Radiocarpal dislocations and fractures: diagnosis and surgical management, case report and review of the literature
Drs. Bensaka Mohammed, Khanouch Marouane, Chafai Alaoui Karim, Mnina Ayoub, Miloudi Mouad, Benamer Anass, Mikou Ayoub, Fallouli Oussama, Pr Abid Hatim, Pr. Elidrissi Mohammed, Pr. Elmrini Abdelmajid
Residence Jnane Pasteur, Boulevard Abdelmoumen, Casablanca, Morocco
*Corresponding author
*Bensaka Mohammed, Residence Jnane Pasteur, Boulevard Abdelmoumen, Casablanca, Morocco
DOI: 10.55920/JCRMHS.2024.07.001289
Abstract
Radiocarpal dislocations and fractures are rare and serious injuries of the wrist (0.2% of dislocations) always occurring during significant trauma. They are defined by a total or partial loss of contact of the carpus with the distal articular surface of the radius; unlike fractures of the distal radius, perilunate dislocations of the carpus or sprains (scapholunate or triquetro-lunate) where the entire carpus always remains centered under the distal radial epiphysis (only the semilunate is dislocated in perilunate carpal dislocations).
Over a period of 2 years, 1 patient was treated in the department, confirming the rarity of these lesions. By definition, pure marginal fracture-dislocations were excludedThe analysis of the literature made it possible to specify the different types of lesions, to propose standardized treatment, to evaluate the long-term functional and radiographic results as well as the necessary secondary treatments.
Materiel and Methodes
This is a retrospective study covering all patients operated on for dislocations and radiocarpal dislocation fractures at the B4 Orthopedic Trauma Department of the Hassan II University Hospital in Fez, over a period of 02 years, going from January 2020 to December 2022. We We excluded from our study: 1) patients aged less than 16 years; 2) patients leaving medical advice; 3) incomplete files (non-usable). At the end of our operation, 01 cases from the radiocarpal fracture dislocation service were retained, and we compared our case with those in the literature (41 patients). The data was analyzed based on an operating sheet; the statistical study was carried out on Microsoft Excel.
Results
In the study by the Tours University Hospital team over a period of 22 years, from 1992 to 2014, 41 patients were treated in the department, including 5 in secondary care for insufficient initial treatment. The population consisted of 34 men and 7 women
Average age at the time of the trauma was 38.6 years (18-75).
According to the classification of Dumontier et al, there were 4 type 1 lesions which were all pure LRC (group 1) and 37 type 2 FLRC (group 2).
In group 1, the displacement was palmar in one case, dorsal in one case, ulnar in 1 case, and unknown in one case. There was never a marginal or radial styloid fracture. Intracarpal lesions were present in all cases.
In group 2, the displacement was palmar in 11 cases, dorsal in 20 cases, anteroulnar in 1 case, dorsoulnar in 1 case and unknown in 4 cases (secondary cases). The fracture of the radial styloid was isolated in 7 cases and associated with a marginal component in 30 cases (radio1.). There were 15 dorsal, 11 palmar, and 4 both palmar and dorsal marginal lesions. Intracarpal lesions were present in 9 cases.
Discussion
In type 1, intracarpal lesions were always present and must therefore be systematically looked for.
In type 2 marginal lesions were present in 80% of cases, and intracarpal lesions were present in approximately 25% of cases.
Out of 41 patients, 6 patients subsequently required wrist arthrodesis (1 total and 5 radiolunararthrodeses). They all had good functional results and all were satisfied (figure 9).
Radio 2: Radiolunar arthrodesis.
Patient who had a pure dislocation, reduced and immobilized in a cuff. Seen at 12 days in our center. Faced with delay and radio-carpal instability decision for radio-lunar arthrodesis from the outset. Last check at 56 months: wrist mobility at 20° flexion, 45° extension; EVA at 2/10.
On the patients reviewed here are the key points to remember:
The functional results are generally good, the arc of mobility of the wrist in flexion and extension is on average 100°.
Radiocarpal or midcarpal osteoarthritis was present in 50% of patients and these patients logically had the worst results on functional scores and VAS.
Cases presenting with osteoarthritis were mostly those with joint malunion or intracarpal lesions. Treatment of intracarpal lesions did not prevent the development of osteoarthritis.
FLRC without osteoarthritis were those where the marginal lesions could be synthesized or were reduced after fixation of the styloid and which did not have an associated intracarpal lesion; at consolidation, there was neither articular malunion nor radiocarpal subluxation.
Compared to our case, he is less than 6 weeks from surgery, he does not present secondary displacement or signs of secondary infection. A removal of the pins is planned at 06 weeks, with the start of rehabilitation.
Conclusion
Radiocarpal dislocations and fractures are rare andserious injuries of the wrist. It’s possible to specify the different types of lesions, to propose standardized treatment, to evaluate the long-term functional and radiographic results as well as the necessary secondary treatments.
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