Zampetakis Konstantinos, Stavrakakis Ioannis M, Alpantaki Kalliopi, Kastanis Grigorios, Ktistakis Ioannis, Tsioupros Alexandros, Ritzakis Nikolaos, Chaniotakis Constantinos
Department of Orthopaedics and Trauma Surgery, "Venizeleion" General Hospital of Heraklion, 71409 Crete, Greece.
J Clin Med. 2024 Dec 21;13(24):7817. doi: 10.3390/jcm13247817.
: Acute isolated distal radioulnar joint (DRUJ) dislocations are rare and often misdiagnosed during initial evaluation due to subtle clinical presentation, low index of suspicion, and imaging barriers. Prompt diagnosis and treatment are critical to avoid chronic instability, limited wrist mobility, and osteoarthritis. This systematic review evaluates the functional outcomes of conservative and surgical treatment protocols for acute isolated DRUJ dislocations. : A systematic search of PubMed, Scopus, and Mendeley databases (2000-2024) was conducted following PRISMA guidelines. Inclusion criteria involved adult patients with isolated DRUJ dislocations diagnosed and managed within one week of injury. Studies reporting on underage patients, associated fractures, delayed management, and open injuries were excluded. Data on demographics, injury mechanism, diagnostic methods, treatment protocols, and functional outcomes were extracted and analyzed. : In total, 22 cases across 20 studies were included. The majority (90.9%) were males, with a mean age of 37.9 years (range: 20-70 years). Falls and sports injuries were the major causes, with volar dislocations predominating (18/22). The misdiagnosis rate was equal to 18%. Most cases were treated conservatively with closed reduction and immobilization for an average of 4.9 weeks. Operative treatment was performed in 6 cases, mainly following failed closed reductions. Functional outcomes were generally favorable, although the same parameters were not consistently studied in all patients. Overall, 82% (14 of 17 patients) achieved a full range of motion; 88% (14 of 16 patients) reported no pain, and all assessed cases had stable DRUJs at follow-up. : This review highlights the rarity and diagnostic challenges of this injury. The functional outcomes of both conservative and operative treatment are generally satisfactory. Conservative treatment should be the first-line approach, with surgery reserved for irreducible or unstable cases. Future research using standardized outcome measures is needed to provide guidance for clinicians.
急性孤立性桡尺远侧关节（DRUJ）脱位较为罕见，由于临床表现不明显、怀疑指数低以及影像学障碍，在初始评估时常常被误诊。及时诊断和治疗对于避免慢性不稳定、腕关节活动受限和骨关节炎至关重要。本系统评价评估了急性孤立性DRUJ脱位的保守和手术治疗方案的功能结局。
按照PRISMA指南，对PubMed、Scopus和Mendeley数据库（2000 - 2024年）进行了系统检索。纳入标准包括在受伤后一周内诊断并接受治疗的孤立性DRUJ脱位成年患者。排除有关未成年患者、合并骨折、延迟治疗和开放性损伤的研究。提取并分析了人口统计学、损伤机制、诊断方法、治疗方案和功能结局的数据。
总共纳入了20项研究中的22例病例。大多数（90.9%）为男性，平均年龄37.9岁（范围：20 - 70岁）。跌倒和运动损伤是主要原因，掌侧脱位占主导（18/22）。误诊率为18%。大多数病例采用闭合复位和固定进行保守治疗，平均持续4.9周。6例进行了手术治疗，主要是在闭合复位失败后。功能结局总体良好，尽管并非所有患者都一致研究了相同的参数。总体而言，82%（17例患者中的14例）实现了全范围活动；88%（16例患者中的14例）报告无疼痛，所有评估病例在随访时DRUJ均稳定。
本综述强调了这种损伤的罕见性和诊断挑战。保守和手术治疗的功能结局总体令人满意。保守治疗应作为一线方法，手术仅用于不可复位或不稳定的病例。需要未来使用标准化结局指标的研究为临床医生提供指导。
