We suggest that all patients with distal radius fractures receive a post-reduction true lateral x-ray of the carpus to assess DRUJ alignment.

Rationale
It is common knowledge that in the presence of a DRUJ injury or distal radius fracture the injury itself can preclude identifying DRUJ dislocation.  In order to not miss this treatable injury which often occurs in association with distal radius fractures, we were interested in determining whether true lateral x-rays can identify DRUJ dislocation. Two studies addressed this question.76, 77 One study described the piso-scaphoid distance and the other studied scaphoid/lunate/triquetrum overlap. Because both of these studies are based on level II evidence and showed that accurately performed lateral x-rays can reliably identify DRUJ dislocation when associated with DRF, we made the recommendation that true lateral x-rays be obtained in patients with distal radius fractures.
  1. (76) Nakamura R, Horii E, Imaeda T, Tsunoda K, Nakao E. Distal radioulnar joint subluxation and dislocation diagnosed by standard roentgenography. Skeletal Radiol 1995;24(2):91-94.
  2. (77) Mino DE, Palmer AK, Levinsohn EM. Radiography and computerized tomography in the diagnosis of incongruity of the distal radio-ulnar joint. A prospective study. J Bone Joint Surg Am 1985;67(2):247-252.