Radiocarpal Dislocations: Classification and Proposal for Treatment

Dumontier, C.; Reckendorf, G. Meyer Zu; Sautet, Alain; Lenoble, E.; Saffar, P.; Allieu, Y.

doi:10.2106/00004623-200102000-00008

Cited by 113 publications

(196 citation statements)

References 15 publications

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“…We observed progressive ulnar translocation of the carpus in 23 % (3 of 13) of the patients with radiographic follow-up. Rates of posttraumatic arthrosis reported in the literature have ranged from 11-25 % [5,8], consistent with our observed rate of 31 % (4 out of 13 wrists).…”

Section: Discussionsupporting

confidence: 92%

“…To our knowledge, ours is the only series of patients treated for radiocarpal dislocation followed long-term with validated clinical outcome measures. Previous studies have demonstrated that persistent ulnar translation of the carpus is the predictable consequence of an avulsive injury to the volar radiocarpal ligaments, specifically the radioscaphocapitate and radiolunate ligaments [5,10]. We observed progressive ulnar translocation of the carpus in 23 % (3 of 13) of the patients with radiographic follow-up.…”

Section: Discussionmentioning

confidence: 56%

“…Associated intercarpal dislocations or associated distal radial metaphyseal fractures were not a reason for exclusion as long as the scaphoid and lunate were completely dissociated from the articular surface of the distal radius. Specifically, we did include patients with a fracture of the radial styloid as long as the ulnar 50 % of the distal radius was intact [5]. Patients without complete clinical records were excluded.…”

Section: Methodsmentioning

confidence: 99%

“…Unlike marginal rim articular fractures of the distal radius, which were originally described by Barton [2], radiocarpal dislocations represent a severe crush or rotational injury to the carpus that results in intercarpal supination and subsequent disruption of the stout radiocarpal ligaments [7]. Common mechanisms of injury include high-speed motor vehicle accidents, falls from height, and industrial injuries [5].…”

Section: Introductionmentioning

confidence: 99%

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Outcomes after Radiocarpal Dislocation: A Retrospective Review

Yuan

Dennison

Elhassan

et al. 2015

Hand (New York, N,Y.)

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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.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 56%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Outcomes after Radiocarpal Dislocation: A Retrospective Review

Yuan

Dennison

Elhassan

et al. 2015

Hand (New York, N,Y.)

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“…The lesions usually are the result of falls from a height or motor-vehicle accidents mostly in young active men with age ranging from 20 to 40 years, and they are usually accompanied by visceral as well as musculoskeletal injuries, whereas low-energy injuries are very rare [1,[4][5][6]. The pathology is extremely infrequent with an incidence of 0,2% of all dislocations [3,7]. Dumontier et al [7] classified these dislocations into two types: type I includes purely ligamentous injuries with or without a small radial styloid avulsion associated with a high risk of persistent radiocarpal instability and generally poor outcomes if they present with PUCT, and type II such as in our case presentation includes a radial styloid fracture involving at least one-third of the scaphoid fossa associated with good outcomes if they can be reducted anatomically.…”

mentioning

confidence: 99%

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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Imaging of Wrist Trauma

Raby

2013

Medical Radiology

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Radiocarpal Dislocations: Classification and Proposal for Treatment

Cited by 113 publications

References 15 publications

Outcomes after Radiocarpal Dislocation: A Retrospective Review

Outcomes after Radiocarpal Dislocation: A Retrospective Review

Imaging of Wrist Trauma

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