Radiocarpal Fracture-dislocation Research Articles

Fracture-dislocation of the radiocarpal joint: bony and capsulo-ligamentar management, outcomes and long-term complications.

Radiocarpal dislocation fractures (RCDF) are rare injuries that usually occur in a violent trauma setting. Our work aimed to analyze our patients' functional and radiological results after surgery and identify potential medium- and long-term complications while reviewing other series previously reported in the literature. We have performed a retrospective study over five years at our university hospital, eleven patients were selected, and the mean follow-up was about 33 months. We used Dumontier's and Moneim's classifications for classifying the injuries. All the patients underwent surgery followed by cast immobilization. The QuickDash score and Green O'Brien score modified by Cooney were used to assess the functional result, while the radiological result was judged on standard wrist radiographs. Out of the eleven patients, only one described a Dumontier type I radiocarpal dislocation; all the others were type II. Following the Moneim classification, two patients were type II. Most cases showed posterior displacement. In 80% of cases, the radiocarpal fracture-dislocation was combined with other bone or ligament injuries. All patients received surgical treatment followed by cast immobilization for 45 days. The mean loss of range of motion at the last follow-up was about 39%, keeping the arch intact in most cases. Quick dash score was 29.54, and Green O'Brien's score was 71.1. Three of the patients showed osteoarthritic remodeling. A careful clinical and radiological evaluation, followed by an anatomic surgical reduction of the articulating surface of the distal radius, as well as the handling of the associated lesions, are major conditions for a satisfactory clinical result.

Redefining radiocarpal fracture-dislocations with injury specific management and a clinical classification system: a retrospective review.

Unlike articular shear fractures of the distal radius, radiocarpal fracture-dislocations defined as complete dislocation of the lunate from its articular facet of the radius are relatively uncommon. The management principles of these fractures have not been defined and there is no consensus on approach to management of these injuries. The aim of this study is to review our series of radiocarpal fracture-dislocations and propose a radiographic classification to guide surgical management. This study is reported based on STROBE guidelines. A total of 12 patients underwent open reduction and internal fixation. All the fracture-dislocations were dorsal and satisfactory objective outcomes achieved were comparable to literature. Injury morphology-specific management approach was used based on the size of dorsal lip fragment and the volar teardrop fragment attached to the short radiolunate ligament assessed by preoperative CT scans. All patients with known outcome (n = 10) went on to resume their prior occupation and hobbies that included high-demand activities and manual labour at mean follow-up of 27 weeks. Average wrist flexion was 43° and wrist extension was 41° while radial and ulnar deviation were 14° and 18° respectively. Average forearm pronation was 76° and supination was 64° at final follow-up. We describe four injury patterns of radiocarpal fracture-dislocations based on preoperative CT scans that guide fixation. We believe that early recognition of radiocarpal fracture-dislocations and appropriate management can yield satisfactory outcomes.

Dumontier group 2 radiocarpal fracture-dislocation: The results of open reduction and fixation without volar ligament repair

IntroductionThe radiocarpal fracture-dislocations are a spectrum of severe injury involving both the bony and ligamentous structures that stabilise the wrist joint. The aim of this study was to analyse the outcome of open reduction and fixation without volar ligament repair for Dumontier group 2 radiocarpal fracture-dislocation and to evaluate the incidence and clinical relevance of ulnar translation and advanced osteoarthritis. Patients and methodsWe retrospectively reviewed 22 patients with Dumontier group 2 radiocarpal fracture-dislocation treated in our institute. Clinical and radiological outcomes were recorded. Postoperative visual analogue scale (VAS) score for pain, Disabilities of the Arm, Shoulder and Hand Outcome Measure (DASH), and Mayo modified wrist scores (MMWS) were collected. Furthermore, extension‒flexion and supination‒pronation arcs were collected by reviewing chart, either. We divided the patients into two groups according to the presence or absence of advanced osteoarthritis, and presented the differences in the pain, disability, wrist performance, and range of motion between the two groups. We performed the same comparison between the patients with and those without the ulnar translation of the carpus. ResultsThere were sixteen men and six women with a median age of 23 years (range, 20‒48 years). The median follow-up period was 33 months (range, 12–149 months). The median VAS, DASH and MMWS were 0 (range 0–2), 9.1 (range, 0–65.9) and 80 (range, 45–90), respectively. The median flexion‒extension and pronation‒supination arcs were 142.5° (range, 20°‒170°) and 147.5° (range, 70°‒175°), respectively. Ulnar translation was recognised in four patients and the development of advanced osteoarthritis was noted in 13 patients during the follow-up period. However, neither was highly correlated with functional outcomes. ConclusionThe current study postulated that ulnar translation might occur following treatment for Dumontier group 2 lesions, whereas injury was predominantly caused by rotational force. Therefore, radiocarpal instability should be recognized during the operation. However, the clinical relevance of ulnar translation and wrist osteoarthritis needs to be assessed in further comparison studies.

