Radiocarpal Dislocation Classification Rationale for Management and

, with absorption and ~~:~ 

en lorgnette) (Fig. 7) ~~~-. 

vith saber tibia defo~~ 

i positive, 1:2, and TPHA~~: 

bv, penicillin but refused amp~ 

i’m. 

ACKNOWLEDGMENTS 

would like to thank the Medical 

)f the Faculty of Medicine for the 

; and Sharmini Devi for 

Radiocarpal Dislocation Classification 

Rationale for Management 

MOHEB S. MONEIM, M.D., F.R.C.S.(C.),* JOHN T. BOLGER, M.D.,** 

AND GEORGE E. OMER, M.D.* 

REFERENCES 

dislocation is a rare injury. The authors 

seven cases with this injury and identified 

, Yaws or syphilis? Br. Med. J. 1:912 

a, A., and Mundt, H.: Test pattern of 

in New Zealand. Br. J. Vener. Dis. 

roups of patients. Type I involves a dislocation 

’only the radiocarpal joint, while Type II involves 

~al dislocation also. Four patients were inin 

Type I dislocation (3 dorsal and 1 volar). 

C. J.: Bone Lesions of Yaws in 

Blackwell Scientific Publications, 195 

other three patients had Type II disloc-qtions, 

of which were volar dislocations. Two patients 

[evidence of injury to the median and ulnar nerves 

, D. R.. and Florenz, D.: Pinta, 

:the time of the injury and both recoveredl corn- 

.syphilis in Colombia. Int. J. 

)77. 

S.: Doigt en lorgnette and concentric I 

~ssociated with healed yaws osteitis. J. 

-g. 54B:341, 1972. 

,. J.: Neuro-ophthalmological 

¯ J. Vener. Dis. 47:223, 1971. 

K: Yaws elimination campaign in 

4ed. J. 20:10t, 1965. 

Closed reduction was possible with good 

ults in three patients with Type I dislocation. 

patients with Type II dislocation required open 

and all had residual problems. The disbetween 

Type I and Type II is essential in 

r to evaluate the full extent of the injury. Closed 

should always be attempted in Type I 

Type II dislocation should be treated 

L. H.: Treponematoses. Institute 

. (Malaya). Bulletin 9:t21, 1959. 

’open reduction and repair of all torn liga:ments. 

[’. H.: Health crusades and tropical 

"act. 15(3):101. 1980. 

J.: Syphilis and yaws. N. Z. Med. J. 75:i 

)Radiocarpal dislocations are rare injuries; 

about 4"~ .2% of all dislocations. 

of the articles written about the subject 

the form of case reports ~’6"9A°’~2"~3 or are 

of reviews of fracture-dislocations about 

~~e wrist. ~’4’5 These injuries are often associated 

~i?ii~~th a fracture of the distal radius 3 and are 

,’~ditionally classified as orvolar 

dorsal ac- 

-~rding~~ to the direction of hand displacement. 

¯~ ~.The treatment of such injuries was varied 

of New Mexico Medical Center, Di- 

,, Department of Orthopaedics and 

Albuquerque, New Mexico. 

Orthopaedic Associates of Waukesha, Waukesha, 

Reprint requests to Moheb S. Moneim, The University 

~ Medical Center, Division of Hand Surgery, 

of Orthopaedics and Rehabilitation, 2211 

Blvd.. N.E.. Albuquerque, NM 87131. 

Received: August 15, 1983. 

and 

and included closed reduction and plaster im.mobilization, 

4’~-~2 closed reduction and skeletal 

fixation of the joint, ~ skeletal traction to 

regain length, 2 and open reduction and pin 

fixation, l’~° Bilos et al. ~ recently reviewed five 

cases ofradiocarpal dislocations that were seen 

over a two-year period. They indicated that 

carpal and intercarpal injuries were present in 

all cases. One of their cases had an associated 

nondisplaced fracture of the scaphoid; however, 

all others had more significant intercarpal 

injuries. Successful closed reduction was only 

possible in the patient with the nondisplaced 

scaphoid fracture. At two years of follow-up 

study this patient had a good result except for 

some radiocarpal arthritis resulting from non.anatomical 

reduction of a radial styloid fracture. 

