Volar Dislocation Research Articles

Neglected Volar Lunate Dislocation Treated With Lunate Excision and Partial Wrist Fusion

Neglected Volar Lunate Dislocation Treated With Lunate Excision and Partial Wrist Fusion

Tarans-Scaphoid Lunate Fracture Dislocation: A Case Report of a Rare Injury

Trans-scaphoid lunate dislocation is an uncommon injury but can be devastating, causing loss of wrist joint movement and function, and compromising grip strength. In this report, we present a case of a 48-year-old man with a history of psychiatric disorder who attempted suicide by jumping from the second floor. He sustained a volar lunate dislocation and scaphoid fracture, with migration of the proximal part of the scaphoid to the volar aspect of the forearm. Open surgical reduction was planned through a dorsal approach: first, the lunate was reduced, then the proximal part of the scaphoid was retrieved from the volar aspect of the forearm and anatomically fixed with a 2.5 mm headless screw. The scapholunate relationship was reduced and fixed with two wires through the scapholunate and scaphocapitate joints. The wound was closed in layers, and the wrist joint was immobilized with a dorsal splint for six weeks. Six weeks postoperatively, the K wires were removed, and the patient started physiotherapy. At three months postoperative follow-up, the wrist joint function was good, with good grip strength and a good range of motion. The gold standard treatment option is open reduction and fixation of the fractured bone and stabilization of the carpal bones in anatomical alignment to reduce possible complications such as median nerve compression, chronic carpal instability, chronic wrist pain, loss of grip strength, wrist arthritis, and carpal collapse.

Complex forearm deformities in brachial plexus birth palsy: Radial head dislocation, forearm bones crossing, and distal ulna volar dislocation

We present a rare and complex case involving a 6-year-old boy with brachial plexus birth palsy, which is complicated by secondary developmental changes such as proximal radial head dislocation, distal ulna dislocation, and a severe supination deformity in the forearm. Despite the severity of his condition, his parents declined further treatment. This case underscores the presence of unclassifiable complex anomalies and highlights the need to expand the current classification system, especially when these anomalies are associated with birth palsy. Our report emphasizes the importance of recognizing and addressing these intricate presentations to enhance diagnostic and therapeutic strategies.

Surgical Management of a Delayed Presentation of Floating First Metacarpal with Multiple Fracture Dislocations: A Case Report.

A 23-year-old man presented with a 2-month-old injury involving a volar base metacarpal fracture dislocation of carpometacarpal joint (CMC), metacarpophalangeal joint (MP) dislocation, floating metacarpal, and proximal phalanx base fracture. Treatment involved open reduction of volar base metacarpal's fracture and CMC dislocation, MP joint reduction, collateral ligament repair, and proximal phalanx fixation with plates and screws. A modified Eaton-Littler procedure with flexor carpi radialis tendon enhanced CMC joint stability. At 6 weeks, fractures had healed well, achieving good thumb motion. One-year follow-up showed no arthritis or dislocation. Thumb injuries are relatively common and can involve complex fractures and dislocations. Open reduction of the delayed fractures, dislocations, and ligament repair and reconstruction can lead to successful outcome.

Isolated volar dislocation of the distal radioulnar joint: Current concepts review and case report

Isolated volar distal radioulnar joint (DRUJ) dislocation is a rare condition with only a few cases reported in the literature. Its diagnosis is often overlooked in the acute phase, and there is no consensus in its management. We present the case of a 20-year-old male patient with an isolated volar radioulnar dislocation, together with a review of the literature. The aim is to present and summarize the acute management of this condition and propose a therapeutic algorithm.

A Review on Volar Fracture-Dislocations of the Proximal Interphalangeal Joint.

Volar fracture-dislocations of the proximal interphalangeal joint are rare injuries caused by an axial force on a flexed digit resulting in an avulsion fracture of the dorsal lip of the middle phalanx with volar dislocation of the joint. This volar subtype is analogous to the more common dorsal subtype with a mirror image fracture on the dorsal lip of the middle phalanx. The main significance in this type of injury lies in the disruption of the extensor mechanism at the central slip. The goals of treatment, apart from restoring a congruent and stable joint, is to restore the extensor mechanism to prevent a boutonnière deformity. In this article, we summarise the current literature and discuss the principles for treatment of this uncommon injury. Level of Evidence: Level V (Therapeutic).

