Comprehensive Management Approaches for Acute Distal Radioulnar Joint Instability Post distal End Radius Fracture.

Abstract

Introduction: The peripheral radioulnar articulation and the bony radioulnar articulation make up the distal radioulnar joint (DRUJ), a diarthrodial trochoid synovial joint stabilizers for soft tissues. Of the DRUJ's stability, only around 20% may be attributed to the bony articulation. Treatment for DRUJ injuries resulting from a solely ligamentous rupture varies and is subject to debate. Usually, non-operative care is coupled with occupational therapy, activity modification, brace or splint immobilization, and pain management.

Aim: The aim of this study was to analyze comprehensive management approaches for acute DRUJ instability post-distal radius fracture.The key takeaway from the article is that TFCC repair may not be essential, with K-wire stabilization providing better range of motion and cast immobilization offering stronger grip, but further large-scale controlled trials are required to fully assess these treatment options in terms of patient satisfaction and functional outcomes.

Materials and methods: After primary fixation of the respective fractures (distal end radius fracture or distal end ulna fracture or both) by ORIF with Plating or CRIF with K-wiring or by Traction for casting, the distal radio ulna joint instability is stabilized by casting, closed reduction internal fixation (CRIF) with K-wiring or open triangular fibrocartilage complex (TFCC) repair and the outcome is measured by grip strength, range of motion with DASH and MMWS scores by follow up and compared.

Results: Between the groups, there was no discernible variation in grip strength (P > 0.05). A noteworthy variation in flexion was seen among the groups (P < 0.05). The groups' differences in extension were statistically significant (P < 0.05). Pronation did not significantly differ across the groups (P > 0.05). Supination did not differ significantly between the groups (P > 0.05). The DASH scores of the groups did not differ significantly (P > 0.05). Between the groups, there was a significant difference in MMWS (P < 0.05).

Conclusion: The major findings of analysis have suggested that the time, effort, and cost of TFCC repair do not appear to be necessary, however, there may be trade-offs between various treatments, with K-wire stabilization offering a better range of motion and cast immobilization a stronger grip.