Radiocarpal collapse after a radiocarpal fracture dislocation despite surgical treatment

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.

RADIOCARPAL FRACTURE DISLOCATIONS: A NEW CLASSIFICATION AND TREATMENT PROPOSAL.

ABSTRACTIntroduction The radiographic and surgical findings, and treatment of radiocarpal fracture dislocations, were analyzed retrospectively in 40 patients.Materials and Methods All patients were classified according to Dumontier´s radiological classification and compared with the surgical findings. Based on this analysis, a new classification and treatment are proposed.Results From 1995 to 2018, 40 patients with radiocarpal fracture dislocation underwent surgery. Thirty-six were males and four were females. The mean age was twenty-four years (range: 18-45). Three dislocations were volar dislocations and 37 were displaced dorsally. Initially, 8 (20%) patients were classified as group I, 29 (72.5%) as group II, and 3 (7.5%) remained unclassified. The main variations occurred in group II. Seven fractures were stable after radial styloid fixation and 6 remained unstable. Sixteen fractures presented articular fragments or an interposed capsule, which prevented anatomical reduction using conservative maneuvers.Conclusion Based in our intraoperative observations and surgical results, we believe that a more detailed classification should be adopted. Level of Evidence IV; Therapeutic Studies; Case Series.

The spanning plate as an internal fixator in complex distal radius fractures: a prospective cohort study.

Minimal invasive temporary spanning plate (SP) fixation of the wrist has been described as an alternative treatment method in complex distal radius fractures (DRFs). The purpose of this study is to conduct an outcome analysis of all consecutive DRFs treated by SP fixation representing the so far largest published patient cohort outside the United States. Indication for SP fixation include DRFs with severe metaphyseal comminution, radiocarpal fracture dislocations with concomitant ligamentous injuries and very distal intra-articular fractures lacking the possibility of adequate plate anchoring. All consecutive patients undergoing SP fixation of DRFs were prospectively included in a single level I trauma centre between 01/01/2018 and 31/12/2020. For functional and patient-rated outcome analysis only patients who completed the 12month follow-up were included. In the mentioned timeframe, a total of 562 DRFs were treated operatively of which 28 underwent SP fixation. Average age was 58.1years (range 22-95years). The fracture type ranged from AO/OTA type B1.1 to C3.3 and included 8 fracture dislocations. SP removal was performed on average 3.7months after the initial operation (range 1.4-6.5months). Twenty-five patients completed the 12month follow-up (mean 14.5months, range 12-24). Radiological evidence of fracture healing appeared on average 9.9weeks (range 5-28weeks) after the initial operation. One patient experienced asymptomatic non-union. Mean radial inclination, volar tilt and ulnar variance at 1year were all within the acceptable limit predictive of symptomatic malunion. Complications included two patients with tendon rupture and one patient with extensor tendon adhesions needing tenolysis at the time of plate removal leaving an overall complication rate of 12%. There was no implant failure and no infection. Mean satisfaction score was 8.3 (range 4-10) and mean visual analogue scale for resting pain was 0.8 (range 0-5). The mean PRWE score was 17.9 (range 0-59.5) and the mean DASH score was 16.6 (range 0-60.8). Grip strength averaged 23kg (range 4-74kg) amounting to 68% of the opposite side. Range of motion regarding the extension/flexion, radial/ulnar abduction and pronation/supination arc reached 72%, 77% and 95% compared to the unaffected side, respectively. The radiological, functional and patient-rated outcomes in this study are remarkably good considering the complexity of the included fractures. Therefore, this method represents a valuable alternative for the treatment of complex DRFs in selected patients.

