Missed isolated volar dislocation of distal radio-ulnar joint: a case report

Isolated volar dislocation of the distal radioulnar joint: Current concepts review and case report

Isolated volar distal radioulnar joint (DRUJ) dislocation is a rare condition with only a few cases reported in the literature. Its diagnosis is often overlooked in the acute phase, and there is no consensus in its management. We present the case of a 20-year-old male patient with an isolated volar radioulnar dislocation, together with a review of the literature. The aim is to present and summarize the acute management of this condition and propose a therapeutic algorithm.

A Case Report of Volar Dislocation of Ulnar Head: A Very Rare Wrist Injury Easy to Overlook and Easy to Diagnose

Introduction:

Ulnar volar dislocation (UVD) is a very rare entity. Due to rarity of condition, usually, it’s misdiagnosed at emergency departments and management of this clinical entity is not well studied. Here, we report a case of UVD impressing diagnostic challenge, indication of treatment, and follow-up.

Case Report:

A 29-year-old man presented to orthopedic outpatient service with complaining of the right wrist pain. He had an assault history 3 days before. In the emergency department, he had been diagnosed as wrist sprain. Splint and pain killers were prescribed. Due to increase of pain, he admitted to orthopedics. He was diagnosed UVD. Under general anesthesia, joint was reduced with forced pronation maneuver. After 3 weeks immobilization period, magnetic resonance images revealed partial injury of triangular fibrocartilage complex then splint removed and rehabilitation initiated. Over than 24 months, he is doing well without movement limitation and wrist strength impairment.

Conclusion:

For prevention misdiagnosis of UVD, physical examination is very important. Forearm rotation limitation with pain in the wrist should be indicative for distal radioulnar joint injury. Physical examination should be supported with proper evaluation of suitable radiographs. After reduction of joint, magnetic resonance images give clues about ligamentous injury. Our case supports the importance of rigorous physical examination and evaluation of radiographs for wrist injury. In the presence of partial injury of ligaments, the condition can be treated with shorter periods of immobilization and early rehabilitation.

Application of Suspension Fixation with Button Plates for Patients with Distal Radioulnar Joint Dislocation: A Case Series

Objective

The aim of the present study was to assess the effect of suspension fixation with button plates on the reconstruction of the distal radioulnar joint dislocation (DRUJ).

Methods

This was a case series of six patients (two men and four women) who underwent suspension fixation with button plates for DRUJ dislocation between January 2015 and May 2017. Physical examination, radiography, MRI, functional activity of the wrist joint, grip strength of the wrist joint, Garland–Werley wrist score, Mayo wrist score, and visual analog scale (VAS) score were used to evaluate the effect of this procedure. All patients were followed up every 3 months. The evaluation time point was 12 months after the operation. Comparisons of the functional indexes of wrist function before and after the operation were performed using paired statistical tests.

Results

The mean range of motion of the affected limb was 70° at forearm pronation and 75° at forearm supination. The subjective assessments and tests of the motor function of the wrist showed improvement after surgery. The Garland–Werley wrist score was 13.50 ± 2.66 preoperatively, the Mayo wrist score was 56.67 ± 18.35, and the VAS score was 4.83 ± 1.17. The Garland–Werley wrist score was 2.83 ± 1.33 postoperatively at 12 months, the Mayo wrist score was 87.5 ± 6.89, and the VAS score was 0.50 ± 0.55. At 12 months, the Garland–Werley wrist score, the Mayo wrist score, and the VAS score showed significant improvements when compared with those before surgery (P = 0.000, P = 0.003, and P = 0.000, respectively). Radiographic examination revealed that the internal fixation device was in place, and no dislocation of the DRUJ could be observed. None of the patients had internal fixation device removal or re‐dislocation of the DRUJ. None of the patients had re‐dislocation of the DRUJ. No secondary ulnar or radial fractures and nerve injury were reported during and after surgery. No tumor recurrence was observed in patients with giant cell tumors of the tendon sheath. No loosening and displacement of screws were reported.

Conclusion

The new method of suspension fixation with button plates for the surgical reconstruction of a DRUJ dislocation is simple, with minimal trauma, and maintains the stability of the DRUJ without the need for intra‐articular or extra‐articular reconstruction of the ligament. Furthermore, it allows early functional exercise and achieves satisfactory postoperative functional recovery.

