DRUJ Instability

Types

 

Dorsal

- most common

Volar

 

Causes

 

1.  Acute traumatic peripheral tear TFCC with DRUJ dislocation

- usually major trauma

- dorsal or volar

 

2A.  Distal radial fracture

- Galleazzi fracture

- sigmoid notch fracture

 

2B.  Radial Malunion

 

3.  Ulna styloid fracture

 

4.  Essex Lopresti 

- fracture radial head with dislocation DRUJ

 

Diagnosis

 

Xray

- need true lateral

- ensure radial styloid overlies proximal scaphoid / lunate / triquetram

 

CT

- Axial view shows DRUJ incongruency

 

1A.  Dorsal Dislocation DRUJ

 

Mechanism

- hyperpronation

- tear of dorsal distal RUJ ligament

- with partial or complete TFCC tear

 

Clinically

- dorsal prominence

- forearm locked in pronation

- attempted supination painful

 

CT scan

 

Management

 

1.  Closed reduction

- maintain in supination 4/52

 

2.  Open reduction

- rarely needed

- failure closed reduction (ECU incarceration)

- chronically dislocated

- may require acute repair TFCC +/- K wires

 

TFCC Repair + K wire

 

1B.  Volar Dislocation DRUJ

 

Mechanism

- forced supination

- usually complete tear TFCC

 

Clinically

- arm locked in supination

 

CT scan

 

Management

- closed reduction

- maintain in pronation 4 weeks

- rarely need open reduction or in chronic cases

 

2A.  Acute Distal radial fracture / Galleazzi

 

Incidence

- up to 60%

 

Treatment

- Anatomical reduction of radius

- usually makes DRUJ stable

- rarely need to repair TFCC / K wire for stability

 

2B. Radial malunion / Non anatomical ORIF

 

A. Short radial fracture

- lengthening radius difficult

- ulna shortening

 

B.  Angulation / rotation

- radial osteotomy

- TFCC repair

- +/- TFCC reconstruction with strip ECU

 

3.  Displaced ulna styloid

 

Classification

 

Type 1

- tip fracture

- stable DRUJ

 

Ulna Styloid Tip FractureUlna Styloid Tip Fracture

 

Type 2

- base fracture

- unstable DRUJ

 

Wrist Ulna Styloid Fracture

 

Management

 

POP immobilisation in neutral rotation and UD for 6/52 

- ensure DRUJ remains located

 

Rarely need ulnar styloid ORIF if displaced and DRUJ unstable

 

4. Essex-Lopresti injury

 

Definition

- fracture radial head with dislocation DRUJ

- Essex-Lopresti variant - radial neck fracture with dislocation DRUJ

 

Type 1

- acute radial head fracture

 

Management

- reconstruct or replace radial head

- assess stability in supination

- occasionally need TFCC repair +/- K wire

 

Type 2

- late

- following excision of radial head with injury to interosseous membrane

- usually occurs within first two years following injury

 

Management

 

Nil degenerative changes

- ulna shortening with plate to reduce DRUJ

- radial head replacement to prevent recurrence

 

Degenerative changes

- Hemiresection / Darrach's / Kapandji