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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