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.