Volar DRUJ dislocations are uncommon, and in many cases can be missed, to our knowledge, only 36 cases have been reported in the literature. We present a case of volar dislocation of the DRUJ caused by combination of hyperextension and hyper supination in a recent wrist trauma. Because of the paucity of this injury, A high index of suspicion with a correct evaluation of wrist radiographs is needed to diagnose the injury early and to avoid later significant functional disability.

A 36-year-old man presented with recent wrist trauma secondary to a work accident in hyperextension and supination. Physical examination showed that wrist was swollen, deformed, and positioned in supination. The wrist locked when the forearm was fully supinated, and the patient was not able to pronate her forearm.

Initial anteroposterior and lateral radiographs of the wrist documented an isolated palmar dislocation of the DRUJ with respect to the radius and ulnar styloid. A CT scan was released, completing investigation by showing impaction of the ulnar head on the distal radius.

The patient was benefit from close reduction and percutaneous pinning with a 1.8-mm K-wire, under supraclavicular block and an image intensifier.

At 6 weeks postoperatively, Diagnostic imaging confirmed that the reduction was maintained. The patient showed full range of motion of the wrist and elbow in flexion and extension.

Dislocation of DRUJ is not always present and radiographs can be difficult to interpret if displacement is minimal particularly if the lateral views are inadequate, a patient with a volar dislocation typically present with the forearm fixed in supination and ventral prominence of the ulnar head, and will be unable to pronate the wrist. Unfortunately, these physical exam findings may be equivocal due to the swelling and apprehension that generally accompany such injuries in the acute setting. High index of suspicion and appropriate imaging then become of utmost importance.

Treatment is usually closed reduction followed by an above-elbow cast for a duration of three to six weeks under Local anesthesia with or without sedation. The reduction can be made more difficult by different blocks to reduction, such as impaction of the ulnar head, spasm of the pronator quadratus, and interposition of the torn TFCC.

A high index of suspicion must be maintained when assessing patients with wrist injuries keeping a low threshold to obtain advanced imaging to assess DRUJ injuries. Promptly closed reduction under appropriate analgesia is widely possible with a good residual stability of the DRUJ in most cases.