Issues in the Pediatric DRUJ

There are several reasons that children and adolescents complain about their wrists. The most common is midcarpal instability, but also overuse injuries such as a gymansts wrist or distal radial ephiphysitis. When it comes to the DRUJ, however, there are several potential things to think about. Sometimes patients may feel a click or may have an inciting even that leads to a locked deformity in either pronation or supination. Long arm films and a thorough history are helpful to understanding if this is related to prior trauma. Madelung deformity, in contrast, is a congenital deformity that characteristically includes ulnar tilt of the radius with subsequent lunate subsidence and palmar carpal displacement. The presence of a Vicker’s ligament, an abnormal radiolunate ligament that spans the physis, is pathognomic. A small percentage of patients have an identifiable genetic mutation of the SHOX gene. Treatment is based on age and symptomotology. For younger patients, resection of the ligament and physiolysis may correct the deformity. In skeletally mature individuals, a 3-dimmensional osteotomy to restore radiocarpal architecture has been described and ulnar shortening osteotomies may be of beneift. Future studies will elucidate the long term benefits of these procedures both in terms of restoration of proper DRUJ mechanics and patient reported outcomes.