➢ Injuries along the length of the forearm, including distal radial fractures with or without ulnar styloid fractures, disruption of the radioulnar ligaments, triangular fibrocartilage complex tears, midshaft radial fractures, and injuries to the interosseous membrane, may lead to acute distal radioulnar joint instability.
➢ Acute distal radioulnar joint instability is primarily a clinical diagnosis, and physical examination remains a mainstay of diagnosis.
➢ Anatomic reduction and stabilization of fractures frequently leads to stabilization of the distal radioulnar joint.
➢ Ligamentous injuries and injuries to the triangular fibrocartilage complex may be treated acutely with immobilization alone, without the need for repair.
➢ The distal radioulnar joint should be immobilized in a position of stability. Transosseous Kirschner wires may be used for unstable joints.
Acute instability of the distal radioulnar joint most commonly results from traumatic injury to the distal part of the radius or the ulnar styloid, although injury to any portion of the radius or ulna may cause distal radioulnar joint instability. Instability between the radius and the ulna at the wrist may limit forearm rotation and may prevent stable transmission of load across the radiocarpal and ulnocarpal joints. Instability is diagnosed primarily on the basis of physical examination. Imaging studies and wrist arthroscopy may be used to distinguish deficient structures and to assist with surgical planning. The treatment of acute distal radioulnar joint instability should address the structures that are injured and should take into account the anatomic variability and the presence of arthritis or other conditions affecting the distal radioulnar joint. Prompt recognition of these injuries and treatment of deficient structures may limit morbidity associated with instability of the distal radioulnar joint.
The distal radioulnar joint is an incongruent, diarthroidal joint between the sigmoid notch of the distal part of the radius and the seat of the …