Radiocarpal collapse after a radiocarpal fracture dislocation despite surgical treatment

Abstract

We present a case of a radiocarpal fracture dislocation. The injury of the distal radioulnar joint was initially underestimated and only fixed with screws and a K-wire without addressing the radiocarpal instability. In the further course, the patient developed a painful radiocarpal dislocation and an impaired Range Of Motion (ROM) of the affected wrist. During rescue surgery the carpus was reduced and centralized into the radial fossa. One year later, the patient was mainly pain free and the ROM improved. Nevertheless, the radiographs showed signs of posttraumatic osteoarthritis already. These complex injuries are rare, often mistaken for distal radius fractures, and highly unstable. Indirect signs for instability need to be recognized, such as carpal bony tears and subluxations. The goal of treatment is to stabilize the reduced joint by a sufficient osteosynthesis of bony structures and a ligament reconstruction if warranted. Nevertheless, the outcome is poor with a high rate of posttraumatic osteoarthritis.