Oral Presentation NZ Association of Plastic Surgeons & NZ Society for Surgery of the Hand

Distal radioulnar joint instability following initial metaphyseal or diaphyseal fracture management in the paediatric population: a systematic review   (1491)

Bridget Moral 1 , Ian Galley 1 , Simon MacLean 1
  1. Tauranga Hospital, Mount Maunganui, BOP, New Zealand

BACKGROUND: Metaphyseal and diaphyseal forearm fractures make up 20% of paediatric forearm fractures. These fractures can be managed both conservatively and surgically with interventions occasionally resulting in complications including limited range of motion. Instability of the distal radioulnar joint (DRUJ) is a complication most often associated with fractures of the distal radius and ulna. This results clinically in an associated loss of pronation and supination, pain and crepitus. There is sparce evidence associating diaphyseal and metaphyseal fractures with DRUJ instability. Our aim was to assess whether DRUJ instability is an observed complication following diaphyseal or metaphyseal forearm fractures following initial intervention in the paediatric population.

METHOD: In alignment with the PRISMA guidelines we conducted a systematic review using EMBASE and PubMed databases and adding relevant reference papers. Studies which reported on clinical correlates of DRUJ instability in the context of metaphyseal or diaphyseal forearm fractures in children <18 years of age at time of fracture were included.

RESULTS: 14 papers reported cases which fit the inclusion criteria. In these 14 papers, 49 cases were assessed. Of these 49 cases, most reported DRUJ instability following both bone diaphyseal fractures. The most observed clinical correlate was limited supination and pronation and was often seen concurrently with malunion. 2 cases also demonstrated a volar subluxation of the ulnar head in supination. The same clinical correlates were observed irrespective of the initial treatment and onset of instability ranged from 6 weeks to 8 years. Symptomatic instability was treated by osteotomy resulting commonly in full functional recovery.

CONCLUSION/DISCUSSION: DRUJ instability can be observed following metaphyseal and diaphyseal fractures however there is a clear lack of research limiting the ability to assess the relationships between initial intervention, DRUJ instability and malunion morphologies.


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