Open volar radiocarpal dislocation with extensive dorsal ligament and extensor tendon damage: A case report and review of literature.
The authors present the case of a patient with a rare combination of open volar radiocarpal dislocation and complete destruction of the dorsal capsule-ligament complex and tendons. The treatment consisted of open reduction and arthrorisis (temporary arthrodesis during 45 days) with four K-wires (radiocarpal and radioulnar). The capsule-ligament complex was fixed with anchors and the extensor tendons were repaired by suturing. A long-arm cast was applied for six weeks. After an 18-month follow-up, the Cooney-modified Green and O'Brien score was 70 and the wrist range of motion was 85°. Dynamic intraoperative X-rays are needed to look for bone or ligament (intracarpal or radioulnocarpal) injuries. Arthrography, arthroscopy or MRI may provide additional information. In cases of stable lesions without intracarpal ligament injuries, conservative treatment may be sufficient. Otherwise, surgical treatment is required, using temporary external fixation or arthrorisis (temporary arthrodesis) associated with anatomic repair of capsular ligaments. The average duration of postoperative immobilization is 6.6 weeks. An external fixator seems to be useful for reduction and for placing optimal tension on repaired ligament repair. Twenty-three cases of volar radiocarpal dislocation are described in published studies. None of them was associated with bone, tendon, skin or capsule-ligament complex injuries. Few studies describe the long-term functional and radiological outcomes of these injuries.
Orthopedic traumatology plastic and hand surgery unit, CHRU, 2, boulevard A.-Fleming, 25030 Besançon, France. Electronic address: manue.jardin@orange.fr.
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Jardin
Orthopedic traumatology plastic and hand surgery unit, CHRU, 2, boulevard A.-Fleming, 25030 Besançon, France. Electronic address: caroline.pechin@gmail.com.
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Pechin
Orthopedic traumatology plastic and hand surgery unit, CHRU, 2, boulevard A.-Fleming, 25030 Besançon, France. Electronic address: pb.rey@wanadoo.fr.
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Rey
Orthopedic surgery center of the upper limb, Sequoia park, 3, chemin des Écoles-des-Tilleroyes, 25000 Besançon, France. Electronic address: docteur.gasse@gmail.com.
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Gasse
Orthopedic traumatology plastic and hand surgery unit, CHRU, 2, boulevard A.-Fleming, 25030 Besançon, France. Electronic address: lobert@chu-besancon.fr.
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Obert
D001174:Arthrodesis / Q000379:methods*; D001864:Bone Wires; D006801:Humans; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000601:surgery*; D008023:Ligaments, Articular / Q000000981:diagnostic imaging / Q000293:injuries*; D008297:Male; D016059:Range of Motion, Articular; D013536:Suture Techniques; D013708:Tendon Injuries / Q000000981:diagnostic imaging; D013997:Time Factors; D016896:Treatment Outcome; D014954:Wrist Injuries / Q000000981:diagnostic imaging; D014955:Wrist Joint / Q000000981:diagnostic imaging; D055815:Young Adult
Antérieure; Atteinte ligamentaire; Atteinte tendineuse; Extensor tendon damage; Ligament damage; Luxation radio-carpienne; Open; Ouverte; Radiocarpal dislocation; Volar