DISTAL RADIOULNAR JOINT DYSFUNCTION FOLLOWING CONSERVATIVELY TREATED DISTAL RADIUS FRACTURE

Abstract

Background: Distal radius fractures (DRFs) are frequent and often complicated by distal radioulnar joint (DRUJ) dysfunction which may pass unnoticed at the outset leading to adverse effects on the hand function. This study aims to detect clinical and radiological features suggestive of DRUJ dysfunction and its functional effects in conservatively treated DRF. Methods: Retrospective observational study including 43 patients with healed conservatively treated DRF were studied for features of DRUJ dysfunctions. Patients’ demographic, clinical and radiological data were examined and compared to those of contralateral uninjured wrist. Computerized tomography (CT) scan examination to assess DRUJ congruency and instability was done for all cases. Correlation between clinical features suggesting DRUJ dysfunction with radiological parameters, CT findings and functional outcome was done using quick DASH score. Results: There is significant reduction of extension, supination and radial deviation with a significantly higher (visual analogue scale (VAS)) and (DASH) scores in the injured wrist as compared with contralateral side. Clinical examination of the DRUJ in 43 DRF showed that 13 (30.2 %) have ulnar sided tenderness and four (9.3%) have positive ulnar abutment test with significantly higher pain and disability scores and six patients (13.9%) have positive piano key sign with significant pain score only. Ulnar abutment test also significantly is related to radiological findings. CT scan examination of the DRUJ showed 21 cases (48.8%) with DRUJ incongruence, which is significantly correlated to ulnar abutment test, piano key sign, diminished mean radial height and higher ulnar variance. Conclusion: Conservatively treated DRF with clinical features of DRUJ dysfunction shows a lower functional outcome with increased ulnar variance and decreased radial height. DRUJ incongruence and instability on CT scan was significantly associated with clinical signs, diminished mean radial height and higher ulnar variance.