Distal Radioulnar Joint Dislocation: Treatment Options and Risks

Distal radioulnar joint dislocation

Dear Dr.
Chen, I have a wrist joint dislocation that was delayed in reduction by a martial arts school.
An X-ray taken by an orthopedic doctor indicated that it is a distal radioulnar joint dislocation that has not been reduced, and it has been 70 days.
Do I need surgery for treatment? If I choose not to have surgery, what are the potential consequences? Is there a risk of disability? Thank you.

Ye Xiansheng, 40~49 year old female. Ask Date: 2014/07/02

Dr. Chen Yongxue reply Orthopedics

Hello, when facing a distal radioulnar joint dislocation, it is important to check for associated fractures, triangular fibrocartilage complex injuries, or tendon dislocations.
A professional physician and radiological examination are necessary for further evaluation.
Distal radioulnar joint dislocations can be classified into dorsal and volar types.
Symptoms generally include limitations in pronation or supination movements.
During the acute phase, reduction should be performed, followed by immobilization in a cast (with the addition of pins if necessary).
After ligament repair, the cast can be removed.
If treatment is delayed, wrist mobility may be compromised, making rotation difficult and exerting force challenging.
If you have any further questions, please consult the orthopedic outpatient department for additional advice.
Thank you.

Reply Date: 2014/07/02

More Info

Distal radioulnar joint (DRUJ) dislocation is a condition that occurs when the distal end of the ulna is displaced from its normal position relative to the radius at the wrist. This type of injury can result from trauma, such as falls or sports injuries, and can lead to significant pain, dysfunction, and long-term complications if not treated properly.

In your case, it appears that the dislocation has not been reduced (realigned) for 70 days, which raises concerns about the potential for chronic issues. The treatment options for a DRUJ dislocation typically include both non-surgical and surgical approaches, depending on the severity of the dislocation, the presence of associated injuries, and the duration since the injury occurred.

Treatment Options:
1. Non-Surgical Management:
- If the dislocation is recent and there are no significant complications, a physician may attempt to reduce the dislocation manually. However, given that 70 days have passed, this option may no longer be viable.

- Immobilization in a splint or cast may be recommended to allow for healing if the dislocation is stable and there are no fractures.

2. Surgical Intervention:
- Surgery is often indicated in cases of chronic dislocation, especially if there is instability, persistent pain, or functional impairment. Surgical options may include:
- Open Reduction and Internal Fixation (ORIF): This involves surgically realigning the bones and securing them with hardware.

- Arthrodesis: In cases where the joint is severely damaged, fusion of the joint may be considered to alleviate pain and restore function.

- Soft Tissue Repair: If there are associated ligament injuries, surgical repair may be necessary.

Risks of Not Having Surgery:
If you choose not to undergo surgery, there are several potential risks and complications:
- Chronic Pain: Persistent pain is common in untreated dislocations, which can significantly affect your quality of life.

- Loss of Function: You may experience reduced range of motion and strength in your wrist and hand, making daily activities challenging.

- Joint Instability: The joint may remain unstable, leading to further dislocations or injuries in the future.

- Arthritis: Chronic dislocation can lead to post-traumatic arthritis, which can develop over time and result in further joint degeneration.

- Deformity: In some cases, untreated dislocations can lead to deformities in the wrist and hand.

Potential for Disability:
While not all cases of untreated DRUJ dislocation lead to permanent disability, the risk increases with time. If the joint remains dislocated and untreated, the likelihood of developing chronic pain, loss of function, and arthritis increases, which could ultimately lead to significant impairment in daily activities.

Conclusion:
Given the duration since your injury and the potential complications associated with untreated DRUJ dislocation, it is advisable to consult with an orthopedic surgeon who specializes in hand and wrist injuries. They can assess your specific situation, including any imaging studies, and discuss the best course of action tailored to your needs. Early intervention is crucial to minimize the risk of long-term complications and to optimize recovery.

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