Volar dislocation of the distal radio‑, ulnar joint (DRUJ) is a rare occurrence in the literature, with only a few cases reported. Dorsal dislocation is more common than a volar dislocation. It can be easily missed due to the lack of a specific clinical presentation. They can be treated by closed reduction or more commonly by open reduction internal fixation. We present a case of volar dislocation of the DRUJ with an ulnar head fracture reduced by closed reduction. We report the case of a right‑, handed 35‑, year‑, old patient with no medical history who presented to our emergency department after sustaining a fall on his left hand. The trauma dated of 1 day and X‑, ray was initially judged normal in the emergency department. Due to the persistence of the pain and the functional impotence, the patient presented again to our department. The investigation showed that the patient’, s hand was in a supine position when the fall occurred. On physical examination, the forearm was locked in supination, with no passive or active pronation elicited. There was a loss of the dorsal ulnar prominence with a palpable deformity on the volar aspect of the wrist. There was no skin lesion and the neurovascular status of the hand was normal. Initial radiographs were made. Anteroposterior and lateral radiographs of the forearm and wrist showed a volar dislocation of the DRUJ with an associated ulnar head fracture. A closed reduction attempt in the emergency department was unsuccessful. The patient was admitted and under general anesthesia, the dislocation was reduced by pronating the forearm and applying direct pressure over the distal ulna. The wrist was tested after the reduction and the DRUJ was stable. Above‑, elbow cast was applied in a pronation position for a period of 5 weeks. Upon cast removal, the result was excellent. The patient regained full range of motion of the wrist and elbow, there was no instability nor pain or tenderness. Grip force was conserved. A radiographic assessment confirmed the reduction. Volar locked dislocation of DRUJ is a rare injury. A high index of clinical suspicion and proper X‑, ray is required for prompt detection. Computed tomography scanning can be useful if the diagnosis is not certain. If the reduction of the joint is stable, there is no need for fixation. Early diagnosis and appropriate treatment are the keys for a good outcome.

Background: The association between ulnar styloid fracture and distal radius fracture is common while the necessity of ulnar styloid fixation is still controversial. We have aimed to elucidate the effect of ulnar styloid fracture fixation on final outcome of distal radius fracture treatment. Methods: In a two-arm randomized clinical trial, patients with Fernandez type I distal radius fracture associated with ulnar styloid fracture in the base were divided into two groups of fixed (group A) and unfixed (group B) ulnar styloid fracture. They were followed up for 12 months using pain visual analogue scale (VAS), quick form of the Disabilities of the Arm, Shoulder, and Hand (DASH) score questionnaire, and Mayo performance score as well as wrist range of motion and grip strength evaluation. Results: Quick DASH score was 35. 4± 14. 0 in group A and 30. 5± 5. 82 in group B (P=0. 027) at 3-month follow-up and 29. 8± 18. 2 in group A and 18. 3± 8. 40 in group B At 6-month follow-up (P= 0. 001). VAS score for pain was declined 4. 46± 2. 17 and 3. 64± 0. 96 after 6 months (P= 0. 339) and 4. 00± 1. 73 and 2. 50± 0. 81 after 12 months (P= 0. 352) in groups A and B, respectively. The mean Mayo wrist scores were measured as 59. 3 and 57. 8 in group A and B three months after the fracture, respectively (P= 0. 504). We found no significant difference in the wrist range of motion and grip strength between two groups after three months (P>0. 05). Conclusion: According to our findings, ulnar styloid fixation using pin and wire have an adverse effect on distal radius fixation outcomes.

ulnar shaft fracture with DRUJ injury in children is rare. This pattern of injury does not adapt to the account for Monteggia or Galeazzi fractures-dislocation. We present the case of patient with ulnar shaft fracture and DRUJ dislocation in 10 years old man and discussed about mechanisms and treatment of this injury.

Objective: Distal radioulnar joint (DRUJ) subluxation with associated both bones forearm fracture is a rare clinical entity and is easily missed, leading to significant functional limitations. Case Presentation: A 28-year-old male fell on the outstretched hand and suffered left side both bones forearm shaft fracture with ipsilateral DRUJ disruption. Operative intervention in the form of plating was done for both bones forearm shaft fracture and DRUJ was stabilised with one k wire and above elbow plaster splint in full supination was given for 6 weeks. At one-year follow-up, fracture was united and Disabilities of the Arm, Shoulder and Hand (DASH) score was 11. 7, and he was well satisfied. Conclusion: DRUJ disruption should be carefully evaluated in all the patients with associated shaft fractures of radius and ulna. Timely diagnosis and optimal intervention may prevent any functional limitations.

Objective: Intra-articular screw penetration is a probable complication of coronoid fracture fixation. Thepresent study aimed to determine the best radiography technique for visualizing the proximal radioulnar joint(PRUJ) space. Moreover, it aimed to determine the safe angle and length of the screw to avoid PRUJ penetrationduring coronoid fracture fixation.Methods: The Mimics software was used to construct a three-dimensional model of a healthy man’s forearmfrom a computer tomography scan. It was analyzed using the Solidworks software to determine the X-ray anglethat clearly showed the PRUJ space to detect penetration of screws from the coronoid process into the PRUJand determine the maximum screw angle and length that could be used without intra-articular penetration. Toverify these findings, a cadaveric study combined with radiographs was conducted.Results: To visualize PRUJ space, the optimal X-ray angle was 13º lateral to the perpendicular line when theforearm was positioned at full supination. If the coronoid process was segmented into zones 1 (closest to theradioulnar joint) to 4 (farthest from the joint), the screw could only be inserted at a right angle in zone 1. In zones2, 3, and 4, inclination angles less than 15, 35, and 60 would prevent intra-articular penetration, respectively.Conclusions: The X-rays could visualize the PRUJ space with an anteroposterior radiograph at an angle of13º ulnar deviation from the perpendicular plane. During coronoid process fracture fixation, shorter screwswith less lateral inclination were safer when inserting screws in the zones of the coronoid process adjacent tothe PRUJ.

Dear Editor, With regard to the published article “ arthroscopic curettage of intraosseous ganglions of lunate bone” in the last journal edition, it is time to review ulnar abutment syndrome with similar clinical and radiologic findings (1).