In spite of the report of excellent results 

obtained in all patients, a critical analysis of 

the other four patients showed that all had 

problems at follow-up evaluation. The__followup 

period was short (from 8-26 months) and 

the problems at follow-up were: resorption of 

the proximal scaphoid fragment, separation 

at the scapholunatearea, arthritic changes all 

around the lunate, radiocarpal arthritis, and 

persistent dislocation that was not possible to 

reduce closed and was treated six weeks after 

the injury by wrist fusion. Bilos et al. indicated 

that there were considerable 

these lesions. 

variabilities of 

In reviewing the authors’ experience with 

these injuries they did identify a group of patients 

in whom the dislocation affects mainly 

the radiocarpal joint and the carpus remains 

as one unit, Only one patient in Bilos’s repo~, 

199

200 Moneim et al. 

the patient with the nondisplaced scaphoid 

fracture, would probably fit in this group. It 

was evident that the prognosis is more favorable 

in this group of patients compared with 

the group with the associated intercarpal fractures 

or dislocations. The authors thought that 

the separation of these two groups was quite 

essential for management and prognosis. 

The purpose of this paper is to review sewm 

patients with such injuries and to introduce 

a new classification based on the extent of the 

injury.. Type I dislocation, where the carpus 

dislocates as one unit on the distal radius, and 

Type II dislocation, where associated intercarpal 

dislocation is also present, will be discussed. 

MATERIAL (Table 1) 

Clinical 

and Related 

Another patient had successful closed red, 

tion of the dislocation, and open 

and internal fixation of the radial st 

ture, also with an excellent result (score of 

100). In the fourth patient the presence of~ 

volar radius lip fracture prevented su~ 

closed reduction. Open reduction and internal 

fixation was required. This patient scored 1 

lowest in the group (50) with marked sti: 

and ~ arthritic changes at one year of folh 

up evaluation. 

TYPE II DISLOCATION 

All patients in this group required open 

duction, two through both volar and 

approaches and one through a dorsal approach 

only. Pin fixation was used in the first two 

patients. One patient had a bone graft to the 

radial styloid at the time of open reduction. 

One patient had a score of ?5 and resumed 

his work as a rancher in spite of the presence 

of arthritic changes. The patient with the lowest 

total score in the group (i 0) had an attempt 

at open reduction that was unsuccessful and 

six months later required a proximal row carpectomy, 

which also failed to relieve his pain. 

Wrist fusion one year after the injury resulted 

in solid, painless fusion. The third patient in 

the group had an open reduction through a 

dorsal approach only, without pin fixation. 

This patient had a total score of 50 and__was 

unable to resume his occupation nine months 

after injury. 

Seven patients were treated between 1969 and 

1982. This represents 20% of all cases of carpal 

dislocations seen in this period. This incidence is 

much higher than in previous reports. 4 Four patients 

had Type I dislocation, while three others had Type 

II dislocation, Of the Type I dislocation, three were 

dorsal and one was volar. All three patients with 

Type II dislocation were volar. The radial styloid 

was fractured in all but one patient with Type: I 

dislocation, while the ulnar styloid was fractured 

in four patients. The volar and the dorsal lips of 

the radius were fractured in two patients. One patient 

had evidence of inju~ to the median and 

ulnar nerves at the time of the dislocation. Both 

nerves recovered completely, the median nerve 

shortly after closed reduction and the ulnar nerve 

seven weeks later. Another patient had paralysis of 

the ulnar nerve that recovered 16 months after injury,. 

Four patients had associated severe injuries 

to other parts of their bodies. Follow-up evaluation 

was available for all patients. The follow-up period 

CASE REPORTS 

ranged from nine months to five years and six 

months, with an average of 33 months. 

Clinical and radiologic evaluation was performed 

with the system outlined by Green and O’Brien. 7 

This is a scoring system whereby pain, range of 

motion, grip strength, occupation change, and radiologic 

findings are given certain numbers. A score 

above 75 indicates a good result. 

Case 1. A 32-year-old housewife was involved 

in a motor vehicle accident in a head-on collision. 

