Radiological radio-carpal and mid-carpal motion after operative treatment of dorsal radio-carpal fracture dislocations

Abstract

Radio-carpal fracture dislocations are rare severe injuries typically seen following high energy trauma. This injury is characterized by complete dislocation of the radio-carpal joint with avulsion fracture of dorsal or palmar cortical rim of the distal radius combined with disruption of the radio-carpal ligament complex. The purpose of our study is to assess the radiological motion outcome of the radio-carpal joint after Moneim type 1 radio-carpal fracture dislocations following surgical treatment. Only Moneim type 1 injuries were included in this study. Eight patients with Moneim type 1 injuries were identified by retrospective examination of our fracture registry and included in this study. All patients were initially treated with closed reduction and plaster immobilization. CT scans were performed after reduction. Operative treatment consisted of anatomic reduction of the distal radial rim fractures and fixation with a small T-plate through a dorsal approach. Cancellous bone graft was utilized if necessary to support the articular surface. Repair of the palmar radio-carpal ligament complex was performed through a palmar wrist approach. Antero-posterior, lateral, as well as lateral flexion and extension radiographs were taken at an average follow-up of 4.1 years. Follow-up radiologic evaluation of standard lateral radiograph revealed a mean scapholunate angle of 55.6°. The mean capitolunate angle was found to be −11.6° and the mean radio-capitate angle was 10.5°. The average noted angles in maximum flexion were as follows: radiolunate 15.3°, capitolunate 18° and radiocapitate 30°. The average angles in maximum extension were: radiolunate −23.9°, capitolunate −31° and radiocapitate −55°. At follow-up, arthritic changes were assessed radiographically using the classification described by Knirk and Jupiter. Fifty-six percent of the patients were found to exhibit stage 1 traumatic arthritis, 33% had stage 2 traumatic arthritis and 11% exhibited stage 3 traumatic arthritis with radio-carpal joint space obliteration. Rigid bony fixation and palmar radio-carpal ligament repair of Moneim Type 1 radio-carpal dislocations resulted in preservation of sagittal plane motion of the proximal carpal row in eight of nine cases. Our data suggest that surgical reconstruction of Moneim type 1 injuries is the preferred treatment and usually leads to satisfactory range of motion.