An Extraordinary case report: Bilateral pure perilunate dislocation

Introduction: Perilunate dislocation of the carpus is an unusual injury, requiring high-energy trauma. The simultaneous bilateral form is so rare that is worthy of report, with only a few cases mentioned in the literature. We present the case of a patient with an open volar dislocation of the right wrist associated with a closed dorsal dislocation of the left wrist and distal radioulnar subluxation. Case report: A 30-year-old, right hand dominant male, suffered injuries to both wrists after being involved in a high-speed car accident. Examination of the patient revealed diffuse swelling and tenderness to both wrists with a lacerated wound over the dorsum of right wrist. Anteroposterior and lateral X-rays of both wrists were obtained, which showed bilateral perilunate pure dislocations: volar in the right side and dorsal the left side combined with a dorsal subluxation of the distal radioulnar joint. Discussion: Perilunate dislocations are relatively rare injuries involving approximately only 7% of all injuries of the carpus. It is often overlooked in primary evaluations, approximately 25% of perilunate injuries were missed. A better comprehension of the injury's mechanism and its full extent has led to better management strategies. It is recommended in the literature, that the best treatment of these injuries is open reduction, restoration of carpal bones relationship, repair of the ligaments and a proper rehabilitation and physiotherapy program.

Arthroscopic Treatment of Traumatic Isolated Volar Dislocation of the Distal Radioulnar Joint: Case Report and Management Proposal

Abstract Background Traumatic isolated dislocation of the distal radioulnar joint (DRUJ) has always been an injury recognized for its rarity, misdiagnosis, and possibility of inability to be reduced at emergency care. As a result, little has been discussed so far about the guidelines and routines for its treatment.It is known that some degree of injury to the triangular fibrocartilage (TFC) is required for a DRUJ to be dislocated. However, there is no evidence to prove that this injury will cause any degree of DRUJ instability following reduction. Methods We show a case of a patient with traumatic isolated volar dislocation of the DRUJ in which, after failure in the attempt to reduce it in the emergency room, surgical treatment was performed using an arthroscopic method. Results Computed tomography and magnetic resonance imaging axial sections showed the impaction of the distal ulna, with its groove to the extensor carpi ulnaris tendon blocked in the anterior labrum of the sigmoid notch of the radius. Arthroscopy before reduction showed that the distal portion of the TFC was intact, with damage to the foveal insertion (Palmer Type 1B, Atzei Class 3). After joint reduction, a loop-shaped repair of the TFC foveal lesion was performed through the central disc and attached to the distal ulna footprint. The patient presented good progression, with quick recovery, and no serious complications or the need for a second surery. Conclusion We indicate the use of arthroscopy in patients with irreducible isolated volar dislocation, with subacute or chronic presentation, who have to be managed in the operating room. It is a useful method for diagnosing and repairing the TFC injury. This will prevent possible complications and provide faster recovery, mainly reducing the time of immobilization.

Volar Lunate Dislocation: A Case Report

Introduction: Perilunate dislocations are rare high-energy injuries which may often have the potential to cause lifelong disability of the wrist if not addressed optimally. Hence, early recognition, diagnosis, and intervention are of paramount importance in the restoring function and prevention of morbidity. Lunate dislocations are the fourth and last stage of perilunate dislocations being extremely rare, with volar dislocations representing <3% of perilunate dislocations. Case Report: A 24-year-old man suffered from an alleged history of fall from a bike on an outstretched hand following which he developed complaints of pain and swelling in the right wrist. On examination, the patient has relative sensory loss over the lateral half of the palm with no vascular deficit. An accurate range of motion could not be documented due to severe pain. Standard digital X-rays revealed lunate displaced and angulated volarly with a typical “spilled teacup” appearance along with radial and ulnar styloid fractures. Management: The patient was initially given an attempt of closed reduction which was not successful and was followed with open reduction and internal fixation with both volar and dorsal approach with Kirschner wires. The patient’s wrist was immobilized for 6 weeks with below elbow cast with the removal of k wires at 8 weeks after which wrist ROM exercises were started. Results: The patient was followed up for 6 months and now has a functional range of motion of the wrist with no sensory deficit and is able to continue with his profession as a car mechanic. Conclusion: Mayfield progression Stage 4 perilunate dislocations are uncommon with a poor prognosis if not addressed timely. Hence, these injuries need to be identified early and optimally managed with surgical intervention for a favorable outcome. Keywords: Perilunate dislocation, carpal bones, avascular necrosis of lunate, wrist trauma, carpal instability

Volar radial Carpometacarpal dislocation of the fourth and fifth fingers

Carpometacarpal ligaments converge at the base of the metacarpal. Only very violent trauma can cause carpometacarpal dislocation. We report the case of a 23-year-old patient admitted for volar dislocation of the 4th and 5th finger with radial displacement. We did proceed to a closed reduction maintained by a splint the evolution was satisfactory with the recuperation of grip force. The mechanism of the injury can be direct or indirect. The displacement can suggest is there or not a complete rupture of the carpometacarpal ligaments. After closed reduction, the treatment can be surgical (which is preferred) with k-wire fixation or nonsurgical with splint immobilization with a close follow-up to avoid the loss of the reduction.

