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?

Abstract

Key words: radiocarpal fracture-dislocation injury, dorsal rim fracture distal radius, luxation distal radioulnar joint, posttraumatic ulnar carpal translocation, volar intercalated segment instability, denervation of the wrist, salvage options for posttraumatic wrist joint osteoarthritis Case presentationA 24-year-old right-handed male sustained a severe closed right radiocarpal fracture-dislocation injury (RCFDI) due to high-energy fall on his hyperextended wrist by a motorcycle accident with speed of 102,5 miles per hour. The initial radiographs showed complete dislocation of the wrist in dorsal direction accompanied with a displaced dorsal rim fracture of the articular surface of distal radius, a displaced intraarticular radial styloid fracture involving much more than one third of the articular surface of distal radius (type II), and complete luxation of distal radioulnar joint (DRUJ) in volar direction (Figure 1). Accompanying visceral, vascular or nerve injuries were not present, but closed non-displaced fractures of the left metatarsal bones II/III. First, the closed reduction and external fixation (CREF) of the wrist and DRUJ with additional radioulnar transfixation using two K-wires was performed. The postoperative computed tomography (CT) scans demonstrated complete restoration of anatomic alignment in both joints ( Figure 2A). Five days after that, the swelling around the wrist had improved, and so, the open reduction and internal fixation (ORIF) of radial styloid fracture using two 3,0 mm cannulated headless titanium compression screws (medartis®, Basel/Switzerland) could be performed that was accompanied with removal of external fixation and early denervation of the wrist ( Figure 2B). Intraoperatively, there was no radiocarpal re-luxation tendency in dorsal direction related to the accompanying dorsal rim fracture, and so its surgical reduction was not necessary. The right upper extremity was immobilized with a plaster splint involving the elbow and wrist joints for another five weeks. After that, the plaster splint and the two K-wires for radioulnar transfixation were removed, and the movement of the wrist was freed accompanied with pain-related gradual increase of load. The left non-displaced fractures of the metatarsal bones II/III were treated conservatively with a plaster splint for six weeks. Fourteen weeks after injury, the patient could be reemployed completely in his original occupation as a mechanic in a professional motorcycle racing team. At the 1-year follow-up, the postero-anterior (PA) and lateral radiographs showed distinctive posttraumatic ulnar carpal translocation (PUCT) of the entire carpus (type I) in comparison to the uninjured left wrist that was accompanied with marked volar angulation of the scaphoid bone in the absence of disruption of scapholunate ligament (SLL), but in the presence of disruption of the lunotriquetral ligament (LTL) with distinctive volar intercalated segment instability (VISI) ( Figure 3A-B). However, the patient rated his pain in visual analogue score ...

Who introduced the "quadrangular-construct" modification of the Sauvé Kapandji procedure first? Case presentation and brief overview of literature with regard to general, specific and practicable aspects to primary trauma-related surgical treatment including possible salvage options at the distal radioulnar joint

“…longitudinal instability) with or without its subluxation in the lateral plane (i.e. transverse instability) first described in 1946 by Curr and Coe in the absence of previous reference to similar cases in the literature, and later clearly investigated by EssexLopresti in 1951 [8,[21][22][23][24][25]. The merit of Essex-Lopresti is that he has first described the mechanism as well as the approach of this injury as follows in the original: "The mechanism of injury appears to be a [24].…”

“…Galeazzi, Monteggia, greater arc injury) is present, open reduction and internal fixation (ORIF) is absolutely required to provide joint stability and alignment, and early mobilization as well ( Figures 9A-E) [21][22][23][24]. Likewise, open reduction and internal fixation (ORIF) of the radial head in case of an Essex-Lopresti injury is the essential prerequisite to obtain the length of radius and to avoid subsequent longitudinal instability of the DRUJ (i.e.…”

“…UPV) [31][32][33][34][35][36][37]55]. In every instance as well when evident DRUJ instability after closed or open reduction of traumatic DRUJ luxation in case of a Galeazzi injury ( Figures 8A-F), greater arc injury, acute isolated DRUJ dislocation injury, or Essex-Lopresti injury persists, radioulnar transfixation using Kirschner-wires is absolutely required to provide DRUJ stability as well as to give the IOM the chance for spontaneous healing [21,27,[31][32][33][34][35][36][37]55]. If a closed DRUJ reduction is unsuccessful due to soft tissue interposition such as the extensor digiti minimi tendon or the traumatically detached TFCC, the open reduction becomes necessary ( Figures 8A-F) [27].…”

“…Care must be taken when using the Darrach's procedure in patients with rheumatoid arthritis, due to the natural course of the disease with progressive ulnar carpal translocation it can leads to severe complications such as migration of the lunate bone or dislocation of a total wrist arthroplasty (TWA) [85][86][87][88][89]. Noted that ulnar carpal translocation is also observed as a posttraumatic complication after fracture-dislocation injuries of the wrist in which the ulnar head is obtained, and, due to the unfamiliarity of this injury by treating physicians, this rare injury can mostly be investigated when comparing radiographs with the uninjured wrist were done such as described for the elbow joint as well [14,21,90].…”

The rare injury of a closed digital extensor tendon avulsion of the third finger at its musculotendinous junction: Case presentation and brief overview of literature with regard to general, specific and practicable aspects to extensor tendon surgery involving tendon transfer procedures

“…Functional flexion postures averaged about 60° at the MCPJ and PIPJ, and 40° at the DIPJ [10,11]. Also noted that a well functioning and exactly aligned extrinsic extensor mechanism is an essential prerequisite for success of total joint replacements in the wrist and all other long finger joints (Figures 5A-C, 6A-H, and 7A-D) [8,9,12]. When an intratendinous disruption of an extrinsic extensor tendon is accompanied with a large gap, the bridging of gap utilizing a free tendon graft such as the palmaris longus (PL) is the method of choice for surgical repair (Figures 8A-D).…”