Outcomes after Radiocarpal Dislocation: A Retrospective Review

Abstract

Background Radiocarpal dislocations are rare, high-energy injuries. High morbidity and poor functional outcomes are common. Currently, there is limited data on functional outcomes following treatment of this injury. Methods A retrospective review was conducted analyzing the radiographic and clinical outcome of patients treated for a radiocarpal dislocation from 1979 to 2010. Outcome assessments included wrist range of motion, grip strength, Mayo wrist score, patient-rated wrist evaluation (PRWE), and disabilities of the arm, shoulder and hand (DASH) score. Statistical analysis was performed with the Student's t test. Results Twenty-six patients (26 wrists) were treated for a radiocarpal dislocation during the study period; 23 wrists were treated acutely (within 4 weeks of injury), and 3 were treated after a delayed presentation (>4 weeks). Clinical follow-up of more than 6 months was available in 17 patients. Three patients (12 %) underwent primary fusion as initial treatment (two radioscapholunate fusion; one total wrist fusion). Four wrists (24 %) failed initial treatment and were salvaged with scapholunate ligament reconstruction (one wrist) or partial wrist fusion (three wrists). Seventeen patients completed PRWE and DASH questionnaires with a mean of 14.6 years following surgery (range 2-32 years). Subjective outcomes tended to be superior in those patients treated with ligament reconstruction versus partial or complete wrist fusion; however, comparisons were not statistically significant. Conclusion Radiocarpal dislocations result in significant osseous and ligamentous injury to the distal radius and carpus. Early recognition and treatment of radiocarpal dislocations with open reduction, internal fixation, and repair of ligaments may result in improved long-term functional outcomes when compared to acute partial or complete wrist arthrodesis.

Perilunate Injury with Concomitant Short Radiolunate Ligament Disruption: Prevalence and Surgical Outcomes—"An Unusual Perilunate Injury Variant”

“…Both types of injuries are relatively uncommon and most frequently are the result of high-energy trauma in young patients. 8,14,15 In up to 25% of cases, missed or incorrect diagnosis may lead to a delay in treatment and undue complications. 8,[16][17][18] Perilunate injuries have been categorized into four distinct stages of injury progression by Mayfield et al; however, disruption of the radiocarpal ligaments, specifically the SRL ligament, has not been described as part of this mechanistic classification system.…”

“…41 Primary ligamentous repair, percutaneous pinning, or arthrodesis, all have been described in the treatment of radiocarpal dislocations. 15 An extensile volar approach allows decompression of the median and ulnar nerves through the carpal tunnel and Guyon's canal if deemed necessary, respectively, as well as repair of the volar radiocarpal ligaments. 41 Therefore, similar to the recommendations for the operative management for radiocarpal dislocations, in the setting of perilunate injury with injury to the SRL may require repair.…”

“…40 The most common complication following these injuries is posttraumatic arthrosis that has been reported to occur in 11 to 31% of patients. 15,40,42 High rates of complication are seen following isolated radiocarpal dislocations or perilunate injuries on the order of 39 and 26%, respectively. 40,44 The mean incidence of posttraumatic arthrosis is 38% in perilunate injury and 22% after radiocarpal dislocation.…”

“…40,44 The mean incidence of posttraumatic arthrosis is 38% in perilunate injury and 22% after radiocarpal dislocation. 15,42,45 Outcomes depend on the severity of the initial injury, time to diagnosis and treatment, and achieving a concentric and stable reduction of the midcarpal radiocarpal joints. 45,46 Additionally, patients with both types of injuries can expect a marked loss of ROM following the injury.…”

Posttraumatic ulnar carpal translocation type I accompanied with disruption of the lunotriquetral ligament caused by a severe radiocarpal fracture-dislocation injury type II accompanied with complete luxation of the distal radioulnar joint. What are the salvage options with its special features in indication when patients develop posttraumatic painful wrist joint osteoarthritis?

“…Despite primary surgical repair of RCFDI, PUCT was observed in 23% of cases at an average follow-up of 2,8 years [12]. PUCT of the wrist without accompanying fractures of the distal radius, distal ulna, and/or carpal bones, is uncommon and was first described in 1930 by Lorenz Böhler ( †1973) [13].…”