gms | German Medical Science

Objectives/Interrogation: Dorsal radiocarpal dislocations can be isolated or accompanied with a spectrum of fractures, as bony depressions and marginal articular avulsions of the distal radius. Although isolated dorsal dislocation of the radiocarpal joint is a rare injury, a dorsal fracture-dislocation is more common and often consists in a translocation of the carpus, which treatment and outcomes are not well defined.

In Literature, various methods of operative stabilization and repair have been recommended but the surgical treatment of these injuries is still not well standardized.

Today, a lot of devices of fragment-specific fixation are available to treat these injueries properly. We retrospectively reviewed the dorsal radiocarpal dislocations treated in our Institute in the last 5 years in order to propose a new classification and define the proper surgical treatment for each type of lesion.

Methods: We retrospectively reviewed the operative records at our institution for all patients undergoing surgical treatment for a dorsal radiocarpal dislocation or translocation in the last 5 years. We included only patients presenting a preoperative X-ray and CT-scan evaluation of the injury. Information regarding the method of reduction and fixation, type of surgical approach, associated injuries, and complications was recorded. Patients with incomplete clinical and/or radiological records were excluded. Grip strength and range of motion were recorded with the Mayo wrist scores. Two questionnaire as DASH and PRWE were calculated at the last follow-up. Postoperative lateral and A/P radiographs of the wrist were used to look for signs of malunion (or osteoarthritis) and determine whether the radiocarpal joint was unstable.

Patients were classified in IV groups of lesions, each group was subdivided in 2 types of fractures. For each type was proposed a standardized and reproducible surgical treatment.

Results and Conclusions: Clinical and radiological outcome were satisfactory. This classification adequately addresses the spectrum of osseous and soft tissue injuries that occur in dorsal radiocarpal fracture-dislocations. Furthermore, it give a practical guide to surgically treat this various spectrum of lesions.