Distal radioulnar instability is an independent worsening factor in distalradial fractures

Distal radial fractures in patients who are younger than the age when osteo porosis usually develops are different from fractures in the elderly. Arthr oscopy has revealed these fractures often have a complex pattern of fractur e related chondral and ligament injuries in the wrist. In Lund, Sweden, of the 92 distal radial fractures that occurred during 1 year in patients youn ger than the age when osteoporosis usually develops, 76 patients were asses sed after more than 1 year (range, 14-38 months). The examination included questions, a visual analogue scale for pain, a physical examination, bilate ral radiographic assessment, and wrist score determination according to Gar tland and Werley. Instability at clinical examination of the distal radioul nar joint was associated with a worse wrist score and doubled the visual an alogue measures for pain at rest and pain at load. This instability was not correlated to any radiographic variable at the time of fracture or at foll owup. The distal radioulnar joint was painful in 17 of the 27 patients with instability. Radiographic scapholunate dissociation did not affect the out come. However, radiographic osteoarthrosis Grade 1 was associated with a wo rse wrist score. The outcome was dependent on the stability of the distal r adioulnar joint, which in turn was not correlated to any radiographic param eter. Thus, destabilizing ligamentous injuries are thought to be an importa nt cause of residual problems.