gms | German Medical Science

Objectives/Interrogation: Distal radio-ulnar joint (DRUJ) is one of the most frequently affected joint with osteoarthritic (OA) change among wrist articulations. Most articles regarding the DRUJ OA is surgical procedure-oriented, and usually includes both OA and rheumatoid arthritis as the subject. There are few reports which are etiology-oriented, and information about detailed clinical characteristics of the primary and post-traumatic DRUJ OA are lacking.

Methods: Twenty-six wrists with in 23 patients (13 male and 10 female) underwent surgical intervention in our hospital between Apr 2009 and Mar 2017. Their medical records were retrospectively reviewed. Fisher's exact test was used to compare the primary (group A) and post-traumatic (group B) DRUJ OA.

Results and Conclusions: Group A consisted of 21 wrists of 8 male and 10 female patients with an average age of 74.7 year-old. Fifteen (83.3%) of them were in their 7th or 8th decades (p=0.089). In 8 patients who had unilateral surgery, contralateral wrist X-ray showed asymptomatic DRUJ OA, thus 11 (61.1%) had bilateral OA (p=0.037). All of these wrists had ulnar variance of 3 mm or more. Wrist pain tended to be less in group A. Only 3 wrists were with severe pain, and 9 wrists were painless. The most frequent chief complaint was dropped finger(s) in 15 patients (p=0.055). In 7 patients, attritional extensor rupture was observed in more than 2 fingers. None had supination restriction.

Group B consisted of 5 wrists of 5 male patients with an average age of 63.8 year-old. The gender ratio was significantly different from group A (p=0.046). Two had malunion of the distal radius fracture, and 2 had maluinon of the Galeazzi fracture-dislocation. One wrist sustained growth arrest of the ulna after a physis injury of the distal ulna in his early teenage. The patients in group B tended to have severe pain (4 wrists, p=0.062), and supination was less than 50 degrees in 2 wrists (p=0.004). In 2 patients, attritional rupture of extensor tendon to the little finger was noted, but there was no patient with multiple finger involvement.

Primary and post-traumatic DRUJ OA exhibited distinct clinical characteristics. Most patients with primary OA were over 70 year-old, and bilateral involvement suggested inherent wrist morphology as an etiological factor, therefore the primary OA might increase as the population ages. The wrist pain tended to be mild in primary OA, and the patients often sought medical attention only after the extensor tendon rupture occurred.