CASE PRSENTATION

2011-04-15R4 이진영

10271888

• 17/M• C.C: 3 일전 축구를 하다가 뒤로 넘어지면서 손목을 짚은 후 발생한 Rt. wrist pain

Right Left

Neutral Pronation Supination

Right Left

Dislocation & Subluxation of distal radioulnar joint(DRUJ)

• Anatomy

– Articulating at distal & proximal radioulnar joints

– Important stabilizers of DRUJ : triangular fibrocartilage complex(TFCC) & radioulnar ligament & interosseous mb

– TFCC : Prevent lateral dislocation of ulnar head

Dislocation & Subluxation of distal radioulnar joint(DRUJ)

• Dislocation of DRUJ w/o concomitant fracture : uncommon

– Over pronation disruption of TFCC and dorsal radioulnar lig dorsal dislocation of ulnar head

– Over supination disruption of TFCC and palmar radioulnar lig palmar dislocation of ulnar head

– DRUJ subluxation : Very easy to miss in first presentation

Imaging finding• Radiographic finding

– Widening of RU joint on AP view – Fracture (or non union) at base of ulnar styloid– Significant shortening of radius– Obvious dislocation on the lateral view 

• CT finding(study of choice)– Suspected dorsal dislocation arm in supination– Suspected volar dislocation arm in pronation– DRUJ incongruity

• MRI: TFCC injury & DRUJ incongruity

REERENCE

• Wrist pain. Clinical imaging and treatment Skeletal Radiol (2010) 39:837–857

• Radial Ulnar Joint Instability Wheeless' Textbook of Orthopaedics