gms | German Medical Science

Objectives/Interrogation: Distal radial fractures, with or without fracture of the ulnar styloid, and radial shaft fractures may result in instability after disruption of the distal radioulnar ligaments or a tear of the peripheral triangular fibrocartilage complex (TFCC). Regardless of the approach taken (i.e. conservative treatment, K-wire fixation, open or arthroscopic repair), correct treatment of this rupture requires immobilization of the wrist and elbow for a period of six to eight weeks. The purpose of this study was to describe the results of distal radio-ulnar joint instability treatment using dynamic stabilization to allow early mobilization of both the radiocarpal and distal radioulnar joint as soon as week one postsurgery.

Methods: Between July 2008 and February 2013, a retrospective study was performed of 16 consecutive patients presenting distal radius fracture or Galeazzi fracture dislocation who exhibited an unstable DRUJ during intraoperative manual stress testing (via the Ballottement test) after fixation of the distal radius. Once instability was confirmed, dynamic stabilization was performed. All patients had radiographic evaluation of their wrist. CT arthrography (CTR) was performed at 3 months to evaluate TFCC healing. After surgery patients were immobilized one week with a short cast. All patients were monitored at 1month, 3 months, 6 months and 1 year after the fracture. Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, Ballottement test, radio-ulnar joint Range of motion (ROM), pain, grip strength, return to work, radiographic angulation and complications were monitored.

Results and Conclusions: All patients were followed for an average of 12 months after surgery. After 1 month, all patients were satisfied with good range of motion and grip strength. The Ballottement test was negative in 15 patients (93.75%), and only 1 patient showed persistent instability probably related with osteoporotic bone. TFCC healing was observed in 14 patients (87.5%) and fracture healing was observed in all 16 patients. Revision surgery was performed in one patient (6.25%) due to flex-extension limitation and no other complications were recorded.

The high incidence of DRUJ instability in fractures of the distal radius and Galeazzi fracture-dislocations is well described in the literature. The technique presented in this article illustrates a reliable method for dynamic stabilization of the DRUJ with satisfactory results at short-term follow-up.