Volar Dislocation of the Distal Radioulnar Joint Associated With Radial Shaft Malunion

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Journal of the Korean Society for Surgery of the Hand 2008;13(1):20-25.
Published online March 1, 2008.

In-Ho Jeon, Dong-Ju Shin, Young-Hon Son, Byung-Woo Lee, Poong-Taek Kim

요골 간부의 부정 유합에 동반된 원위 요척 관절의 전방 탈구

전인호, 신동주, 손영헌, 이병우, 김풍택

Abstract

Purpose
We report four cases of adolescent recurrent volar instability of the DRUJ associated with radial shaft malunion. Materials and Methods: Four patients between the age 14 and 22 years presented recurrent volar ulnar head dislocation with painful clunk. All patients had radial shaft fracture at an average age of 11 years (range:9-13 years) and all were male. Two patients had been treated conservatively with long arm cast, one with open reduction/ internal fixation and another one had no formal treatment. Patients complained the volar dislocation of ulnar head in pronation and the reduction of ulnar head in supination with clunk. Plain radiographs showed malunion of the radial shaft with an average volar angulation of 11 degrees and the arthritic deformity of the distal radioulnar joint. CT scans in supination demonstrated the disruption of the distal radioulnar joint. Corrective osteotomy of the radius was performed in three patients. We evaluated the preoperative and postoperative pain and grip power (Mayo wrist score) and radiographic outcome. Mean follow-up period was 18months (range: 6~25 months). Results: Redislocation of the ulnar head and painful clunk disappeared after corrective osteotomy. Radiographs showed anterior bowing of radial shaft decreased to 3.3 degrees and bone union was achieved in 3 months postoperatively. Mayo modified wrist scores improved from 76.1 points to 86.5 points at the time of the last follow up. Conclusion: Corrective osteotomy should be considered in volar instability of the DRUJ associated with radial shaft malunion to restore unstable DRUJ

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