title: The value of computed tomography in detecting distal radioulnar joint instability after a distal radius fracture.
abstract: This study evaluated the value of computed tomography scans for the diagnosis of distal radioulnar joint instability. A total of 46 patients, conservatively treated for a unilateral distal radius fracture, were evaluated. Clinical instability was tested using the stress test and clunk test. A computed tomography scan of both wrists was performed in pronation and supination. Two independent observers reviewed the computed tomography scans using: the radioulnar line, subluxation ratio, epicentre and radioulnar ratio methods. Radiological distal radioulnar joint instability was assessed by comparing the measurements of the injured wrist with those of the contralateral uninjured wrists. A total of 22 patients had clinical instability of whom 12 suffered from pain in the injured wrist. Distal radioulnar joint instability was diagnosed on computed tomography in 29 patients. Reliability analysis between clinical and radiological evaluations showed at best moderate, but generally poor agreement. The diagnostic ability of computed tomography for identifying distal radioulnar joint instability seems limited.
  
  
  METHODS
  IV.
authors.affiliation: 1 Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: R H
authors.initials: RH
authors.lastname: van Leerdam
authors.affiliation: 1 Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: M M E
authors.initials: MME
authors.lastname: Wijffels
authors.affiliation: 2 Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Reijnierse
authors.affiliation: 2 Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: W
authors.initials: W
authors.lastname: Stomp
authors.affiliation: 1 Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: P
authors.initials: P
authors.lastname: Krijnen
authors.affiliation: 1 Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: I B
authors.initials: IB
authors.lastname: Schipper
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011885:Radius Fractures / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014954:Wrist Injuries / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D055815:Young Adult
keywords: Distal radio ulnar joint instability; distal radius fracture; traumatic hand injury; wrist