PMC6098930_01
A clinical photograph of the patient's deformity. Notice the loss of the dorsal bulge of the ulnar head (black arrow) and the fullness of the volar aspect of the right wrist (white arrow). Of note, the patient's multiple tattoos were digitally removed to reduce the risk of identification.
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There was loss of the dorsal ulnar prominence, and a palpable and tender solid mass was felt on the volar aspect of the wrist, which was presumed to be a volarly dislocated ulnar head (Figure 1).
AP (a) and lateral (b) radiographs of the injured wrist. Notice overlap between the radius and ulna on the AP view and slight anterior position of the ulna in relation to the carpal bones on the lateral view. Select coronal cut (c) and 3D reconstruction (d) of the forearm clearly show that the ulnar head is dislocated outside of the sigmoid notch and impacted on the radius.
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fig2
A CT scan was performed, completing the clinical picture by revealing impaction of the ulnar head on the distal radius (Figure 2).
Reenactment of the reduction technique. An assistant applies pressure on the interosseous membrane (IOM) of the forearm, while the physician pushes posteriorly on the ulnar head and pronates the forearm.
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fig3
After an unsuccessful first attempt, a second attempt was performed with an assistant applying pressure on the interosseous membrane (IOM) of the forearm using the palm of both of his hands, in an effort to free the impacted ulnar head from the distal radius (Figure 3).
Postreduction radiographs of the right wrist. There is no more overlap between the radius and the ulna on the AP view, and the ulnar head is now slightly dorsal to the radius on the lateral view.
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fig4
Postreduction radiographs confirmed the success of the reduction maneuver (Figure 4).