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Distal radioulnar joint disruption
From WikEM
Contents
Background
- Seen with intra-articular or distal radial shaft fractures or both bone fracture
Clinical Features
- Easy to miss due to concomitant injuries
- Painful pronation or supination of wrist/forearm, possible crepitus
- Prominent or displaced ulnar styloid
Differential Diagnosis
Distal radius fractures
- Colles' fracture
- Smith's fracture
- Barton's fracture
- Radial styloid fracture
- Distal radioulnar joint disruption
Evaluation
Imaging
- PA
- Narrowing and overlap of distal radioulnar joint
- Lateral
- Volar or dorsal displacement of ulna (which is usually centered/overlapping the radius)
- Requires a true lateral to avoid a false positive result
- Consider forearm radiographs to evaluate for Galeazzi fracture-dislocation and Essex Lopresti
Radiographic signs of instability[1]
- Radial shortening
- Fracture of the sigmoid notch of radius
- Fracture of ulnar styloid base with >2mm displacement
Management
- Dorsal dislocation
- Immobilize wrist in supination
- Volar dislocation
- Immobilize wrist in pronation
Disposition
- Outpatient with ortho followup
See Also
References
- ↑ German C. Hand and wrist emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.
