Ulna Rotation Osteotomy in Complete Dislocation of the Distal Radioulnar Joint

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Abstract

Background

Complete dislocation of the distal radioulnar joint (DRUJ) is a rare injury. Dislocation can present as uni- or multidirectional, acute or chronic, reducible or irreducible. It can occur due to isolated loss of ligamentous restraints or more frequent in Galeazzi - or Essex-Lopresti-type fractures.

Case Description

A 28-year-old man sustained a distal radius fracture and presented after conservative treatment with blocked supination. Examination revealed a malunion of the distal radius in combination with an irreducible dorsal dislocation of the DRUJ. Corrective osteotomy of the distal radius was performed, the DRUJ was reduced, and the ulnar avulsed triangular fibrocartilage complex (TFCC) refixed with transosseous sutures. Redislocation occurred 8 weeks later. Revision surgery showed a palmar dislocated TFC fixed in a palmar scar formation along the distal interosseous membrane (DIOM). The scar was released and a rotation osteotomy of the distal ulna was performed. At follow-up, the patient was pain-free, had good range of motion, and returned to work and sport activities.

Literature Review

For reconstruction of chronic complete dislocations of the DRUJ, ligament plasty procedures are described. In case of additional cartilage damage, salvage procedures are recommended.

Clinical Relevance

We report a procedure in which the rotation of the distal ulna is corrected to restore DRUJ congruity in chronic dislocations. The rotation osteotomy described is useful in gross ligamentous instability following loss of constraint by the TFCC and the DIOM.

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