Volar Radiocarpal Ligament Repair with Suture Anchors for Radiocarpal Fracture Dislocations: Case Series.

Background  Radiocarpal fracture dislocations cause significant intraarticular disruption and instability difficult to treat with traditional plating methods. Description of Technique  Suture anchor fixation of the volar radiocarpal ligaments through an extended carpal tunnel approach, supplemented with radial styloid fixation, restores stability to the radiocarpal joint. Patients and Methods  We performed a retrospective review of 14 consecutive radiocarpal fracture-dislocations (RCFDs) treated at two-level one trauma center from 2011 to 2015. In all cases, the volar radiocarpal ligaments were repaired to the distal radius with suture anchors. Results  We reviewed 14 Dumontier Group 2 RCFDs in 14 patients (10 males, four females) with an average age of 39 years (range 22-53 years). Final follow-up averaged 288 days (range 7-1,364 days). Surgeons performed volar ligament repair with suture anchors in all cases, radial styloid fixation in 79% (11/14), and dorsal plate fixation in 29% (4/14). Eight of 14 patients (57%) had a "flipped" volar lip fragment of the distal radius. Three patients had forearm compartment syndrome and two patients had acute carpal tunnel syndrome. No patients experienced radiocarpal subluxation after volar ligament repair. Conclusion  No recurrent subluxation or dislocation occurred after primary repair of the volar radiocarpal ligaments using suture anchors in this series of radiocarpal fracture dislocations. Volar radiocarpal ligament repair also addressed the "flipped" volar rim fragment that could not be addressed through a dorsal approach alone. Level of Evidence : This is a Level IV, case series therapeutic study.

Dorsal fracture-dislocation of the radiocarpal joint: a new classification and implications in surgical treatment.

Dorsal dislocations and fracture-dislocations of the radiocarpal joint are a spectrum of pathology involving both the bony and ligamentous structures that stabilize the radiocarpal joint. We retrospectively reviewed 63 dorsal radiocarpal dislocations treated in our Institute in order to propose a new classification and define surgical treatment. Preoperative CT-scan findings together with clinical and radiological outcomes were recorded. We identified four main types of lesions: Type I, pure dorsal radiocarpal dislocation; Type IIA, dorsal wall impaction and radial styloid avulsion; Type IIB, as IIA with additional intra-articular die punch; Type III, volar and dorsal marginal fragments; Type IV, larger volar and dorsal fragments. For each type of lesion, we propose specific options for treatment that are progressively more invasive. We believe that this classification adequately addresses the whole spectrum of bony and soft tissue injuries that occurs in dorsal radiocarpal fracture-dislocations giving a practical guide for surgical treatment.Level of evidence: IV.

