Distal radioulnar joint subluxation and dislocation diagnosed by standard roentgenography

Abstract

The use of standard lateral roentgenography for diagnosing distal radioulnar joint (DRUJ) subluxation and dislocation was investigated. Using a wrist support, bilateral standard lateral roentgenograms of the wrist were obtained in 42 patients with normal wrists and in 56 patients with a unilateral wrist injury. In normal wrists the difference between the radioulnar distance in the right and the left wrist did not exceed 4 mm when the difference in the pisoscaphoid distance was less than 3 mm. Of the 36 patients with wrist injury whose difference in pisoscaphoid distance was less than 3 mm, 15 had a radioulnar distance of 5 mm or more, and computed tomography (CT) confirmed DRUJ dislocation in 14. Concordance between lateral roentgenograms and CT was present in 33 of 36 patients (92%). These results demonstrate the value of a standardized technique for bilateral lateral roentgenography in diagnosing DRUJ subluxation and dislocation.

Easily Missed Fractures of the Upper Extremity

“…76 In addition, the radiographic features of distal radioulnar dislocation can be subtle. Although it has been reported that a greater than 5 mm discrepancy between the radioulnar distance on the injured versus noninjured wrist on lateral views is considered diagnostic for dislocation, 77 in our experience this has been difficult to reproduce. Because the majority of Essex-Lopresti injuries require surgical treatment, and surgical outcomes are improved with early intervention, 76 once the suggestion of possible distal radioulnar injury in the setting of a comminuted radial head fracture is raised, further investigation, including a focused physical examination, and dedicated CT should be considered.…”

Diagnosis of distal radioulnar joint subluxation in patients with rheumatoid wrist by computed tomography

“…Furthermore, standard X-ray fi lms cannot detect some cases of dynamic subluxation, which can only be seen in views other than in neutral DRUJ rotation. 6 Due to sigmoid notch scalloping, ulnar head erosion, and development of a volar shelf in the rheumatoid wrist, the usual methods 7-17 for detecting subluxation of the DRUJ on CT scans are diffi cult to apply. To overcome these diffi culties, we devised a new method for assessing subluxation of the DRUJ in the rheumatoid wrist.…”

Ulnar Shortening Osteotomy in Idiopathic Ulnar Impaction Syndrome

“…These findings suggest that the prevalence of idiopathic ulnar impaction syndrome may be more common in Asians than in white individuals. Nakamura et al 5 reported that, in normal wrists, the difference between the radioulnar distance in the right and left wrists does not exceed 4 mm when the difference in the piso-U Subjective motion score 6.9 ± 2.1 9.4 ± 1.1 <0.0001…”

“…However, patients who presented with ulnar impaction syndrome and coexistent problems of the distal radioulnar joint were included. To quantify the status of the distal radioulnar joint, the radioulnar distance 5 was measured perioperatively on a true lateral radiograph of the wrist, in which the pisoscaphoid distance was <3 mm (Figs. 2-A and 2-B).…”