Distal radioulnar involvement in trauma of the wrist

The distal radioulnar joint is the weakest point of the rotational column of the wrist. This joint is a functional part of the radiocarpal joint, united to it by an elastic tightening system, and perfectly controlled by the ulnaris (especially the extensor carpi) tendons. Our anatomic study allowed to define the mechanisms of the lesions and the methods for their correction. The key to success seems to be a functionally dynamic extensor carpi ulnaris and its dorsal position in supination. Our clinical study shows that all injuries to the distal radioulnar joint associated with trauma of the wrist or of the forearm are a factor of severity and they may be responsible for the high rate of complications. Therefore, in Galeazzi's fracture-dislocation, a specific method of stabilization may need to be associated with the radius osteosynthesis. In the absence of degenerative changes, chronic instability of the distal radioulnar joint can benefit from ligament stabilization. Results so far have been very encouraging, as far as young patients are concerned. Complex injuries remain a major obstacle, in which ligamentous and bone lesions must be distinguished by confronting clinical observation with paraclinical investigations. Computerized tomography seems to be of limited value, although this method of investigation is still in its prospective stages. Concerning management, shortening of the ulna with dorsal repositioning of the extensor carpi ulnaris allows to decompress the carpo-ulnar compartment, to stretch the tendinous and ligamentous structures, and, if need, to restore radioulnar congruity. Better knowledge of this pathology will allow to categorize radioulnar tears associated with wrist injuries. Under emergency conditions, surgical or non operative management must be adapted, allowing healing to occur with perfect restoration of the distal epiphysis of the radius. By doing so good functional results may be guaranteed.