gms | German Medical Science

Objectives/Interrogation: High energy impact injuries of the wrist entail complex fracture patterns of the wrist and ligaments injuries, depending on the dynamic and the position of the hand at the time of the trauma. The lesions are often bilateral and occur in male patients with high functional demand.

We report a case of a 51 years old male with bilateral wrist lesions that occurred in a car accident. Right dominant wrist: plurifragmentary dislocated radius fracture with lesion of the sigmoid cavity (AO C3-3; Gustilo type 2; Fernandez type 3), multifragmentary distal ulna fracture with DRUJ lesion associated with bone and soft tissue loss (DRUJ Fernandez type 3), and scaphoid fracture (Herbert and Fisher B2).

Left wrist: it was investigated with x rays with no sign of fracture. After 10 weeks he underwent a magnetic resonance that showed a dislocated scaphoid fracture with bone edema and bone resorption.

Methods: At first the patient was treated in another hospital. He underwent a damage control stabilization of the fractures with external fixator and dermal substitute in the area of the exposition. 3 weeks after the trauma he came at our attention showing no sign of infection. We removed the external fixator and we fixated the fracture with volar plate and screws, filled the bone defect with a graft, we removed the dermal substitute and we covered it with autologous dermal grafting. The scaphoid fracture was stabilized with a staple and percutaneous k-wire.

The left wrist was stabilized with a staple and bone grafting (omolateral olecranon).

He executed biophysical stimulation for two months after surgery in both wrists.

Wounds were medicated periodically. Clinical and radiological follow up was completed every month.

Results and Conclusions: At 2 months follow up the fractures showed signs of consolidation and wounds healed. At 3 months the patient returned to work. 1 year after, right wrist AROM was 50° of flexion, 55° of extension, 10° of radial deviation and 5° of ulnar deviation. Left wrist AROM was 80° of flexion, 70° of extension, 10° of radial deviation, 30° of ulnar deviation. We did not notice any complication.

The fixation method we choiced for this case provided high compression in the area of the bone graft. Early mobilization avoided stiffness and the onset of algodistrophy. Biophysical stimulation aided bone graft integration and fracture healing.

This is a rare bilateral complex lesion. Early treatment and absolute stability of the fracture assured a good clinical and functional outcome.