Radiocarpal dislocations and fracture-dislocations: Injury types and long-term outcomes.

INTRODUCTION: Radiocarpal dislocation (RCD) and fracture-dislocations (RCFD) are severe but rare injuries for which the treatment and outcomes are not well defined. The aim of this retrospective study was to describe the prevalence of the various injury types and their long-term outcomes.

PATIENTS AND METHODS: Between 1992 and 2014, 41 patients with RCFD were seen at our institution. According to the Dumontier classification, there were 4 cases of type 1 and 37 cases of type 2. Thirteen patients were reviewed again after a mean follow-up of 168 months (20-260).

RESULTS: Among these 41 patients, 6 required secondary wrist fusion. At the latest follow-up evaluation, flexion-extension amplitude was 100° (25°-152°), grip strength was 86% of the contralateral side (10kgf-112kgf), the mean VAS for pain was 1.3 (0-5), the mean QuickDASH was 23 (0-59) and the mean PWRE was 27 (0-75). Six patients developed osteoarthritis in the radiocarpal and midcarpal joints.

DISCUSSION: For cases of RCD, when reduction and stabilization have been confirmed by a dorsal approach, there is no reason to perform volar capsule and ligament suturing. For cases of RCFD, after anatomical reduction, radiostyloid pinning can be performed and an open surgical approach is not always required. Radiolunate fusion is a good solution for treating secondary instability.

CONCLUSION: The good functional outcomes and absence of osteoarthritis can be attributed to the effective reduction and radiocarpal stabilization, along with the absence of radial and intracarpal marginal fractures.

LEVEL OF EVIDENCE: IV, retrospective.