Treatment of concomitant injuries of the DRUJ

One of the more difficult problems in wrist surgery is an injury to the ulna side of the wrist associated with a distal radius fracture. When should these be treated acutely and when do they resolve without the need for surgical intervention? The long term disability due to DRUJ problems is significant and includes pain, instability, loss of motion or any combination of the above. Importantly not all patients distal radioulnar joints have the same amount of “play” and therefore assessment of the contralateral side pre operatively (if uninjured) is beneficial prior to surgical treatment of a distal radius fracture to help guide the decision making process. Geissler et al in 1996 classified these injuries into: Type I – Stable Distal Radioulnar Joint Lesions Type II – Unstable Distal Radioulnar Joint Lesions Type III – Potentially Unstable Distal Radioulnar Joint Lesions Injuries can be to the soft tissues, the bone or both.