Carpal Instability Nondissociative Following Acute Wrist Fractures

Carpal malalignment following intra-articular fractures has been reported in the literature, with no clear description of possible ligamentous injury leading to the radiological appearance. This study presents a series of patients that developed carpal instability nondissociative (CIND) following acute wrist fractures. The mechanism of injury is postulated by using a cadaveric laboratory investigation. Twelve patients with average age of 32 years were identified with CIND, between 2013 and 2018. Ten patients with a normal carpal alignment in the initial postoperative radiographs exhibited CIND-palmar radiographically at different postoperative periods, and 2 patients showed CIND-dorsal in the initial postoperative x-rays. Four cadaveric specimens were used to validate this injury pattern. In cadaveric dissections, CIND-palmar could be reproduced by applying an axial loading and dorsal shearing force on a wrist with sequential sectioning of dorsal and palmar extrinsic wrist ligaments. For the intra-articular fractures with CIND-dorsal, the cause is likely a result of volar radiocarpal extrinsic ligament injury combined with intra-articular incongruity of the scaphoid fossa. Eight out of the 12 patients had severe wrist pain and underwent additional surgery. Three patients with reducible CIND-palmar had open capsular repair, and 5 patients with fixed nonreducible malalignment were treated with radioscapholunate arthrodesis. At an average follow-up of 2.3 years, pain relief was noted, together with an improvement in grip strength and range of movement. Radiographically, the wrist alignment was corrected and maintained. This article highlights the existence of possible concomitant radiocarpal ligament lesions and residual articular incongruity, associated with acute intra-articular fractures and radiocarpal fracture-dislocations, that destabilize the proximal carpal row into a pattern of nondissociative carpal instability. Early detection of this condition may preserve wrist function by capsular repair, whereas cases with fixed deformity and residual joint incongruity may be best managed with a limited radiocarpal arthrodesis. Diagnostic IV.

A rare combination of elbow dislocation and radiocarpal fracture dislocation

A 31-year-old male came to the hospital with ipsilateral radiocarpal fracture dislocation and elbow dislocation. Elbow was reduced immediately in the emergency, and the open reduction and internal fixation with plating were done for the radiocarpal fracture dislocation. The patient recovered with a good range of motion of both elbow and wrist. This combination of fracture is rare with the possible mechanisms being single impact due to the fall from a height on an outstretched hand or double impact on the elbow and the wrist.

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?

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?

Les fractures-luxations radiocarpiennes : à propos d’une série de 10 cas et revue de la littérature

The authors report a retrospective series of ten cases of radiocarpal fracture-dislocation after sport injuries. Anterior displacement for two dislocations and dorsal displacement was observed for eight dislocations, of which one was complicated by anterior cutaneous opening. Average age of patients was 34 years, with a male predominance (9 men and a woman). Diagnosis was confirmed by x-ray of the wrist. Radial styloid fracture and posterior rim avulsion were constant in dorsal displacement. Three patients were treated conservatively and seven surgically. The overall functional outcome was satisfactory according the Grumillier score.

A Scaphoid Osteochondral Autograft for Reconstruction of the Lunate Fossa of the Distal Part of the Radius After a Complex Open Fracture: A Case Report.

Complex fractures of the distal part of the radius in high-energy injuries or in elderly osteopenic patients often have extensive articular comminution. Often, these small fragments are not amenable to primary fixation. In high-energy open fractures, there may be substantial bone loss or missing osteochondral fragments. Moreover, concomitant carpal fractures are often present, as well as associated radiocarpal and carpal dislocations that offer additional challenges. Primary total wrist arthrodesis has been suggested for treatment of these difficult injuries1. Motion-preserving salvage procedures include total wrist arthroplasty, limited wrist fusion, and proximal row carpectomy (PRC). Total wrist arthroplasty is contraindicated in younger, more active patients because current implants require a low-demand lifestyle, and complication rates following surgery remain high2. Limited wrist fusion and PRC require an intact lunate fossa and thus may not be options in cases with substantial loss of articular surface. Autogenous osteochondral graft reconstruction of the articular surface of the distal part of the radius has been described in some small case series3-7. PRC involves resection of the scaphoid, lunate, and triquetrum, allowing the capitate to articulate with the lunate facet of the distal part of the radius. The scaphoid is therefore an ideal potential osteochondral donor graft for salvage of the lunate fossa when PRC is to be performed because it does not require a separate graft harvest procedure and does not cause additional donor-site morbidity. We report a case of a complex open radiocarpal fracture-dislocation with bone loss, demonstrating salvage of the lunate facet of the distal part of the radius with a scaphoid osteochondral autograft. The patient was informed that data concerning the case would be submitted for publication, and he provided consent. A twenty-five-year-old man was involved in a rollover motor vehicle collision and was transferred to …

