DRUJ Reconstruction

OVERVIEW:

Distal radio-ulnar joint(DRUJ) is formed at the wrist. It is a complex soft tissue which stabilises the wrist joint. It plays a pivotal role in almost all movements of the wrist joint. It is commonly injured due to a fall or eccentric axial or torsional load over the hand & wrist. The injury may be subtle to start with but may have a limiting disability if not detected and treated in time. DRUJ Reconstruction is a surgical procedure for complete injuries.

SYMPTOMS:

Most cases will present with a history of traumatic episode or sudden loading of the wrist joint with associated torsional force. This leads to a distal radius and or an ulnar styloid fracture in most cases. The patients complain of Pain, Restricted range of movement, Loss of grip strength and swelling at the wrist. There is an irreducible deformity at the end of the medial corner of the wrist which represents a balloting ulnar styloid(prominent bone). Once compressed, it gives severe pain and crunching noise.

DIAGNOSIS:

The diagnosis depends on time of presentation. Early presentation should be vigorously treated if accompanied with fracture of any of the two bones of the forearm. In case there is no evidence of fracture but high index of suspicion on basis of examination, MRI scan is always advised after a 2-3 week rest period to delineate the exact injury. This clearly shows all components of the injury

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DRUJ Injuries may require radiology to delineate concomitant injuries and grade of injury
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Wrist injury involves TFCC and Meniscal homologue

TREATMENT:

The treatment is mostly conservative initially and may be followed by a surgical procedure if need be. Small subset of patients (high grade tear or high demand patients) should be explained surgical procedure for restoration of joint kinematics. DRUJ reconstruction yields good results in expert hands. Physiotherapy and rehabilitation plays essential role in functional recovery.