Radioulnar Disruption

Radioulnar joint disruption is generally seen with intra-articular or distal radial shaft fractures (Galeazzi's fracture-dislocation), or with fractures of both bones of the forearm. These more apparent injuries often overshadow radioulnar joint disruption and, unfortunately, cause these injuries to be unrecognized until subsequent pain and diminished wrist movement are appreciated.

Isolated radioulnar joint dislocations are uncommon and are unrecognized acutely in as many as 50 percent of cases. Dorsal dislocation of the ulna results most often from falls on the wrist in hyperpronation. The rare volar dislocation results from forced hypersupination of the wrist. These individuals present with a painful wrist that has restricted range of motion. There may be a palpable prominence of the ulnar head, but this can be quite subtle and easily overlooked.

The anteroposterior radiograph reveals narrowing and overlap of the distal radioulnar joint. The lateral radiograph demonstrates either volar or dorsal displacement of the ulna, which is normally centered and overlapping the radius. Because slight oblique positioning of the wrist can produce a misleading appearance of ulnar displacement, it is crucial that a properly positioned lateral view be obtained. A true lateral view should have superimposition of the four-ulnar metacarpals, superimposition of the proximal pole of the scaphoid with the lunate and triquetrum, and the radial styloid centered over its distal articular surface. CT scanning may be necessary to establish the diagnosis if plain films are inconclusive. Immobilizing the wrist in supination reduces dorsal dislocations, whereas volar dislocations are placed in pronation. These injuries unfortunately have a high recurrence rate, particularly if there are delays in diagnosis, and may require reconstructive surgery.

BIBLIOGRAPHY

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