Irreducible Chronic Volar Dislocation of the Distal Radioulnar Joint After Surgery for Distal Radius Fracture: A Case Report

CASE

We report a case of irreducible chronic volar dislocation of the distal radioulnar joint (DRUJ) after surgery for distal radius fracture. The patient underwent volar locking plate fixation for distal radius fracture. Despite the satisfactory alignment of the distal radius, irreducible volar dislocation of the DRUJ was discovered at 5 weeks after the initial surgery. DRUJ reconstruction at 9 weeks after injury using the Adams-Berger procedure resulted in a stable and functional DRUJ and wrist.

CONCLUSION

To prevent postoperative DRUJ instability or dislocation, the DRUJ should be evaluated for stability immediately after fracture fixation.

Isolated Volar Dislocation of the Distal Radioulnar Joint: A Case Report

Introduction

Isolated dislocation of the distal radioulnar joint (DRUJ) is a rare phenomenon. Approximately 50% of isolated DRUJ dislocations are undiagnosed or diagnosed late with significant functional consequences. This clinical injury is rarely described in the literature and management is not well established. We reported a case of volar DRUJ dislocation early diagnosed.

Case Report

A 36-year-old man was diagnosed with an isolated volar dislocation of the DRUJ. The clinical examination, X-rays, and computed tomography scan allowed an early diagnosis. A reduction by external maneuvers was performed and the patient was immobilized in an above elbow plaster cast for 6 weeks. Magnetic resonance imaging did not reveal any capsuloligamentous lesions requiring surgery. Evolution was favorable.

Conclusion

Isolated volar dislocation of the DRUJ is an uncommon injury which can be easily missed. Missed or late diagnosis may lead to significant morbidity. Early diagnosis and treatment of such injuries usually results in excellent functional recovery.

Habitual volar dislocation of the ulnar head with a locked distal radioulnar joint after distal radius fracture: A case report

RATIONALE

Habitual volar dislocation of the ulnar head with a locked distal radioulnar joint (DRUJ) is a rare complication after distal radius fracture. We present a case of habitual volar dislocation of the ulnar head in a woman with a dorsally displaced malunited distal radius fracture.

PATIENT CONCERNS

A 72-year-old woman presented with occasional painful locking of the forearm in full supination. She had fractured the left distal radius in a fall 6 months previously. The fracture had been treated non-surgically with wrist immobilization in a long and short arm cast for 6 weeks. Physical examination showed no swelling of the left hand. The wrist locked when the forearm was fully supinated, and the patient was not able to pronate her forearm without reducing the ulna by pressing the left ulna down toward the DRUJ. She experienced sharp pain during the reduction procedure and pronation of the left forearm. The affected wrist had 91% motion compared with the contralateral wrist.

DIAGNOSIS

Radiography and computed tomography showed 28° dorsally angulated malunion of the distal radius and ulnar head subluxation with respect to the radius. Magnetic resonance imaging revealed disruption of the ulnar-side triangular fibrocartilage complex (TFCC) from the ulna fovea.

INTERVENTIONS

The patient desired surgery to address the painful click during full supination of her left wrist and the limitations in her activities of daily living. Corrective osteotomy of the distal radius and arthroscopic repair of the ulnar-side tear of the TFCC were performed. The TFCC was arthroscopically repaired to the ulnar fovea to stabilize the DRUJ.

OUTCOMES

At 1 year postoperatively, radiography showed complete union of the radius. The affected side had 97% wrist motion compared with the contralateral wrist and a full range of forearm rotation without pain or clicking. The grasp strength was 100% compared with the normal wrist.

LESSONS

Malunited distal radius fracture with concomitant TFCC injury can result in habitual volar dislocation of the ulnar head due to severely dorsally angulated malunion of the radius and avulsion of the ulnar-side TFCC from the ulna fovea. This condition required corrective osteotomy plus TFCC repair.

Isolated Distal Ulna Fracture With Distal Radioulnar Joint Dislocation: A Novel Fracture Pattern

Background: Galeazzi fractures composed of a middle to distal third radius fracture with dislocation and/or instability at the distal radioulnar joint (DRUJ) have been well described for decades. However, the inverse scenario has seldom if ever been described in the literature. Methods: We explore the case of a 25-year-old active patient who experienced a traumatic distal ulna fracture with dislocation of the DRUJ without a distal radius fracture. Results: It was successfully treated with open reduction and Kirschner wire fixation. The patient regained equivalent strength and range of motion compared with the contralateral uninjured extremity. Conclusion: We feel this patient's successful postoperative course can guide future treatment plans for orthopedic surgeons who encounter similar fractures.

