What is the diagnosis and treatment for a Druj (Distal Radioulnar Joint) dislocation?

From the Guidelines

For a DRUJ dislocation, the initial evaluation should include a CT scan of the wrist to assess distal radioulnar joint stability, as it is the modality of choice for evaluating this condition 1. The treatment approach depends on the acuteness and stability of the dislocation.

• For acute dislocations, the first line of treatment typically involves closed reduction under local anesthesia, followed by immobilization in a long-arm cast or splint for 4-6 weeks.
• The forearm should be positioned in either supination for dorsal dislocations or pronation for volar dislocations.
• Pain management is crucial and can be achieved with NSAIDs such as ibuprofen (400-600mg three times daily) or naproxen (500mg twice daily).
• If closed reduction fails or the dislocation is unstable, surgical intervention may be necessary, which could involve repair of the triangular fibrocartilage complex (TFCC), ligament reconstruction, or ulnar shortening osteotomy.
• Chronic dislocations almost always require surgical management.
• Physical therapy should begin after immobilization to restore range of motion and strength. The choice of treatment is guided by the need to restore joint stability and prevent long-term morbidity, with the goal of minimizing impact on quality of life and reducing the risk of complications such as chronic pain or limited wrist mobility 1. Given the importance of accurate diagnosis and treatment planning, CT examination with coronal, sagittal, and 3-D reformed images is recommended to demonstrate the extent of injury and guide treatment, particularly in cases of chronic perilunate dislocation 1.

From the Research

Definition and Causes of DRUJ Dislocation

• DRUJ (Distal Radioulnar Joint) dislocation is a rare injury that can occur due to high-energy trauma, resulting in instability, pain, and limited rotation of the forearm and wrist 2.
• The injury can be acute or chronic and may occur in isolation or in combination with other upper extremity injuries, such as distal radius fractures 3.

Diagnosis and Treatment of DRUJ Dislocation

• Early recognition and treatment of DRUJ dislocation are crucial to avoid limitation and disability associated with delayed diagnosis and management 4.
• Closed reduction, stabilization of the wrist joint, and early mobilization of the elbow joint can help preserve joint function and promote faster recovery 4.
• Treatment options range from conservative measures like splinting and physiotherapy to surgical procedures, including arthroscopy and DRUJ arthroplasty 5.

Classification and Management of DRUJ Injuries

• A new classification system has been proposed to categorize DRUJ injuries into three distinct grades, providing clear guidance for treatment based on injury severity 5.
• The classification system is intended to be practical for both clinical and radiological evaluations, enhancing the accuracy of diagnosis and supporting more effective decision-making in clinical practice 5.

Outcomes and Prognosis of DRUJ Dislocation

• Outcomes are predicated on anatomic reduction and restoration of stability to the DRUJ and PRUJ (Proximal Radioulnar Joint) with or without ligamentous repair or reconstruction 2.
• With proper treatment, patients can experience significant improvement in symptoms and function, with some cases reporting no pain and no restrictions in work or sports-related activities 6.