Ch. Pai et al., CARPAL BONE DISLOCATIONS - AN ANALYSIS OF 20 CASES WITH RELATIVE EMPHASIS ON THE ROLE OF CRUSHING MECHANISMS, The journal of trauma, injury, infection, and critical care, 35(1), 1993, pp. 28-35
Twenty cases of carpal bone dislocation were encountered during a 7-ye
ar period, with an average of 27 months of follow-up. There were ten t
ypes of dislocation in this series; the most common type was transscap
hoid perilunate dislocation which was seen in nine cases. In addition,
there were two scaphoid subluxations; one volar lunate dislocation; o
ne dorsal perilunate dislocation; one scaphoid perilunate dislocation;
one hamate and pisiform dislocation; one transhamate pisiform disloca
tion; one trapezoid dislocation with dislocation of carpometacarpal jo
ints two to five; one dislocation of the trapezium, trapezoid, and car
pometacarpal joints two to four; and two trapezium periscapholunate di
slocations. Methods of treatment included open reduction, closed reduc
tion, proximal row carpectomy, total wrist arthrodesis, and excision o
f the lunate. In this series, the patterns of dislocation were differe
nt for crushing injuries and dorsiflexion injuries. The clinical resul
ts associated with the soft-tissue injuries of the ipsilateral hand we
re mostly caused by crushing forces. Although carpal instabilities wer
e noted, there was no significant correlation between the clinical and
roentgenographic results in some of our cases. Best results invariabl
y relied on a stable anatomic reduction and an adequate period of immo
bilization. Poor results were demonstrated in the cases with incomplet
e initial reduction, secondary degenerative arthrosis, or nonunion.