Distal Radioulnar Joint Instability in Distal Radius Fractures Managed with Volar Locking Plates

Abstract

Abstract Introduction: Distal radioulnar joint (DRUJ) injuries are the most common cause of residual wrist disability after fractures of the distal radius. There is a lack of consensus regarding the diagnosis of these injuries along with their management when being accompanied by a fracture of the distal radius. The present prospective study aimed to assess the effect of the involvement of DRUJ on the outcome of distal radius fractures. The study also evaluated the role of clinical and radiographic indices in the diagnosis, management and outcome of these injuries. Materials and Methods: This prospective study involved 51 patients aged >18 years with distal radius fractures treated using volar plating. The intra-operative assessment was done clinically using a piano key or ballotment test after fixation of distal radius fracture using K-wire stabilisation. The mean follow-up was 24 months. The patients were all clinically evaluated using the Modified Gartland and Werley scoring system. Radiographically, we calculated the dorsal/volar tilt, radial inclination, radial height and the ulnar variance. Results: A total of 44 patients with distal radius fractures were managed with the volar plate. The mean age was 45 years (range = 18–77; SD = ±13.6). The majority were men. The maximum cases were found to be of 2R3C type of AO/OTA fractures. Axial instability was observed in 12 cases, with 5 having negative and 7 showing positive axial instability. No statistically significant correlation was identified between the instability of the DRUJ and the overall outcome of distal radius fractures treated with volar plating (P = 0.241). However, a significant association was observed between fractures involving the base of the ulnar styloid (US) and the final clinical outcome (P = 0.023). The mean modified Gartland and Werley score was calculated at 6.09 ± 5.36, and 28.9% of cases suffered from loss of dorsiflexion. Conclusion: The present study revealed that it is important to recognise DRUJ instability in both axial and anteroposterior (AP) planes through clinical and radiological parameters. US base fractures cause DRUJ instability and also create a negative impact on the outcome of distal radius fracture fixed with volar plating. Ulnar variance is a good marker for checking instability in the AP plane by ballotment test. We found that in cases of DRUJ instability, fractures of the ulnar base should be examined and fixed if needed.