Uncommon Dorsal Radiocarpal Fracture Dislocation Complicated with Median Nerve Palsy: Case Report, Review of the Literature, and a New Classification System Guiding the Management

Abstract

We report the case of a 36-year-old lorry driver who sustained left dorsal radiocarpal fracture dislocation and left median nerve injury in a traffic accident in 2010. Emergency operation of closed reduction, cross-wrist-bridging external fixation, percutaneous transradial styloid Kirschner wire fixation, decompression of left median nerve, and repair of the partially torn palmar radiocarpal ligament were performed under general anaesthesia. Because of the persistent depressed dorsal articular rim fracture of left distal radius, another operation of open reduction, corticocancellous bone grafting, and dorsal buttress plating was performed 5 days after the initial operation. Six months after the operation, the patient enjoyed good range of wrist motion but weak twisting power, especially in supination. There was no radiological feature of radiocarpal subluxation.

Volar Radiocarpal Dislocation: A Case Report and Review of Literature

“…Type 1 refers to dislocation or a fracture-dislocation involving fracture of the tip of the radial styloid process, whereas type 2 RCD corresponds to dislocation with a fracture of a larger fragment of styloid of the radius passing through the scaphoid facet [5]. In both types, it is common to find median nerve compression, and patients often experience neurapraxia [11]. Thus, the surgical treatment of RCDs includes ligamentous repair combined with percutaneous Kirschner wire pinning and/or distraction-plating with or without external fixation using either open or closed reduction method [3,[12][13][14].…”

“…As in our case, it was difficult during the first time to rule out the injury in the normal X-ray; a CT scan helped to evaluate and confirm the RCD. MRI and wrist arthroscopy are also useful for identifying intra-articular soft tissue injuries in such cases [4,11].…”