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A brief anatomy of the Distal RadioUlnar joint

www.diuchirurgiemain.org
Christian Dumontier
MD,
Lorem PhD
Ipsum Dolor
Guadeloupe

Distal radio-ulnar joint

The joint that allows pronosupination (With the proximal and
middle Radio-ulnar joints)

One of the main criteria of
hominisation (appears after thumb
opposition)

Phylogenetic Evolution

Ulna « shortens » and looses its primitive articulation
with the carpus

Triangular ligament is the evolution of the inferior
capsule of the ulnocarpal joint

Lemur Fulvus

Cercopithecus nictitans

Hylobates lar leucicus

homo

Pan Satyrus

Pre-styloid
recess
Future pre-styloid recess

And in humans

20 mm CR embryo

30 mm CR embryo

52 mm CR foetus

92 mm CR foetus

The distal radioulnar joint

Complex structure which
participate to forearm
motion, DRUJ stability and
carpal biomechanics as
well

Ulno-carpal “joint”

Convexe dome in its lateral
part (load-bearing joint)

Medial depression for the
insertion of the discus
articularis (fovea)

Postero-medial expansion: the
ulnar styloid

TFCC: Triangular FibroCartilage Complex

Triangular ligament with the
interossseous radio-ulnar
ligaments

Ulno-carpal ligaments (ulnolunate and ulno-triquetral)


Meniscus homologus
The sheath of the extensor
carpi ulnaris

Triangular ligament (discus articularis)

Avascular Fibrocartilage

1 to 2 mm thickness (reverse to
length of the ulna)

Anterior and posterior
reinforcements are called
radioulnar ligaments

They are in a vascularized area

2 parts: proximal (or deep
radioulnar ligaments),
stabilizing function and
distal (superficial, absorption
of loads)

the DRUJ has a variability of shape according to the
length of the two forearm bones

Other stabilizing structures

Pronator quadratus ?
Interosseous membrane
(distal oblique bundle)

DRUJ biomechanics

From experiments, the ulna remains fixed

The radius rotates around a rotation axis going from the
radial head to the middle of the fovea (mean: 68° of
pronation/ 74° of supination)

In pronation the ulna « shorten » of an average 1 mm

DRUJ and prono-supination


Radius: concave arch of 47 to 80°
Distal ulna: convexe surface covered by cartilage over
200 to 230°
DRUJ congruency is maximum (60%)
in neutral, < 10% in extreme positions

Posterior dislocation

Hyper-pronation = “posterior dislocation”
= narrowing of joint space

Anterior dislocation

Hyper-supination = anterior
dislocation = DRUJ diastasis

DRUJ sprains

Ballotement test

The longitudinal axis of forearm rotation passes through
the center of the radial head proximally. Distally, the
axis passes through:

A. The articulation of the ulnar head and sigmoid notch

B. The foveal sulcus of the ulna

C. The tip of the ulnar styloid

D. The medial cortex of the ulnar styloid

E. The lunate fossa of the distal radius

Following open reduction and internal fixation of a
displaced distal radius fracture using a palmar
approach and fixed angle plate, repair of the pronator
quadratus has been shown to:

A. Improve grip strength

B. Provide no significant benefit

C. Improve range of motion

D. Decrease the incidence of tendon rupture

E. Improve DASH scores