The proximal radioulnar joint is the proximal pivot of forearm rotation, where the radial head rotates within the socket of the radial notch and annular ligament. The radial head is elliptical in cross-section — during forearm rotation it must accommodate this elliptical geometry, which is why a malunited radial head fracture (changing the ellipse) restricts rotation before articular surface incongruence. The PRUJ is also the site of radiocapitellar impingement in lateral elbow overuse.
Radial head fractures are the most common elbow fractures in adults. Mason classification: Type I (non-displaced, treat non-operatively), Type II (partial, may require ORIF if mechanical block), Type III (comminuted, ORIF or radial head replacement), Type IV (with elbow dislocation). Radial head excision alone is contraindicated if the PRUJ is the only proximal ulna support (Essex-Lopresti).
PRUJ injury from FOOSH classified by Mason system — non-operative for Type I, ORIF or arthroplasty for Type III-IV.
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