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Instability of the Distal Radioulnar Joint.

Andreas Harbrecht1, Frank Unglaub, Martin Franz Langer

  • 1Clinic and Polyclinic for Orthopedics, Trauma and Plastic-Esthetic Surgery, University Medical Center Cologne; Vulpius Clinic, Department of Hand Surgery, Bad Rappenau, and Mannheim Faculty of Medicine at Heidelberg Ruprecht Karls University; Dept. for Trauma, Hand and Reconstructive Surgery, Münster University Clinic, Münster; Clinical for Plastic and Hand Surgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland; Hand Surgery, Spital Langenthal, Spital Region Oberaargau SRO AG, Langenthal, Switzerland, and Faculty of Medicine of the University of Cologne.

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Summary
This summary is machine-generated.

Distal radioulnar joint (DRUJ) instability is a common complication of wrist injuries. Early recognition and specific treatment are crucial to prevent pain and functional loss.

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Area of Science:

  • Orthopedic Surgery
  • Radiology
  • Sports Medicine

Background:

  • Distal radioulnar joint (DRUJ) instability is an often overlooked complication of distal radius fractures and soft-tissue injuries.
  • It can lead to significant functional impairment of the wrist.
  • In Germany, the incidence and prevalence in 2023 were 23.55 and 30.55 per 100,000 inhabitants, respectively.

Purpose of the Study:

  • To review the current understanding of distal radioulnar joint (DRUJ) instability.
  • To outline diagnostic methods and treatment options for DRUJ instability.
  • To emphasize the importance of recognizing and managing DRUJ instability.

Main Methods:

  • A narrative review of publications from PubMed and the Cochrane Library.
  • Inclusion of 4 out of 10 selected studies.
  • Consideration of current guidelines, expert recommendations, and data from health insurance and statistical offices.

Main Results:

  • Clinical examination and specific tests (press test, ulna-fovea sign, stress tests, ballottement) are initial diagnostic steps.
  • Plain wrist films in orthogonal projections, thin-slice CT (radioulnar quotient method), and MR arthrography aid in diagnosis.
  • Arthroscopy is the gold standard for assessing triangular fibrocartilage complex lesions; treatment may involve reconstruction, refixation, grafts, or osteotomies. Ulnar styloid process fractures may not require refixation.

Conclusions:

  • DRUJ instability requires specific recognition and treatment to prevent chronic pain and functional deficits.
  • Further research is necessary to establish robust scientific evidence for optimal surgical and conservative management strategies.