gms | German Medical Science

Introduction: Distal radio ulnar joint (DRUJ) is important for stability of the wrist. DRUJ disruption can result either from a bony injury, TFCC tear with ligament injury, or other soft tissue injury (capsule, tendon ).

DRUJ injury can be further divided into acute and chronic instability. Most acute cases are treated conservatively however the management of chronic problems usually requires surgery.

Case report: A 30-year-old lady presented to us complaining of right wrist pain. She sustained right Galeazzi fracture and had plating done with DRUJ k-wire 3 months ago. She defaulted follow-up and was seen at our clinic 3 months post operatively with a complaint of chronic pain over wrist and was unable to fully supinate her forearm. Clinically, there was presence of a clicking sound at the end of supination. Examination revealed an unstable DRUJ with pain over mid wrist and dorsal displacement of the ulna. X-ray of the right radius/ulna showed a DRUJ disruption.

Results: We proceeded with open reduction and primary dorsal capsular repair without MRI investigation. A dorsal approach was used at the 5th compartment of the wrist. Intra operatively, it was noted that the dorsal radio ulnar ligament was torn. Part of the Extensor Carpi Ulnaris of the same side was inserted into the sigmoid notch following which the dorsal radio ulnar ligament was repaired with prolene size 6. Post operatively, patient claimed that there was great reduction in pain. Supination is now full and there is absence of clicking sound. She is currently 8 months post op and is undergoing physio therapy.

Conclusion: Dorsal radio ulnar ligament reconstruction can rebuild the anatomic stability of the DRUJ, which does not damage the adjacent structures of the joints and can obtain satisfactory function of the reconstructed joint. It is a good choice for chronic instability of the distal radio ulnar joint in a young patient without articular degeneration.This relatively simple procedure can be used as an early management of DRUJ instability in district hospital setting.