MANAGEMENT OF TRUAMATIC DISorderS OF THE DISTAL RADIOULNAR JOINT

The distal radioulnar joint (DRUJ) consists of two parts : the radioulnar and the ulno carpal ligamentous articulations . The articular surface of the distal radius toward the ulnar head is the sigmoid notch and the corresponding surface of the head constitutes the seat of the joint.The DRUJ plays a role in the mechanism of longitudinal rotation of the forearm. Therefore, the joint has to be considered in relation with the proximal radio-ulnar joint (PRUJ) being coupled functionally .The stabilizing factors of the DRUJ include : the TFCC, the dorsal and volar distal radio-ulnar ligaments, the osseous depth of the sigmoid notch of the radius, the pronator quadratus, the inter-osseous membrane and the tension of the ECU in its intact fibro-osseous tunnel. The extensor retinaculum and the ulnar collateral ligament do not play a part in stabilization of the distal radio-ulnar joint .Disorders of the DRUJ can be divided into those due to ligamentous injuries, fractures, and arthritic changes. Further classification of the first two categories relates to acute versus chronic problems.Many authors believe that in the absence of a distal radial deformity a lateral radiograph of the wrist is an accurate and simple study to determine incongruency of the DRUJ, But if a deformity of the distal end of the radius exists, lateral radiographs are not accurate and CT scan through the DRUJ is recommended. Advances in magnetic resonance imaging (MRI) now allow for the visualization of small structures, such as the TFCC of the wrist. arthroscope may be used as a diagnostic as well as a therapeutic tool. Chronic disorders of the DRUJ are challenging problems and include DRUJ dislocation, ulno-carpal abutment syndrome, and osteoarthritis of the DRUJ. Numerous operations have been proposed. Chronic dislocation of the DRUJ with an intact articular surface can be treated by either soft tissue reconstruction or a bone or joint procedure. However when chronic dislocation has damage the articular surface, a bone or joint procedure such as the Sauve- Kapandji procedure , or one of the DRUJ arthroplasty procedures have