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. 2015 Sep;10(3):367-73.
doi: 10.1007/s11552-014-9736-5.

Outcomes after radiocarpal dislocation: a retrospective review

Brandon J Yuan  1 , David G Dennison  1 , Bassem T Elhassan  1 , Sanjeev Kakar  1
Affiliations

Outcomes after radiocarpal dislocation: a retrospective review

Brandon J Yuan et al. Hand (N Y). 2015 Sep.

Abstract

Background: Radiocarpal dislocations are rare, high-energy injuries. High morbidity and poor functional outcomes are common. Currently, there is limited data on functional outcomes following treatment of this injury.

Methods: A retrospective review was conducted analyzing the radiographic and clinical outcome of patients treated for a radiocarpal dislocation from 1979 to 2010. Outcome assessments included wrist range of motion, grip strength, Mayo wrist score, patient-rated wrist evaluation (PRWE), and disabilities of the arm, shoulder and hand (DASH) score. Statistical analysis was performed with the Student's t test.

Results: Twenty-six patients (26 wrists) were treated for a radiocarpal dislocation during the study period; 23 wrists were treated acutely (within 4 weeks of injury), and 3 were treated after a delayed presentation (>4 weeks). Clinical follow-up of more than 6 months was available in 17 patients. Three patients (12 %) underwent primary fusion as initial treatment (two radioscapholunate fusion; one total wrist fusion). Four wrists (24 %) failed initial treatment and were salvaged with scapholunate ligament reconstruction (one wrist) or partial wrist fusion (three wrists). Seventeen patients completed PRWE and DASH questionnaires with a mean of 14.6 years following surgery (range 2-32 years). Subjective outcomes tended to be superior in those patients treated with ligament reconstruction versus partial or complete wrist fusion; however, comparisons were not statistically significant.

Conclusion: Radiocarpal dislocations result in significant osseous and ligamentous injury to the distal radius and carpus. Early recognition and treatment of radiocarpal dislocations with open reduction, internal fixation, and repair of ligaments may result in improved long-term functional outcomes when compared to acute partial or complete wrist arthrodesis.

Keywords: Outcome assessment; Radiocarpal dislocation; Retrospective review; Wrist.

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Figures

Fig. 1
Fig. 1
Injury (a) and 1-year postoperative (b) radiographs of a patient treated for a radiocarpal dislocation by open reduction and percutaneous pinning of the radial and ulnar styloid with ligament repair via suture anchors. The patient’s PRWE and DASH scores at 4 years after injury were 7 and 4, respectively
Fig. 2
Fig. 2
Injury (a) and postoperative (b) radiographs of a patient treated for a radiocarpal dislocation by open reduction with percutaneous pinning. Two-year follow-up (c) radiographs demonstrate severe degenerative changes. The patient’s PRWE and DASH scores at 5 years after injury were 17 and 19, respectively
Fig. 3
Fig. 3
Injury (a) and 4-month postoperative (b) radiographs after open reduction, ligament reconstruction, and free tissue transfer, demonstrating rapid progression of radiocarpal arthrosis. This patient was subsequently lost to follow-up
See this image and copyright information in PMC

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