Isolated palmar dislocation of distal radioulnar joint: a new mechanism of injury: a case report

BACKGROUND

Isolated palmar dislocation of distal radioulnar joint is a rare injury. It can easily lead to misdiagnosis. Previous literature reports were all rotation violence. We reported a patient with direct impact violence.

CASE PRESENTATION

We report a 31-year-old male laborer presented to our hospital with an acute trauma. Severe tenderness and limited mobility were seen in his right wrist. He received an x-ray film examination and diagnosed as the isolated palmar dislocation of distal radioulnar joint. The treatment was closed reduction and splint fixation. After half a year, the patient gained a functional recovery of his previously afflicted wrist.

CONCLUSIONS

To the best of our knowledge, this is the first case of isolated palmar dislocation of distal radioulnar joint caused by a direct impact violence. Patients and physicians should be aware of the properties of this mechanism of injury so that early diagnosis and treatment can be achieved.

[Galeazzi fracture in children: about 5 cases and literature review]

Galeazzi fracture describes a fracture of the radial diaphysis in association with distal radioulnar dislocation (most often dorsal). We conducted a retrospective study in the Department of Pediatric Orthopedic Trauma at the Mother-Child Hospital CHU Hassan II in Fez (Morocco). The study involved five male children. Four children underwent orthopedic treatment while one child underwent surgical reduction. Mean follow-up was 24 months (8-30).

Closed Reduction of an Acute Volar Dislocation of the Distal Radio-Ulnar Joint by a Modified Technique

There is scarce literature describing treatment of volar dislocation of the distal radio-ulnar joint (DRUJ). Irreducible dislocation is usually treated surgically. We present the case of a 37-year-old male with acute right wrist pain and loss of pronation. A diagnosis of volar DRUJ dislocation was made. Reduction using conventional technique was unsuccessful. A second attempt was successful by applying pressure over the interosseous membrane of the forearm and manipulating the ulnar head. At three weeks, the patient had minimal pain, a stable DRUJ, and near complete range of motion. This modified technique for reduction of a locked anterior DRUJ dislocation can be used to avoid an unnecessary surgical intervention.

The "second ulnar groove", a MRI sign suggesting a previous palmar luxation of the ulna at the distal radioulnar joint

INTRODUCTION

A cortical lined impaction on the radiodorsal side of the ulnar head may be at the origin of a "second ulnar groove" (SUG). The goal of this article is to illustrate this MRI sign, prompting for further investigation of the distal radioulnar joint (DRUJ). Hence associated soft tissue pathology may be detected, which may lead to instability.

MATERIAL AND METHODS

Following an anterior luxation of the ulna at the DRUJ a second cortical lined groove in a previously normal distal ulna was discovered. A data base review from January 2008 to August 2016 of the axial FS PD-TSE WI 1.5T MRI views of 1.716 patients was accomplished in search of similar bone defects.

RESULTS

Eight patients with previous severe wrist trauma presented with a similar posttraumatic ulnar bone defect. The preceding anterior luxation at the DRUJ was only clearly demonstrated in five patients. However, two more patients had a residual anterior subluxation. Different imaging techniques are discussed and the differential diagnosis is well illustrated.

CONCLUSIONS

The type of trauma, the specific location and the morphology of a second ulnar groove, all compatible with a sequel of an anterior luxation of the ulna at the DRUJ, should lead to a further specific clinical and MRI revaluation of the DRUJ.

Volar Distal Radioulnar Joint Dislocation Associated with Acute Median Nerve Neuropathy and a Distal Radius Fracture

Volar distal radioulnar (DRUJ) dislocations are uncommon and can easily be missed. We present a rare case of an irreducible volar DRUJ dislocation associated with a distal radius fracture and acute median nerve neuropathy at the wrist. An attempt to reduce the DRUJ dislocation in the emergency department had failed. The patient was then taken to the operating room requiring a carpal tunnel release, as well as an open reduction and internal fixation of the distal radius fracture and repair of the volar distal radioulnar ligament. We also review some of the volar DRUJ case reports in the literature.

