Posttraumatic ulnar translation of the carpus

Rayhack, John M.; Linscheid, Ronald L.; Dobyns, James H.; Smith, J. H. F.

doi:10.1016/s0363-5023(87)80268-x

Cited by 89 publications

(97 citation statements)

References 6 publications

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“…This allows the carpus, including the scaphoid, to slide ulnarly on the radial articular surface. Ulnar translation can also be seen in combination with other instabilities, such as triquetrolunate dissociation (Rayhack et al 1987). In severe trauma, we believe that direct ulnar carpal translation can occur without lesions of the intercarpal scapholunate ligament.…”

Section: Discussionmentioning

confidence: 85%

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Posttraumatic ulnar translation of the carpus

Mulier

Reynders

Broos

et al. 1992

Acta Orthopaedica Scandinavica

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Section: Discussionmentioning

confidence: 85%

“…The pathogenesis of posttraumatic u l n a translation appears to be a hyperextension injury, similar to that producing perilunar dislocation, with pronation of the forearm on the fixed hand (Lindscheid et al 1972, Dobyns et al 1975, Lindscheid et al 1983, Taleisnek 1985, Rayhack et al 1987.…”

Section: Discussionmentioning

confidence: 99%

Posttraumatic ulnar translation of the carpus

Mulier

Reynders

Broos

et al. 1992

Acta Orthopaedica Scandinavica

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“…Due to the unfamiliarity of PUCT by treating physicians, the diagnosis is often delayed up to averaged 7,3 Surgical treatments for PUCT include repair of radiocarpal ligaments, tendon augmentation, radiocarpal pinning or external fixation. However, persistent or recurrent PUCT within the first postoperative year associated with patient's disability and late posttraumatic osteoarthritis have been recognized in nearly all cases, regardless of the repair technique or surgical timing, and early radiolunate fusion to prevent recurrence was recommended by Rayhack et al [19]. However, fusions crossing the radiocarpal row cause a loss of approximately 55% of the pre-fusion flexion-extension range of motion [23].…”

Section: Case Presentationmentioning

confidence: 99%

“…Two types have been described by Taleisnik [15]: type I such as in our case presentation is associated with ulnar translocation of the entire carpus, and type II is associated with SLL disruption and the scaphoid bone is not involved in ulnar translocation. Due to the unfamiliarity of PUCT by treating physicians, the diagnosis is often delayed up to averaged 7,3 months, and it may be present when less than 50% of the lunate bone articulates with the radius in neutral position in the PA radiograph [19][20][21]. Nonetheless, all measurements are quite variable and should be compared to radiographs of the opposite uninjured wrist [22].…”

Section: Case Presentationmentioning

confidence: 99%

“…However, fusions crossing the radiocarpal row cause a loss of approximately 55% of the pre-fusion flexion-extension range of motion [23]. Posttraumatic degenerative changes in the wrist have been described in majority of all cases at average follow-up's ranging from 32 months to 6,5 years, despite primary surgical restoration and/or stabilization of radiocarpal alignment [19,24]. Irreparable cartilage damage may have occurred at the time of initial injury from compression, shear, and torsional forces.…”

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confidence: 99%

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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?

Schmidt¹

2017

Trauma Emerg Care

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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 ...

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Carpal kinematics and instability: A clinical and anatomic primer

Amadio

1991

Clinical Anatomy

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The complex anatomy of the wrist can be difficult to comprehend, and concepts of normal and abnormal motion may be difficult to convey to students. A conceptual framework may aid understanding in this difficult area. The key concept is that of the proximal carpal row as an intercalated segment stabilized by ligaments. On this foundation are added concepts of normal, synchronous, proximal row movement and analysis of abnormal movements. Abnormal movements are characterized by their direction and severity. The final step in analysis is localization of ligament abnormality, determining first the general class of ligament injured (extra-articuladintra-articular), then the specific location (proximal/distal, medialilateral, anterior/posterior), and finally the specific ligament name.

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Posttraumatic ulnar translation of the carpus

Cited by 89 publications

References 6 publications

Posttraumatic ulnar translation of the carpus

Posttraumatic ulnar translation of the carpus

Carpal kinematics and instability: A clinical and anatomic primer

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