Advancements in Diagnosis and Management of Distal Radioulnar Joint Instability: A Comprehensive Review Including a New Classification for DRUJ Injuries

Abstract

Distal radioulnar joint (DRUJ) instability is a complex condition that can severely affect forearm function, causing pain, limited range of motion, and reduced strength. This review aims to consolidate current knowledge on the diagnosis and management of DRUJ instability, emphasizing a new classification system that we propose. The review synthesizes anatomical and biomechanical factors essential for DRUJ stability, focusing on the interrelationship between the bones and surrounding soft tissues. Our methodology involved a thorough examination of recent studies, incorporating clinical assessments and advanced imaging techniques such as MRI, ultrasound, and dynamic CT. This approach allowed us to develop a classification system that categorizes DRUJ injuries into three distinct grades. This system is intended to be practical for both clinical and radiological evaluations, offering clear guidance for treatment based on injury severity. The review discusses a range of treatment options, from conservative measures like splinting and physiotherapy to surgical procedures, including arthroscopy and DRUJ arthroplasty. The proposed classification system enhances the accuracy of diagnosis and supports more effective decision making in clinical practice. In summary, our findings suggest that the integration of advanced imaging techniques with minimally invasive surgical interventions can lead to better outcomes for patients. This review serves as a valuable resource for clinicians, providing a structured approach to managing DRUJ instability and improving patient care through the implementation of our new classification system.

Keywords: DRUJ arthroscopy; distal radioulnar joint (DRUJ) classification; distal radioulnar joint (DRUJ) instability; imaging modalities; triangular fibrocartilage complex (TFCC) injuries.

Figure 1

Anatomy of the radius (R) and ulna (U) showing the DOB and illustrating of the three-locker system concept.

Figure 2

Forearm fracture with radiographic evidence indicating distal radioulnar joint (DRUJ) injury: (a) antero-posterior view (increased radioulnar space); (b) lateral view (dorsal dislocation of the ulnar head).

Figure 3

Wrist MRI evaluation of the soft tissues (intact TFCC) following a scaphoid nonunion fracture.

Figure 4

3D reconstruction of an articular distal radius fracture with associated ulnar styloid fracture displaced inside the DRUJ.

Figure 5

ORIF of a distal radius fracture associated with an ulnar styloid fracture.

Figure 6

AP and lateral views of a Galeazzi fracture.

Figure 7

ORIF of a Galeazzi fracture via the Henry approach using a titanium plate.

Figure 8

Dorsal dislocation of the right ulnar head following a distal radius fracture managed with closed reduction and immobilization.

Figure 9

Intraoperative images of DRUJ pinning after distal radius fracture fixation with K wires and an external fixator: (a) antero-posterior view; (b) lateral view.

Figure 10

Illustration of DRUJ injury classification. Grade 1 shows normal joint alignment, with intact ligaments. Grade 2 displays subluxation and partial ligament tears. Grade 3 depicts severe dislocation with complete tears of the TFCC, as well as the DOB.