Volar Ligament Repair for Radiocarpal Fracture-dislocation

Radiocarpal fracture-dislocations are uncommon injuries, comprising a spectrum of trauma to the capsuloligamentous complex and osseous structures of the radiocarpal joint along with the adjacent structures. Management guidelines are derived from limited case series and expert opinions. An understanding of the relevant anatomy suggests that restoration of an anatomically reduced joint in conjunction with repair or reconstruction of the osseous and soft tissue structures optimizes outcome. Special consideration should be given to repair of the radial styloid, intercarpal ligaments, and radiocarpal capsuloligamentous complex. The authors report 2 patients with radiocarpal fracture-dislocations in which reduction and stabilization of the carpus was achieved using suture anchor fixation of the volar extrinsic radiocarpal ligaments.

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

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

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

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.

Fracture-luxation radiocarpienne postérieure ouverte du poignet. À propos d’un cas

The radiocarpal fracture-dislocations are uncommon injuries, occurring at a high-energy trauma explains the frequency of associated lesions in patients with multiple trauma often. The frequency of skin involvement very varies, but is rare (few cases reported in the literature). A combination of median nerve and worsens the functional prognosis of the hand. The authors report the case of a radiocarpal fracture-dislocation of the right wrist, which was complicated by anterior cutaneous opening in a young footballer after a sports accident.

Diagnostik und Therapie von radiokarpalen Luxationsfrakturen

In contrast to the common intra- or extra-articular fractures of the distal radius, radiocarpal fracture dislocations are rare injuries. Concerning this issue, only a small number of publications can be found. Nevertheless, it is important to be informed about this injury since prompt operative treatment is often required and immobilization alone will not be sufficient. Sometimes, radiocarpal fracture dislocations are combined with carpal injuries. In such cases, both the radiocarpal dislocation and carpal injury have to be treated. Diagnostic difficulties can lead to misinterpretation or underdiagnosis. Insufficient reduction and fixation may result in joint incongruity and subsequent osteoarthritis. Reconstruction of the radiocarpal ligaments is a substantial part of operative treatment.

Arthroscopically Guided Osteotomy for Management of Intra-Articular Distal Radius Malunions

A malunion with a step-off of 1 mm or more after an intra-articular distal radius fracture may cause pain and arthritic changes at midterm follow-up. We present our technique for treating intra-articular distal radius malunions by carrying out an osteotomy from inside the joint outward under arthroscopic guidance using the dry arthroscopy technique, with emphasis on the clinical and radiologic outcomes. We performed surgery on 11 patients for intra-articular malunion of the distal radius 1 to 5 months after the injury. Preoperative step-offs ranged from 2 to 5 mm (average, 2.5 mm) on plain radiographs. Original fracture patterns involved 1 radial styloid fracture, 1 radiocarpal fracture-dislocation, and 9 comminuted intra-articular fractures. In 5 cases an anterior-ulnar or radial styloid fragment was repositioned. In the rest, more than 1 fragment (up to 3) was osteotomized. In 1 patient the articular osteotomy was combined with an ulnar shortening osteotomy. Follow-up ranged from 12 to 48 months. Step-offs were reduced in most cases to 0 mm; however, localized gaps (<2 mm) and cartilage defects were commonly seen intraoperatively because the fragments did not accurately fit. According to the Gartland and Werley score, there were 4 excellent and 7 good results (mean score of 2.8). The Modified Green and O'Brien system achieved a mean score of 83, with 3 excellent, 5 good, and 3 fair results. One patient showed radiolunate narrowing on follow-up radiographs. Arthroscopically assisted osteotomy permits direct visualization of the osteotomy site with good midterm clinical and radiologic outcomes. The technique can be used in irregularly defined fragments. Therapeutic IV.

Volar Marginal Articular Fractures with Loss of Articular Apposition

Five patients with a volar marginal articular fracture with dislocation (complete loss of apposition of the articular surfaces) were treated with open reduction and internal plate fixation. This is an unusual type of volar shearing fracture and represents the volar type of radiocarpal fracture-dislocation. The results of treatment were comparable to other volar shearing type fractures.