Acute and chronic proximal radio-ulnar joint injuries: current concepts

The proximal radio-ulnar joint (PRUJ), which comprises the annular ligament, quadrate ligament, and oblique cord, is the proximal stabilizer of the forearm. PRUJ injuries are relatively uncommon but may significantly impair elbow and forearm function. This review summarizes current techniques for PRUJ repair and reconstruction, classifying treatment according to patient age (pediatric or adult), timing (acute or chronic), and the presence of associated bony or ligamentous injuries. Current evidence on acute and chronic PRUJ lesions was reviewed to outline the surgical techniques required to restore the anatomy and function of the proximal radio-ulnar joint. Conservative treatment is mainly reserved for less severe acute injuries in pediatric patients. In adults, PRUJ injuries most commonly occur in association with proximal radius and ulna fractures and usually require surgical management, with annular ligament repair in the acute setting or reconstruction in chronic cases, using either synthetic sutures or biological grafts. PRUJ injuries may occur in isolation but are more frequently associated with soft-tissue and osseous injuries. Several surgical techniques have been described for repair or reconstruction of the annular ligament. The choice of technique depends on injury timing, associated injuries, and patient age. This article describes the main treatment options for PRUJ lesions, ranging from conservative management to annular ligament repair or reconstruction, with or without corrective osteotomy of the proximal ulna.