Volar distal radioulnar joint dislocation: A case report and literature review

Volar distal radioulnar joint dislocation: A case report and literature review

Ulnar Head Fracture with Volar Dislocation of the Distal Radioulnar Joint: A Case Series and Systematic Review

AbstractDislocations of the distal radioulnar joint associated with a fracture of the distal ulna articular surface without an associated radial fracture are extremely rare.We present a case of a fracture of the distal ulna with an associated dislocation of the distal radioulnar joint, where the articular head fragment was displaced anterior to the sigmoid notch.We also present the results of a formal systematic review of these injuries which confirmed this is the first such injury described, although there is a very similar fracture pattern described in the literature with dorsal dislocation.We describe the mechanism of injury and hypothesize about the etiology of the fracture pattern and suggest that it represents the end of a spectrum that also includes the isolated dislocations and those associated with an ulna styloid fracture.

Erratum: Chronic Volar Distal Radial Ulnar Joint Dislocation: A Case Report with Proposed Treatment Algorithm

Erratum: Chronic Volar Distal Radial Ulnar Joint Dislocation: A Case Report with Proposed Treatment Algorithm

Application of a Low-cost, High-fidelity Proximal Phalangeal Dislocation Reduction Model for Clinician Training.

Introduction: Patients present to the emergency department (ED) relatively commonly with traumatic closed proximal interphalangeal joint (PIPJ) dislocations, an orthopedic emergency. There is a paucity of teaching models and training simulations for clinicians to learn either the closed dislocated dorsal or volar interphalangeal joint reduction technique. We implemented a teaching model to demonstrate the utility of a novel reduction model designed from three-dimensional (3D) printable components that are easy to connect and do not require further machining or resin models to complete. Methods: Students watched a two-minute video and a model demonstration by the authors. Learners including emergency medicine (EM) residents and physician assistant fellows assessed model fidelity, convenience, perceived competency, and observed competency. Results: Seventeen of 21 (81%) participants agreed the model mimicked dorsal and volar PIPJ dislocations. Nineteen of 21 (90%) agreed the model was easy to use, 21/21 (100%) agreed the dorsal PIPJ model and 20/21 (95%) agreed the volar PIPJ model improved their competency. Conclusion: Our 3D-printed, dorsal and volar dislocation reduction model is easy to use and affordable, and it improved perceived competency among EM learners at an academic ED.

Neglected Posterior Dislocation of the Proximal Interphalangeal Joint of the 5th Finger by Incarceration of the Volar Plate: About A Case

Volar dislocation of the proximal interphalangeal joint phalanx of the fingers is a very rare entity. Indeed, there is still no consensus that specifies the treatment of this injury. The closed reduction external maneuver should always be tried first intention, but it can lead to failure and will be followed by surgical treatment. We report the case of palmar dislocation of the proximal interphalangeal joint phalangeal pure treated by opened and surgical reduction, followed by an arhtorisis by a Kirschner pin size 16.

Post traumatic volar complex dislocation of first metacarpophalangeal joint: a case study

First metacarpophalangeal (MCP) joint dislocations are very uncommon injuries. These dislocations are classified as volar or dorsal, and then as simple or complicated, based on the direction of the dislocation and its reducibility. Dorsal being the most common approach as it is safer. It is found that reduction was stable and started with immobilisation for 15 days followed by physiotherapy. Postoperatively patient was having range of motion (25-50 deg) and post operative 2 months patient was able to do daily activities with his affected hand with VAS score of 1. Complex metacarpophangeal joint dislocations needs operative management combined with postoperative physiotherapy to achieve good clinical outcomes so as to reduce the risk of arthritis and decreased grip force.

The Medial Femoral Trochlea Osteochondral Flap for Scaphoid Reconstruction: A Systematic Review.

