Case Reports
Surgical Reconstruction of a Late-Presenting Volar Radiocarpal Dislocation
Am J Orthop. 2008 February;37(2):96-99
Author and Disclosure Information
Eric P. Hofmeister, MD, Brian T. Fitzgerald, MD, Michael A. Thompson, MD, and Alexander Y. Shin, MD
CDR Hofmeister, MC, USN, is Director, Orthopaedic Hand Surgery Division, and Orthopaedic Intern Director, Dr. Fitzgerald is a staff Orthopaedic Hand Surgeon, and CAPT Thompson, MC, USNR, is a staff Orthopaedic Hand Surgeon and Director of Orthopaedic Residency Education, Naval Medical Center San Diego, San Diego, California.
Dr. Shin is Professor of Orthopaedic Surgery, Mayo Medical College, Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, Minnesota.
Abstract not available. Introduction provided instead.
Radiocarpal dislocations are rare and usually associated with fractures of the distal radius.1,2 Isolated volar dislocations of the radiocarpal joint are exceedingly rare, and fewer than 20 cases have been reported.3-16 Although reported treatment of this acute injury has ranged from closed reduction and casting3,5,9 to percutaneous pinning,6,9 most recent reports have recommended open reduction and internal fixation when feasible.4,7,11-15 Total wrist fusion has also been reported as a treatment.17 Surgical reconstruction of a delayed volar radiocarpal (VRC) dislocation has not been reported.
This entity differs from a volar Barton fracture, as the major destabilizing force is the volar ligaments as opposed to a large volar articular fragment. When the injury is purely ligamentous, or only a small volar articular rim fracture fragment is present, fixation can be challenging.
We report the case of a 7-week-delayed presentation of a VRC dislocation with a volar articular radius rim fracture. This case illustrates surgical reconstruction as a treatment and the use of a specific volar wireform (TriMed, Inc, Valencia, Calif) in conjunction with Kirschner wires (K-wires), suture anchors, and immobilization that yielded an excellent functional result.