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Frequency and Outcomes of Distal Radioulnar Joint Dislocation Associated With Distal Radius Fractures in the Elderly
Manami Ishimatsu1, Takashi Oda1, Yuka Yamanaka2
1Department of Orthopedic Surgery, Hokkaido Saiseikai Otaru Hospital, Otaru, Japan.
Purpose:
Although dislocation or subluxation of the distal radioulnar joint (DRUJ) rarely coexists with distal radius fractures, the necessity for complementary repair of the triangular fibrocartilage complex (TFCC) in the elderly is debated. We investigated the frequency and surgical outcomes of TFCC reattachment for DRUJ dislocations with distal radius fractures in elderly patients.
Methods:
We retrospectively reviewed consecutive patients aged 65 years or older who underwent internal fixation of distal radius fractures. The fracture type and dislocation or subluxation of the DRUJ at the time of injury were evaluated. Pain, range of motion, grip strength, Modified Mayo Wrist Score, and Disability of the Arm, Shoulder, and Hand (DASH) scores were retrieved from medical records after 6 months. All cases were divided into three groups to compare the clinical outcomes: dislocation, subluxation, and nondislocation.
Results:
A total of 173 wrists (77.8 years old; 12 men and 159 women) were included. Two (1.2%) and 3 (1.7%) wrists showed dislocation and subluxation of the DRUJ, respectively, and all five wrists had Arbeitsgemeinschaft für Osteosynthesefragen (AO) type A3 distal radius fractures. Both cases of dislocation that demonstrated recurrent volar dislocation of the ulnar head after internal fixation of the radius involved repair of the TFCC using a bone anchor. Wrist extension and grip strength were worse; however, pain and DASH scores were better in the dislocation group than those in the subluxation and nondislocation groups.
Conclusions:
The incidence of DRUJ dislocation/subluxation associated with radius fractures is low in elderly patients. If the DRUJ remains unstable after internal fixation of the radius, good outcomes can be expected with one-stage reattachment of the TFCC, even in elderly patients.
Type Of Study/Level Of Evidence:
Therapeutic IV.
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