2. Definition
• fracture of the radial shaft with dislocation of
the distal radioulnar joint.
• “fracture of necessity” / Piedmont fracture /
Reverse Monteggia fracture
• 25% of isolated radial shaft fractures
• 7% of adult forearm fractures
3. Mechanism of Injury
• fall with a hyperpronated forearm and wrist extension
• fracture generated through the radial shaft
• progresses distally rupturing the interosseous
membrane
• injuring the triangular fibrocartilage complex (TFCC),
rendering the distal radioulnar joint unstable
4.
5. • Associated injury of the TFCC usually occurs,
occasionally leading to further disruption of the
fifth and sixth extensor compartments of the
wrist.
• Ring et al established that in the setting of
isolated radial shaft fractures, associated distal
radioulnar joint injury is present in 10 out of 36
cases
6. • fracture of the base of the styloid
• widening of the DRUJ on the PA view
• dislocation of the ulna seen on the lateral view
• Dorsal displacement of the distal ulna and a
change in ulnar variance of more than 5mm
suggests an injury to the DRUJ
7. • CT showing volar subluxation of the right distal radioulnar
joint (arrow) and volar translation of the distal ulna in
relation to the radius because of incomplete reduction of a
fracture of the distal radial diaphysis. There is little contact
remaining between the dorsal articular surface of the
distal ulna and the volar lip of the distal radial articular
surface.
8. • Type 1 fractures occur within 7.5 cm of the
articular surface of the distal radius
• Type 2 more proximally
• type 1- associated with a significantly higher
rate of instability of the DRUJ, frequently
requiring open repair of this joint
9. • Simple dislocations readily reduce after radial
alignment has been restored
• Complex dislocations are those in which the
DRUJ is irreducible after anatomic reduction of
the radial shaft fracture
10.
11.
12.
13.
14. Management
• poor results with nonoperative treatment-
inadequate control of deforming forces- PQ,
brachioradialis, and thumb abductors and
extensors
• Plate and screw fixation is the preferred mode
of fracture stabilization- preferably volar
Henry’s approach
15. four key criteria:
1. Obtain adequate reduction
2. Achieve and maintain fracture reduction
while
3. Preserving biology
and allowing
4. Early range of motion.
16. • after fixation of the radial shaft, the DRUJ
should be assessed for stability (piano key
sign)
• Stable injuries are routinely immobilized for 3 to
6 weeks in a long arm splint or cast
• Unstable DRUJ- pinning of the DRUJ using
Kirschner wires with or without open repair of
the TFCC
17. • DRUJ translation is examined at different
positions of forearm rotation. The position that
allows the least amount of translation is
selected and two 2 mm Kirschner wires are
placed from the ulna into the radius. The most
distal pin is placed just proximal to the distal
ulnar facet of the radius. The second pin is
placed 1 cm proximal to the first pin. Pins are
then bent and cut and the forearm immobilized
in a long arm splint without changing forearm
rotation
18. If DRUJ reduction is not achieved
after ORIF of the radius
• inadequate fracture reduction has been
performed or
• interposition of soft tissue or bony fragments
may be present at the DRUJ- ECU, EDC, and
EDQ tendons, periosteum, or an avulsed foveal
fragment
• open reduction of the DRUJ will be required.
Stabilization of the DRUJ with primary repair of
the TFCC
19. • Postoperatively, immobilization for 3 to 6 weeks
in a long arm cast is recommended.
• Galeazzi fractures with dorsal dislocation are
immobilized in supination, whereas those with
volar dislocation are immobilized in pronation
