Distal Radioulnar Joint Locking with Bipolar Injury

Abstract

Background Locking of the distal radioulnar joint (DRUJ) induces restriction of the active and passive motion of pronation or supination of the forearm. Diagnosis of DRUJ locking due to a triangular fibrocartilage complex (TFCC) tear is sometimes difficult.

Case Description A 15-year-old female suffered from restriction of forearm supination after cast immobilization for the treatment of an elbow injury. The active and passive range of motion (ROM) of supination was 30 degrees, while the active ROM of pronation was normal. Radiographs of the elbow showed a fracture of the medial epicondyle and a fracture around the radial head. Radiographs of the wrist showed a subluxation of the ulnar head. Accurate diagnosis of supination restriction was difficult before surgery, so an operation was performed for the diagnosis and treatment. DRUJ locking was reduced manually and arthroscopic findings showed central perforation of the TFCC. Forearm supination improved to 90 degrees postoperatively.

Literature Review DRUJ locking due to a TFCC injury is rare and this condition with bipolar injury has not been reported.

Clinical Relevance DRUJ locking due to an injured TFCC should be considered as one of the differential diagnoses of supination contracture.

Keywords

bipolar injury - DRUJ locking - DRUJ blocking - locking - triangular fibrocartilage complex

Note

This work was performed at Department of Orthopaedic Surgery, Keio University School of Medicine.

Ethical Approval

Informed consent has been obtained from the patient and her parents for publication.

Publikationsverlauf

Eingereicht: 14. März 2021

Angenommen: 09. Dezember 2021

Artikel online veröffentlicht:
20. Januar 2022

• References

• 1 Yano K, Kaneshiro Y, Sakanaka H. Arthroscopic resection of an osteochondral loose body in the distal radioulnar joint: a case report. Acta Orthop Traumatol Turc 2018; 52 (05) 404-407
• 2 Slesarenko YA, Hurst LC, Dagum AB. Synovial chondromatosis of the distal radioulnar joint. Hand Surg 2004; 9 (02) 241-243
• 3 Koh S, Nakamura R, Horii E, Nakao E, Shionoya K, Yajima H. Loose body in the wrist: diagnosis and treatment. Arthroscopy 2003; 19 (08) 820-824
• 4 Ono H, Yajima H, Fukui A, Tamai S. Locking wrist with synovial chondromatosis: report of two cases. J Hand Surg Am 1994; 19 (05) 797-799
• 5 De Smet L, Van Wetter P. Synovial chondromatosis of the distal radio-ulnar joint. Acta Orthop Belg 1987; 53 (01) 106-108
• 6 Araki S, Kachi S, Mishima S. Locking of the forearm in pronation due to extensor carpi ulnaris tendon dislocation with dorsal distal ulna dislocation. J Hand Surg Am 1994; 19 (03) 402-404
• 7 Takahashi Y, Nakamura T, Sato K, Toyama Y. Subluxation of the palmar radioulnar ligament as a cause of blocked forearm supination: a case of DRUJ locking. J Wrist Surg 2013; 2 (01) 83-86
• 8 Suzuki T, Nakamura T, Tanino Y, Obara Y, Yoshikawa Y, Iwamoto T. Acute blocking of forearm supination secondary to tearing of the triangular fibrocartilage complex. J Hand Surg Eur Vol 2020; 45 (09) 939-944