Her examination revealed obvious deformity and 

volar displacement of the left hand in relation to 

the forearm. Radiographs of the hand showed volar 

radiocarpal dislocation, Type I dislocation. There 

was no fracture of the distal radius: however, the 

ulnar styloid was fractured (Fig. 1). The patient was 

given 15 mg of morphine and finger traps were 

RESULTS (Table 1) 

applied to the index, long, and ring fingers, with 

countertraction of ten pounds on the upper arm. ¯ 

TYPE I DISLOCATION 

Closed reduction was successful in two patients 

with good results (scores of 90 and 85). 

After approximately 15 minutes of finger-trap trac-_ 

tion, repeat radiographs showed good reduction 

the dislocation and a long-arm cast was applied 

¯ (Fig. 2). The cast was !eft on for five weeks and

TABLE 1. Radiocarpal Dislocation: Material and Results 

Patient Age Sex Mechanism qf lnjury Nerve Injury Associate Fractares Di.wlaeement Type Period Treatment Total Score 

H.M. 37 F MVA 

W.W. 32 M Fell off scaffold 

R.B. 22 M MVA--Head-on collision 

W.D. 30 M Motorcycle accident 

S.M. 51 M Hand pinned between 

truck and wall 

D.V. 41 M Truck accident 

T.M. 29 M MVA, struck several cars, 

passenger died 

MVA = motor vehicle accident. 

Median and ulnar 

(resolved) 

Ulnar (resolved) 

Ulnar styloid 

Radial and ulnar 

styloids, volar 

and dorsal lips 

of radius 

Radial styloid 

Volar and dorsal 

lips of radius; 

radial and ulnar 

slyloids 



Radial and ulnar 

styloids 

Volar I 4 yrs & Closed reduction 90 

9 mos 

Dorsal I 2 yrs Closed reduction 85 

Dorsal I 16 mos 

Dorsal 

Volar 

Volar 

Volar 

1 yr 

II 5 yrs & 

6 mos 

11 

II 

3 yrs & 

8 mos 

9 mos 

Closed reduction 

of dislocation, 

open reduction 

and internal 

fixation of 

radial styloid 

Open reduction, 

volar and 

dorsal 



dorsal 



dorsal; bone 

graft, radial 

styloid 


dorsal 

100 

5O 

75 

10 at 6 months of 

follow-up study. 

Successful wrist 

fusion 1 yr after 

injury 

50

202 Moneim et at. 

was then removed for active range of motion. At 

the time of follow-up study, which was four years 

and nine months later, she was asymptomatic with 

full function. Radiographs showed residual volar 

subluxation. However, there were no arthritic 

changes. She scored a 90 (Fig. 3). 

Case 2. A 22-year-old male miner was involved 

in a head-on collision automobile accident. His left 

wrist was deformed and radiographs revealed a 

dorsal radiocarpal fracture-dislocation (Type I dislocation) 

and a fracture of the radial styloid (Fig. 

4). He also had fib fractures and total paralysis of 

Clinical 

and Rela 

FIG. I. 

and lateral radi 

showi: 

of the entire carpus on 

distal radius. Note the 

sence of a fracture of~ 

distal radius and 

maintenance of 

intercarpal relation. 

is Type I dislocation. 

the ulnar nerve. Under general anesthesia close~ 

reduction of the dislocation was conducted successfully. 

There was a stepoff of the radial styloid 

fracture. Open reduction and internal fixation of 

the radial styloid fracture was performed (Fig. 5) 

and the patient was kept in a cast for six 

Sixteen months after the injury (Fig. 6) he had 

excellent result with a total score of 100. His ulnar 

nerve was explored nine months after injury and 

was found to be in continuity. It was completely 

recovered at 16 months. 

Case 3. A 51-year-old male rancher injured his 

3. Fo 

of 

~lFig. 1 show 

axation e 

no arthri 

mainten 

bones 

reunited fro 

styloid 

wrist 

a lc 

! ag~ainst it by 

ir0om obvi~ 

I ~.’:f0und. The 

Radiograph 

rarpal ffac~ 

gap 

the patient 

reduc 

a vok 

long! 

