Outcomes after radiocarpal dislocation: a retrospective review.

Abstract

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. 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. Twenty-six patients(26 wrists) were treated for a radiocarpal dislocation during the study period; 23 wrists were treated acutely (within 4weeks of injury), and 3 were treated after a delayed presentation (>4weeks). Clinical follow-up of more than 6months 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 14.6years following surgery (range 2-32years). 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. 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.