Subtle radiographic findings of acute, isolated distal radioulnar joint dislocation

Distal radioulnar dislocations typically occur in association with fractures of the distal radius and/or ulna. Rare isolated dislocations or subluxations are more difficult to diagnose and are initially missed in up to 50 % of cases. We present two cases of missed isolated volar rotatory dislocation of the distal radioulnar joint. Subtle, overlooked radiographic findings of abnormal radioulnar alignment and ulnar styloid projection are highlighted. The supplemental role of cross-sectional imaging is reviewed. Adequate clinical information, appropriate radiographic technique, and high index of suspicion are necessary for the accurate and timely diagnosis of this rare injury pattern.

Imaging of the Proximal and Distal Radioulnar Joints

The proximal and distal radioulnar joints form a unique articular arrangement between the radius and ulna, allowing pivot motion of the forearm and positioning the hand in space. Typically imaged in conjunction with the elbow, radiographs, computed tomography (CT), and MR imaging of the proximal radioulnar joint contribute unique diagnostic information. Because dysfunction of the distal radioulnar joint is often a result of instability, dynamic CT protocols stressing the joint in addition to anatomic imaging with radiographs and MR imaging is valuable. Detailed knowledge of the patient's clinical condition and careful selection of imaging protocols will maximize the benefits.

Non-reducible palmar dislocation of the distal radioulnar joint

A rare case of an isolated traumatic palmar dislocation of the distal radioulnar joint is presented. Clinically, there is a loss of pronation and supination. The dislocation was treated using an open reduction, reinsertion of the capsule-ligamentous complex and temporary stabilization using K-wires.

Subacute volar dislocation of the distal radioulnar joint without fracture: A case report and literature review

This is the first report describing subacute volar dislocation of the distal radioulnar joint treated by open reduction and stabilization of the distal radioulnar joint by means of a suture anchor. Acute volar dislocation of the distal radioulnar joint successfully treated by closed or open reduction has previously been reported. In our case, surgery was performed five weeks after the initial injury. Good stabilization was obtained by reattaching the triangular fibrocartilage complex to the ulnar fovea with a suture anchor. It is important not to misdiagnose distal radioulnar joint dislocation, and the suture anchor technique is an effective treatment option.

Acute isolated volar dislocation of the distal radio-ulnar joint: case report and literature review

The acute isolated distal radio-ulnar (DRU) dislocation is a rare traumatic pathology and no consensus concerning its management has been established. This case report describes an acute isolated volar DRU dislocation in a 26-year-old patient. The authors propose, based on this case and after an exhaustive review of the literature, a non-operative management for these isolated and non-complicated dislocations.

Imaging the distal radioulnar joint

Imaging the DRUJ requires knowledge of the complex bony, muscular, and ligamentous anatomy that contribute to this unique joint. Standard well-positioned radiography is always the appropriate first step in any imaging evaluation of the wrist. High-resolution MRI of the wrist, preferably performed at 3T, helps to delineate the important ligamentous structures relevant to the DRUJ and ulnar wrist, whether the joint is unstable or not. The presence of instability on physical examination is an indication for dynamic CT evaluation. Close attention to technique, no matter what the modality of choice, offers the best chance for success in providing added value with imaging. Finally, communication between the radiologist and hand surgeon allows the advanced imaging examinations to be tailored to the specific clinical problem for the most effective use of resources for each individual patient.

[Volar distal radio ulnar joint dislocation, case report and literature review]

The authors report the case of a volar distal radio ulnar joint dislocation. The rarity of this lesion seems to be linked to the anatomical relationship of the distal portion of the ulna with the tendons of the extensor carpi ulnaris and the tendon of the extensor digiti minimi. Early diagnosis based on physical examination and radiology gives a better prognosis for closed treatment, reserving surgery for failure or irreducible luxations.

Recurrent palmar dislocation of the distal radioulnar joint. A case report

Recurrent palmar dislocation of the distal radioulnar joint is not a common injury. We report one case in a 73-year-old female. This injury was incorrectly diagnosed at the first presentation because there has been no distinct deformity at the wrist and extension-flexion was normal. The need for proper physical examination and accurate radiographic positioning is stressed. Distal diaphysis resection combined with distal radioulnar arthrodesis (modified Sauve-Kapandji procedure) was the preferred method of treatment in an old patient. Two years after the injury, the patient was asymptomatic.