Treatment of Acute DRUJ Dislocation
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Treatment Approach
For acute isolated DRUJ dislocations, closed reduction followed by immobilization in a long arm cast for 4-6 weeks should be the first-line treatment, with surgery reserved only for irreducible or persistently unstable cases. 1, 2
Initial Management Algorithm
Step 1: Confirm the Diagnosis
- Obtain a true lateral radiograph post-reduction to assess DRUJ alignment 3
- Be aware that 18-50% of cases are initially misdiagnosed due to subtle clinical presentation 1, 2
- Look for limited forearm rotation and wrist pain after a twisting injury 2
- In dorsal dislocations, the forearm is locked in pronation; in volar dislocations, the wrist appears narrow and the forearm is locked in supination 2
Step 2: Attempt Closed Reduction
- Perform closed reduction under local anesthesia 2
- For dorsal dislocations (most common at 82% of cases): reduce with supination 1, 2
- For volar dislocations: reduce with pronation 2
- Test stability after reduction with Ballottement testing 4
Step 3: Immobilization Protocol
- Apply a long arm cast for 4-6 weeks if reduction is stable 1, 2
- Position depends on dislocation type: supination for dorsal dislocations, pronation for volar dislocations 2
- Critical caveat: Start active finger motion exercises immediately to prevent stiffness, which does not compromise healing of a properly stabilized joint 3
Surgical Indications
Proceed to operative treatment only if: 1, 5
- Closed reduction fails (irreducible dislocation)
- Joint remains unstable after closed reduction
- Recurrent instability during immobilization period
Expected Outcomes
With proper treatment, functional outcomes are generally favorable: 1
- 82% achieve full range of motion
- 88% report no pain at follow-up
- 100% demonstrate stable DRUJ at final assessment
Critical Pitfalls to Avoid
- Missing the diagnosis initially: Maintain high index of suspicion with any wrist injury involving limited forearm rotation 1, 2
- Inadequate immobilization duration: Less than 4 weeks risks TFCC non-healing and recurrent instability 1, 4
- Restricting finger motion: Failure to mobilize fingers immediately leads to disabling stiffness that requires extensive therapy 3
- Treating as simple sprain: Unrecognized DRUJ dislocation leads to chronic instability and symptomatic osteoarthritis 5