Radiocarpal Dislocations: Classification and Proposal for Treatment

Author(s): Dumontier C, Meyer zu Reckendorf G, Sautet A, et al.

Source: J Bone Joint Surg

Summary:

The authors report a series of 27 radiocarpal dislocations with clinical follow-up of 18 cases reviewed retrospectively. Patients were divided into two groups. Group 1 had no radius fracture or a small radial styloid injury. Group 2 had a radial styloid fracture involving greater than one-third of the scaphoid fossa of the distal radius. Four of five patients in Group I developed ulnar translocation at final follow-up. In Group 2, no patient had evidence of ulnar translocation of the carpus. Although treatments varied (including closed reduction, ORIF and external fixation), clinical indices revealed similar motion parameters in both groups, with significantly improved grip strength in Group 2. Functional results correlated with the degree of articular damage and the associated injuries to the carpus and distal radioulnar joint. Treatment recommendations for Group 1 injuries include ORIF with reattachment of the radiocarpal ligaments through a volar approach. For Group 2, ORIF of the radial styloid through a dorsal approach is recommended.

This paper reports the largest series of radiocarpal dislocations to date with an anatomically based classification system. Group 1 injures with significant ligamentous disruption can have late ulnar translocation due to a failure of soft-tissue healing. Group 2 injuries involve a large styloid fracture, which maintains the important radiocarpal ligament attachments. Internal fixation of the styloid should restore stability. Both groups, however, have a high risk of distal radioulnar joint disruption and significant limitation of motion and persistent pain is common following this rare high-energy injury.

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