Distal radial ulnar joint (DRUJ) instability is a common clinical condition. The stability of the DRUJ is a result of the bony structure and the integrity of the surrounding soft tissues including the traingular fibrocartilage complex, pronator quadratus and interosseous membrane. The instability occurs in the setting of a distal radius fracture. This is a commonly missed diagnosis.
The clinical suspicion of DRUJ instability is strengthened with a history of wrist trauma, pain and limited range of motion with supination and pronation. Patients may report feeling a “click” with forearm motion.
Nonsurgical treatment of chronic DRUJ instability is possible in some cases. In less active patients, functional bracing can be considered as the primary therapy. This can only be used as initial therapy in active patients, and surgery is ultimately needed is nonsurgical treatment fails to restore normal function and stability of the forearm.
Surgery should be considered to recover the bone and ligament injuries if nonsurgical treatment fails to restore forearm stability and function. Osteotomies of the radius, ulna, or in some cases sigmoid notch osteoplasty, are used.