated if DRUJ reducible but unstable following ORIF of radius cross-pin ulna to radius leave pins in place for 4-6 weeks open surgical reduction indicated if reduction is blocked suspect interposition of ECU tendon open reduction internal fixation indicated if a large ulnar styloid fragment exists fix styloid and immobilize in supination Complications Compartment syndrome increased risk with high energy crush injury open fractures vascular injuries or coagulopathies diagnosis pain with passive stretch is most sensitive Neurovascular injury uncommon except type III open fractures Refracture usually occurs following plate removal increased risk with removing plate too early large plates (4.5mm) comminuted fractures persistent radiographic lucency prevention do not remove plates before 18 months after insertion amount of time needed for complete primary bone healing Nonunion Malunion DRUJ subluxation displaced by gravity, pronator quadratus, or brachioradialis
QUESTIONS 1 of 5 1 2 3 4 5 Previous Next You have 100% on this question. Just skip this one for now. Take This Question Anyway (OBQ12.147) A 33-year-old man sustains blunt trauma to his forearm and presents with the injury seen in Fig A and B. Definitive management of this injury involves the following: Review Topic QID: 4507 FIGURES: A B Type & Select Correct Answer Type in at least one full word to see suggestions list 1 Perform closed reduction of the radius, then immobilize the forearm in a long arm cast in supination. 1% (50/5343) 2 Perform open reduction and internal fixation of the radius, then assess the proximal radioulnar joint for instability, and percutaneously fix the proximal radioulnar joint if instability persists. 4% (226/5343) 3 Perform open reduction and internal fixation of the radius, then assess the distal radioulnar joint for instability, and reconstruct the distal radioulnar joint with a looped palmaris longus autograft if instability persists. 3% (186/5343) 4 Perform closed reduction of the radius, then assess the distal radioulnar joint for instability, and perform internal fixation of the radius if instability persists. 3% (177/5343) 5 Perform open reduction and internal fixation of the radius, then assess the distal radioulnar joint for instability, and percutaneously fix the distal radioulnar joint if instability persists. 87% (4664/5343) L 1 Select Answer to see Preferred Response SUBMIT RESPONSE 5 You have 100% on this question. Just skip this one for now. Take This Question Anyway (OBQ10.117) A 42-year-old female sustains the injury shown in Figure A. What other anatomic structure is most commonly injured with this fracture? Review Topic QID: 3211 FIGURES: A Type & Select Correct Answer Type in at least one full word to see suggestions list 1 Volar long radiolunate ligament 3% (125/4906) 2 Radioscaphocapitate ligament 3% (130/4906) 3 Dorsal radioulnar ligaments 90% (4426/4906) 4 Ligament of Testut and Kuentz 1% (73/4906) 5 Scapholunate ligament 2% (120/4906) L 1 Select Answer to see Preferred Response SUBMIT RESPONSE 3 Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK You have 100% on this question. Just skip this one for now. Take This Question Anyway (OBQ07.47) A 30-year-old female presents with the injury shown in Figure A after falling on her outstretched arm. During operative treatment of the fracture, anatomic reduction of the radius is achieved. However, the surgeon is unable to reduce the distal radioulnar joint. What structure is most likely impeding the reduction? Review Topic QID: 708 FIGURES: A Type & Select Correct Answer Type in at least one full word to see suggestions list 1 Median nerve 1% (9/910) 2 Flexor carpi radialis 6% (58/910) 3 Pronator quadratus 40% (364/910) 4 Extensor carpi ulnaris 44% (402/910) 5 Flexor carpi ulnaris 8% (72/910) L 4 Select Answer to see Preferred Response SUBMIT RESPONSE 4 Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK
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