The medial femoral trochlea flap has been used to resurface scaphoids with recalcitrant proximal pole fractures or avascular necrosis, providing vascularized osteochondral tissue with similar morphological characteristics. This article aims to review the contemporary literature on its use for scaphoid reconstruction. A systematic review of Embase, PubMed, Cochrane Central Register of Controlled Trials, and MEDLINE assessed the use of medial femoral trochlea flaps in scaphoids. Eight studies were included, with 76 patients at a mean age of 26 years. Forty-three patients underwent clinical review, and 10 patients underwent radiographic evaluation, at a mean 23.3 months of follow-up. Flaps were generally performed for proximal pole fractures, avascular necrosis, nonunion, or failure of prior fixation; 94.4% of the flaps united. No marked change in sagittal plane motion was noted; reductions were seen in axial and coronal plane motion. The Disabilities of the Arm, Shoulder, and Hand scores improved from a mean of 25.2 to 11.5. Radiographic markers also improved. A total of 12.3% of patients had unplanned return to theater. Three patients required early revision for vascular thrombosis, and 1 patient suffered a volar carpal dislocation. Three patients underwent salvage procedures for ongoing pain. Although technically demanding, promising early-term to medium-term results are noted with the use of medial femoral trochlea flaps in the scaphoid.

Late Distal Radio-Ulnar Joint Instability after Childhood Distal Forearm Fracture

Introduction: Paediatric distal radius fractures are considered benign, and associated ulnar styloid injury is mostly ignored. Although a significant portion evolves to non-union, only a minority present associated complications such as ulnar pain, ulnocarpal abutment, or distal radio-ulnar instability. Distal radio-ulnar dislocations are rare and point to failure of the stabilizing mechanisms of this joint, warranting urgent reduction. Case Report: 18-years old male presents to the emergency department with a volar distal radio-ulnar joint dislocation after a twisting motion of the left wrist. Patient was submitted to urgent closed reduction under general anesthesia and cast immobilization, and surgical repair of ulnar styloid non-union and triangular fibrocartilage complex tear was performed 1 week later. At 6 months follow up the patient as achieved pain free full mobility without instability. Conclusion: The triangular fibrocartilage complex and distal radio-ulnar joint may be affected by seemingly benign injuries, later presenting with acute complications. Fracture and subsequent non-union of the ulnar styloid in the setting of a distal radius fracture is common and underdiagnosed, but clinical significance of and optimal treatment of this injury are still undefined.

Six month old neglected metacarpophalangeal joint volar complex dislocation: a case study

<p class="abstract">Metacarpophalanegal dislocations are rare, accounting for 3-5% of all dislocations with thumb being the most common finger affected. these dislocations can be decided into volar and dorsal and further into simple and complex, depending upon direction of dislocation and reducibility respectively. Although there is no approach superior over another, we selected volar approach for better visualization and direct reduction of dislocation and found reduction was unstable. hence a temporary fixation was attempted with K-wire which was removed 7th day postoperative and started with physiotherapy. Postoperatively patient was having near total range of motion (25-90 degree) and patient was able to do all the routine daily activities with his affected hand post operative 2 month. Complex metacarpophangeal joint dislocations needs intervention and should be combined with vigorous postoperative physiotherapy to achieve good clinical outcomes.</p>

Thumb metacarpal dislocation after trapeziectomy with ligamentous reconstruction and tendon interposition: A case report

Thumb carpometacarpal (CMC) arthritis is one of the most common and debilitating pathologies evaluated by the hand surgeon, affecting up to 35% of individuals over 55 years of age. Though multifactorial in etiology, dorsal and radial subluxation of the thumb CMC due to incompetency of the volar beak ligament is thought to be among the most important factors contribution to the arthritis. Multiple operative interventions have been proposed to best address this pathology. In the United States, trapeziectomy with ligament reconstruction and tendon interposition (LRTI) as described by Burton and Pellegrini remains the most widely used technique. As an isolated trauma, dislocation of the thumb CMC joint is a rare injury, only comprising approximately 1% of injuries evaluated by hand surgeons. Typically, thumb CMC dislocations occur due to axial load with the thumb in a flexed position. They are most commonly dorsal dislocations, and are thought to occur due to failure of the dorsoradial ligament. To date, no cases of CMC dislocation after LRTI have yet been described in the literature. Here we present a patient with volar thumb CMC dislocation as a rare complication after LRTI. After percutaneous pinning and immobilization followed by hand therapy, the patient has had a successful return to work with improved pain, restored function, and no further instability.