Injuries of the Distal Radioulnar Joint and Triangular Fibrocartilage

The proximal radioulnar joint (PRUJ) and distal radioulnar joint (DRUJ) function as a unit to achieve pronation and supination of the forearm axial rotation. The most critical ligaments of DRUJ stability include the deep portion of the dorsal and volar radioulnar ligaments, which attach at the ulnar fovea. Lesions around the distal radioulnar joint are not uncommon. The injury can be purely involving the soft tissue especially the triangular fibrocartilage (TFCC) or the radioulnar ligaments, but it is usually associated with distal radius fractures, fractures of the ulnar styloid, DRUJ dislocation, and Galeazzi or Essex-Lopresti fracture-dislocations. An adequate knowledge of the complex anatomy and biomechanics of the TFCC and DRUJ is essential in understanding treatment options to restore stability and proper rotation, avoiding the need for secondary procedures or salvage procedures in the future. Failure to recognize, anatomically reduce or repair, and stabilize injuries to these joint leads to instability, stiffness, and/or painful arthritis. Typically, nonoperative management consisting of activity modification and immobilization is first attempted for acute traumatic tears of the TFCC prior to diagnostic arthroscopy with possible surgical repair. Operative management is indicated for persistent DRUJ instability, persistent ulnar-sided wrist pain, and acute injuries in high-demand patients. Successful outcomes of acute DRUJ dislocations are predicated on anatomic restoration and stability of the DRUJ. In Galeazzi lesions, anatomic reduction and rigid internal fixation of the radius are imperative to obtain concentric closed reduction of the DRUJ and achieve a favorable outcome.