C. Dumontier et al., Radiocarpal dislocations: Classification and proposal for treatment - A review of twenty-seven cases, J BONE-AM V, 83A(2), 2001, pp. 212-218
Citations number
29
Categorie Soggetti
Ortopedics, Rehabilitation & Sport Medicine","da verificare
Background: The radiographic characteristics and treatment of radiocarpal d
islocation are not well defined. There have been only two reported series o
f more than eight patients. Thus, there are many questions concerning treat
ment and functional results.
Methods: Two groups of patients were defined. Group 1 included all patients
with pure radiocarpal dislocation and patients with only a fracture of the
tip of the radial styloid process. Group 2 included patients with radiocar
pal dislocation and an associated fracture of the radial styloid process th
at involved more than one-third of the width of the scaphoid fossa. A retro
spective review and a clinical evaluation were performed.
Results: From 1975 to 1998, we observed twenty-seven cases of radiocarpal d
islocation. Four were displaced volarly, and twenty-three were displaced do
rsally. Fourteen patients presented with associated lesions. Four patients
were treated with closed reduction and immobilization in a plaster cast; fi
ve, with percutaneous Kirschner wire fixation and cast immobilization; and
two, with an external fixator. Eleven patients had open reduction with Kirs
chner wire fixation and cast immobilization. The seven patients in Group 1
had a highly unstable injury, and four of the seven patients presented with
ulnar translation of the carpus. At the time of follow-up, at an average o
f 26.8 months, pronation averaged 76 degrees; supination, 66 degrees; wrist
flexion, 54 degrees; wrist extension, 54"; radial inclination, 15 degrees;
and ulnar inclination, 18 degrees. The average grip strength was 27 kg. Gr
oup 2 included twenty patients. Only thirteen, with dorsal dislocation, wer
e evaluated at the time of follow-up, which averaged fifty-one months. At t
hat time, six reported no pain; four, slight pain; and two, moderate pain.
Pronation averaged 63 degrees; supination, 76 degrees; wrist flexion, 51 de
grees; wrist extension, 56 degrees; radial inclination, 21 degrees; and uln
ar inclination, 39 degrees. Grip strength averaged 38 kg. Seven patients ha
d complications.
Conclusions: On the basis of our experience and a review of the literature,
we believe that patients with pure radiocarpal dislocation or with radioca
rpal dislocation with a fracture of the tip of the radial styloid process s
hould be treated with reattachment of the ligaments through a volar approac
h. In patients with radiocarpal dislocation and a fracture of the radial st
yloid process that involves more than one-third of the width of the scaphoi
d fossa, the ligaments are still attached to the radial fragment. We believ
e that in this group of patients, exact articular reduction should be perfo
rmed through a dorsal approach. Additional studies are needed to support th
ese hypotheses.