Distal radioulnar joint disruption: Difference between revisions
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==Background== | ==Background== | ||
*Seen with intra-articular or distal radial shaft fractures or both bone fracture | *Seen with intra-articular or [[distal radius fractures|distal radial shaft fractures]] or [[Radia ulna fracture|both bone fracture]] | ||
==Imaging== | ==Clinical Features== | ||
*Easy to miss due to concomitant injuries | |||
*Painful pronation or supination of wrist/forearm, possible crepitus | |||
*Prominent or displaced ulnar styloid | |||
==Differential Diagnosis== | |||
{{Distal radius fracture DDX}} | |||
==Evaluation== | |||
===Imaging=== | |||
*PA | *PA | ||
**Narrowing and overlap of distal radioulnar joint | **Narrowing and overlap of distal radioulnar joint | ||
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**Volar or dorsal displacement of ulna (which is usually centered/overlapping the radius) | **Volar or dorsal displacement of ulna (which is usually centered/overlapping the radius) | ||
**Requires a true lateral to avoid a false positive result | **Requires a true lateral to avoid a false positive result | ||
*Consider forearm radiographs to evaluate for [[Galeazzi fracture-dislocation]] and [[Essex Lopresti]] | *Consider forearm radiographs to evaluate for [[Galeazzi fracture-dislocation]] and [[Essex Lopresti]] | ||
== | ===Radiographic signs of instability<ref name="Hand and wrist emergencies">German C. Hand and wrist emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.</ref>=== | ||
*Radial shortening | |||
*Fracture of the sigmoid notch of radius | |||
*Fracture of ulnar styloid base with >2mm displacement | |||
==Management== | ==Management== | ||
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*Volar dislocation | *Volar dislocation | ||
**Immobilize wrist in pronation | **Immobilize wrist in pronation | ||
==Disposition== | |||
*Outpatient with ortho followup | |||
==See Also== | ==See Also== | ||
Latest revision as of 16:30, 27 October 2017
Background
- Seen with intra-articular or distal radial shaft fractures or both bone fracture
Clinical Features
- Easy to miss due to concomitant injuries
- Painful pronation or supination of wrist/forearm, possible crepitus
- Prominent or displaced ulnar styloid
Differential Diagnosis
Distal radius fractures
- Colles' fracture
- Smith's fracture
- Barton's fracture
- Radial styloid fracture
- Distal radioulnar joint disruption
Distal radius fracture eponyms
| Eponyms | Description |
| Barton's | Fracture-dislocation of radiocarpal joint (with intra-articular fracture involving the volar or dorsal lip) |
| Chauffer's | Fracture of radial styloid |
| Colles' | Dorsally displaced, extra-articular fracture |
| Die-punch | Depressed fracture of the lunate fossa (articular surface) |
| Smith's | Volar displaced, extra-articular fracture |
Evaluation
Imaging
- PA
- Narrowing and overlap of distal radioulnar joint
- Lateral
- Volar or dorsal displacement of ulna (which is usually centered/overlapping the radius)
- Requires a true lateral to avoid a false positive result
- Consider forearm radiographs to evaluate for Galeazzi fracture-dislocation and Essex Lopresti
Radiographic signs of instability[1]
- Radial shortening
- Fracture of the sigmoid notch of radius
- Fracture of ulnar styloid base with >2mm displacement
Management
- Dorsal dislocation
- Immobilize wrist in supination
- Volar dislocation
- Immobilize wrist in pronation
Disposition
- Outpatient with ortho followup
See Also
References
- ↑ German C. Hand and wrist emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.