Delayed Distal Radioulnar Joint Dysfunction after Pediatric Forearm Fractures: A Systematic Review.

BACKGROUND

Distal radioulnar joint (DRUJ) dysfunction is a complication observed acutely with forearm fractures. However, there is some evidence associating delayed presentation of dysfunction to previous forearm fractures in childhood.

PURPOSE: The purpose of this to review the presence of delayed DRUJ dysfunction and factors contributing to dysfunction, following metaphyseal or diaphyseal forearm fractures sustained in childhood.

METHOD: Utilizing the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, we conducted a systematic review using the PubMed database. Papers that reported cases of delayed DRUJ dysfunction in the context of metaphyseal or diaphyseal forearm fractures in children < 18 years of age at time of fracture were included.

RESULTS

A total of 85 cases fit the inclusion criteria. Onset of dysfunction ranged from 6 weeks to 32 years. Limited supination was seen in 65 cases and pronation in 65. Overall, 76/85 (89%) of patients had deficits in range of motion. A total of 58 cases had both bone fractures. A total of 64/85 (74%) had a concurrent malunion at the time of symptom onset. Symptomatic dysfunction and malunion was treated with corrective osteotomies to one or both bones. Of cases discussing subsequent osteotomies, 50% were treated with computed tomography-guided 3-dimensional customized operative guides for corrective osteotomy. In all cases, there was improvement in dysfunction after osteotomy.

CONCLUSION

Delayed DRUJ dysfunction can be observed following metaphyseal and diaphyseal fractures in childhood. Dedicated wrist radiographs on discharge from follow-up for childhood forearm fractures and advanced imaging if DRUJ dysfunction suspected is recommended. There is a clear lack of research, limiting the ability to assess the relationships between initial intervention, DRUJ dysfunction, and malunion morphologies.