Alba Gómez Sánchez (Madrid / ES), Lorena García Lamas (Madrid / ES), Daniel Bustamante Recuenco (Madrid / ES), Eva García Jarabo (Madrid / ES), Jorge Gómez Alcaraz (Madrid / ES), Juan David Serrano Alonso (Madrid / ES), Leandro Manuel Ramos Ramos (Madrid / ES), Verónica Jiménez Díaz (Madrid / ES)
Abstract text (incl. references and figure legends)
Case history
An 18 year-old male arrived at the emergency service with right wrist pain after a fall.
Clinical findings
Distal radioulnar pain without instability was observed, with complete range of movement. The patient was discharged with diagnosis of contusion.
Investigation/Results
Two weeks later, a distal radioulnar joint (DRUJ) dislocation with complete pronosupination block was observed. The X-ray showed an ulnar styloid fracture. An MRI was performed, showing an interposition of the ulnar styloid in the DRUJ.
Diagnosis
Inveterate distal radioulnar joint fracture-dislocation with ulnar fragment interposition.
Therapy and Progressions
The patient was admitted for surgical treatment. A dorsal approach to the DRUJ was performed. The interposed ulnar styloid fragment was then reduced and fixed to the distal ulna using an anchor. Intraoperative radioulnar stability was verified and pronosupination was temporarily blocked with radioulnar K-wire for three weeks.
6 weeks postoperatively the patient presented complete passive motion, with limited active motion to 40º of supination. At 6 months, complete active range of motion was observed, with no functional limitations.
Comments
Close monitoring of traumatic distal radioulnar injuries is advisable, as they are uncommon lesions which can be easily missed initially, and they can lead to significant limitation of wrist functionality if left untreated.
The previously described injury is a very unusual lesion, with only a few reports in the literature. We show a successful treatment option for these injuries, in order to increase the educational background and to assist in the development of future studies.
References
Carlsen BT , Dennison DG, Moran SL. Acute dislocations of the distal radioulnar joint and distal ulna fractures. Hand Clin. 2010 Nov;26(4):503-16.
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