Thomas Binu P, Sreekanth Raveendran
Dr. Paul Brand Centre for Hand Surgery, CMC Hospital, Vellore, Tamil Nadu, India.
Indian J Orthop. 2012 Sep;46(5):493-504. doi: 10.4103/0019-5413.101031.
Distal radioulnar joint is a trochoid joint relatively new in evolution. Along with proximal radioulnar joint, forearm bones and interosseous membrane, it allows pronosupination and load transmission across the wrist. Injuries around distal radioulnar joint are not uncommon, and are usually associated with distal radius fractures,fractures of the ulnar styloid and with the eponymous Galeazzi or Essex_Lopresti fractures. The injury can be purely involving the soft tissue especially the triangular fibrocartilage or the radioulnar ligaments. The patients usually present with ulnar sided wrist pain, features of instability, or restriction of rotation. Difficulty in carrying loads in the hand is a major constraint for these patients. Thorough clinical examination to localize point of tenderness and appropriate provocative tests help in diagnosis. Radiology and MRI are extremely useful, while arthroscopy is the gold standard for evaluation. The treatment protocols are continuously evolving and range from conservative, arthroscopic to open surgical methods. Isolated dislocation are uncommon. Basal fractures of the ulnar styloid tend to make the joint unstable and may require operative intervention. Chronic instability requires reconstruction of the stabilizing ligaments to avoid onset of arthritis. Prosthetic replacement in arthritis is gaining acceptance in the management of arthritis.
桡尺远侧关节是一种在进化过程中相对较新的车轴关节。它与桡尺近侧关节、前臂骨和骨间膜一起，使前臂能够进行旋前和旋后运动，并通过腕部传递负荷。桡尺远侧关节周围的损伤并不少见，通常与桡骨远端骨折、尺骨茎突骨折以及以其命名的盖氏骨折或埃塞克斯-洛普雷蒂骨折相关。损伤可能仅累及软组织，尤其是三角纤维软骨或桡尺韧带。患者通常表现为尺侧腕部疼痛、不稳定体征或旋转受限。手部负重困难是这些患者的主要困扰。通过全面的临床检查来确定压痛部位以及进行适当的激发试验有助于诊断。放射学检查和磁共振成像非常有用，而关节镜检查是评估的金标准。治疗方案不断发展，范围从保守治疗、关节镜手术到开放手术。单纯脱位并不常见。尺骨茎突基底部骨折往往会使关节不稳定，可能需要手术干预。慢性不稳定需要重建稳定韧带以避免关节炎的发生。人工关节置换在关节炎的治疗中越来越被认可。
