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: instability; joint; predictor; radioulnar.

Fig. 1

(a) Anteroposterior prereduction radiograph of a fractured wrist with a complete deep radioulnar ligament tear. White arrow indicates DRUJ widening between the distal radius and the ulnar head. Note the significant radial translation of the distal radial fragment. Arrow head points to the ulnar corner of the sigmoid notch of the radius. (b) Arthrotomy confirmed there was a complete radioulnar ligament tear at the fovea of the ulnar head (black arrow). We reattached the ligament using a suture anchor. (c) Postoperative X-ray indicating no DRUJ widening between the radius and the ulna. Two suture anchors fix the radioulnar deep ligament foveal avulsion (black arrow) and ulnar styloid fragment (white arrow).

Fig. 2

Experimental setup of upper extremity specimens shows fixation of the humerus and the ulna. The radius is held in the forearm neutral rotation, and 2 kg of radially directed force is applied to the distal radius fragment.