Closed reduction of volar distal radio-ulnar joint dislocation

Authors

1 Department of Orthopedic, Kassab Orthopedic Institute, Medical University of Tunis Manar, Tunis, Tunisia

2 Department of Orthopedic, Military Hospital of Instruction, Medical University of Tunis Manar, Tunis, Tunisia

Abstract

Volar dislocation of the distal radio-ulnar joint (DRUJ) is a rare occurrence in the literature, with only a few cases reported. Dorsal dislocation is more common than a volar dislocation. It can be easily missed due to the lack of a specific clinical presentation. They can be treated by closed reduction or more commonly by open reduction internal fixation. We present a case of volar dislocation of the DRUJ with an ulnar head fracture reduced by closed reduction. We report the case of a right-handed 35-year-old patient with no medical history who presented to our emergency department after sustaining a fall on his left hand. The trauma dated of 1 day and X-ray was initially judged normal in the emergency department. Due to the persistence of the pain and the functional impotence, the patient presented again to our department. The investigation showed that the patient's hand was in a supine position when the fall occurred. On physical examination, the forearm was locked in supination, with no passive or active pronation elicited. There was a loss of the dorsal ulnar prominence with a palpable deformity on the volar aspect of the wrist. There was no skin lesion and the neurovascular status of the hand was normal. Initial radiographs were made. Anteroposterior and lateral radiographs of the forearm and wrist showed a volar dislocation of the DRUJ with an associated ulnar head fracture. A closed reduction attempt in the emergency department was unsuccessful. The patient was admitted and under general anesthesia, the dislocation was reduced by pronating the forearm and applying direct pressure over the distal ulna. The wrist was tested after the reduction and the DRUJ was stable. Above-elbow cast was applied in a pronation position for a period of 5 weeks. Upon cast removal, the result was excellent. The patient regained full range of motion of the wrist and elbow, there was no instability nor pain or tenderness. Grip force was conserved. A radiographic assessment confirmed the reduction. Volar locked dislocation of DRUJ is a rare injury. A high index of clinical suspicion and proper X-ray is required for prompt detection. Computed tomography scanning can be useful if the diagnosis is not certain. If the reduction of the joint is stable, there is no need for fixation. Early diagnosis and appropriate treatment are the keys for a good outcome.

Keywords

References

1. Weseley MS, Barenfeld PA, Bruno J. Volar dislocation distal radioulnar joint. J Trauma 1972;12:1083‑8.
2. Kumar A, Iqbal MJ. Missed isolated volar dislocation of distal radio‑ulnar joint: A case report. 11Selected Topics: Emergency Radiology is coordinated by Jack Keene, MD, of Emergency Treatment Associates, Poughkeepsie, New York. J Emerg Med 1999;17:873‑5.
3. Werthel JD, Masmejean E, Silvera J, Boyer P, Schlur C. Acute isolated volar dislocation of the distal radio‑ulnar joint: Case report and literature review. Chir Main 2014;33:364‑9.
4. Szabo RM. Distal radioulnar joint instability. J Bone Joint Surg Am 2006;88:884‑94.
5. Dukan R, Kassab Hassan S, Delvaque JG, Khaled I, Nizard R. Isolated volar dislocation of the distal radioulnar joint: A case report. J Orthop Case Rep 2020;10:97‑100.
6. Larrivée S, Matthewson G, Barron L. Closed reduction of an acute volar dislocation of the distal radio‑ulnar joint by a modified technique. Case Rep Orthop 2018;2018:4289406.
7. Adams JE. Forearm instability: Anatomy, biomechanics, and treatment options. J Hand Surg Am 2017;42:47‑52.
8. Mittal R, Kulkarni R, Subsposh SY, Giannoudis PV. Isolated volar dislocation of distal radioulnar joint: How easy to miss! Eur J Emerg Med 2004;11:113‑6.
9. Slattery D, Gohil S, Hogan G. A case report and the literature review: Volar dislocation of the DRUJ and stabilisation using mini‑suture anchors. Eur J Orthop Surg Traumatol 2013;23 Suppl 2:S203‑5.
10. Bouri F, Fuad M, Elsayed Abdolenour A. Locked volar distal radioulnar joint dislocation. Int J Surg Case Rep 2016;22:12‑4.
Archives of Trauma Research
Volume 10, Issue 3
July 2021
Pages 176-179

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History

  • Receive Date: 15 September 2022
  • Accept Date: 15 September 2022

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