DRUJ/TFCC Injuries and Treatment-Instability of the Distal Radioulnar Joint

Instability of the Distal Radioulnar Joint

Pdf Summary

The distal radioulnar joint (DRUJ) is an important structure in the wrist that plays a crucial role in forearm motion and force transmission. Instability of the DRUJ can be primary (inflammatory or connective tissue disorder), post-traumatic, or post-surgical. Instability is often associated with other wrist or forearm pathology and requires a comprehensive understanding for successful management. The bony architecture of the DRUJ contributes to its instability, as the bony anatomy is asymmetric. The soft tissues, particularly the triangular fibrocartilage complex (TFCC), are primarily responsible for stabilizing the DRUJ. Other soft tissues, such as the pronator quadratus, interosseous membrane, joint capsule, and extensor carpi ulnaris (ECU), also contribute to DRUJ stability. Pathology of the DRUJ includes primary, post-traumatic, or post-surgical instability, which can be dorsal, palmar, or bidirectional. Imaging of the DRUJ includes bilateral wrist radiographs, CT scans, and sometimes magnetic resonance imaging. Treatment strategies for DRUJ instability include nonoperative management, TFCC reconstruction, corrective osteotomies, DRUJ reconstruction, and radioulnar synostosis or salvage procedures. The choice of treatment depends on the specific pathology and the patient’s individual characteristics.

Keywords

distal radioulnar joint

DRUJ

wrist

forearm motion

instability

triangular fibrocartilage complex

TFCC

imaging

treatment strategies

nonoperative management