FIG. 2. Anteroposterior FIG. 4. ~ 

and lateral radiographs i iand latera 

of the patient in Fig- showing a 

1 showing satisfactory carpal fra 

closed reduction of.the 

tion. Not~ 

dislocation. : .nance of t1 

relation. - 

i dislocatio~

FIG. 1. 

and lateral rad 

showin 

of the entire carpus or~ 

distal radius. Note the 

sence of a fracture ofl 

distal radius and 

maintenance of 

intercarpal relation. 

is Type I dislocation. 

er general anesthesia 

)cation was conducted 

, stepoff of the radial styloid i 

ion and internal fixation of 

ture was performed (Fig. 5) 

:ept in a cast for six weeks. 

:he injury (Fig. 6) he had 

total score of 100. His ulnar 

ne months after injury and ~. 

~ntinuity. It was completely 

IS. 

~ld male rancher injured his 

FIG. 2. Anteroposterior 

and lateral radiographs 

of the patient in Fig. 

1 showing satisfactory 

closed reduction of the 

dislocation. 

1985 

i, FIG. 3. Follow-up raof 

the patient 

Fig. 1 showing residual 

ion of the carpus 

no arthritic changes 

maintenance of the 

bones relation. A 

mired fracture of the 

styloid is also evi- 

wrist when he attempted to brace himself 

nst a loading dock when he was pushed up 

against it by a truck. On his arrival at the emergency 

:room obvious deformity of the right wrist was 

md. The hand was lying volar to the forearm. 

i~Radiographs of the hand revealed a volar radio- 

~¢arpal fracture-dislocation with severe volar dis- 

: placement of the lunate and the scaphoid (Type II 

) (Fig. 7). There was also a 7-mm scapholunate 

gap. Closed reduction was unsuccessful and 

the patient was taken to the operating room for 

open reduction under axillary block anesthesia. 

~Both a volar carpal tunnel release incision and a 

’IS!dorsal longitudinal incision were made. At the time 



showing a dorsal radiocarpal 

fracture dislocation. 

Note the mainte- 

dislocation. 

Radiocarpal Dislocation 

203 

of ° surgery the lunate was found to be rotated 180 

on the distal radius and its capsular attachments 

to the radius were intact. There was a severe tear 

at the volar midcarpal level between the lunate and 

the capitate that extended radially into the radiocapitate 

and radiolunate ligaments and ulnarly into 

the triquetrocapitate ligament. On the dorsal side 

the capsular ligaments between the radius and the 

scaphoid and lunate were torn. The scapholunate 

intercarpal ligament was completely torn and there 

was a fracture of the articular surface on the head 

of the capitate. The dislocation was reduced with 

some difficulty. Pins were used to fix the radial 

’styloid to the radius; two additional pins were used


to fix the lunate to the ulna and one more pin was 

passed across the carpus. Intraoperative radiographs 

revealed reduction of the dislocation with persistence 

of widening of the scapholunate interval (Fig. 

8). Because of severe swelling, it was impossible to 

close the wound: however, that was successfully 

accomplished five days later by skin grafting to th~ 

volar incision. The patient was maintained in a 

sugar-tong splint that was changed two days later 

to a long-arm cast. After six weeks both the cast 

and the pins were removed. 

and, 

FIG. 5. Same case as 

Fig. 4 showing the 

tomical reduction of [ 

dislocation and the 

ning of the radial 

fracture. 

At the time of follow-up evaluation (Fig. 

:/ears and six months later, there was persistence 

of widening of the scapholunate interval with cystic 

changes in the lunate and arthritic changes affecting 

the wrist joint. This man’s total score was 75 and 

he was performing his work as a rancher. 

Case 4. A 41-year-old male truck driver injured 

his right wrist after being involved in a truck 

cident. At the time he presented to the emergency. 

room there was obvious deformity of the right wrist 

with volar displacement of the hand over the distal 

FIG. 6. ’Radiographs of 

the patient in Fig. 5 at follow-up 

evaluation showing 

the maintenance of 

the reduction and the ab-, 

sence of any arthritic: 

changes. 

192 

-February, 

FIG. 7. Ante.," 

lateral rz. 

a vola 

fracture ci 

qote the sever 

of the 1 

scaphoid v, 

ius and t 

II disloc 

ntrast mater 

arthrogr: 

seen on the r: 

forearm. Rad 

radiocarpal " 

10). There ,x: 

Other systerv 

ation. Attem; 

room under 

was taken tc 

duction was 

dorsal incisic 

ing at surgerl 

which was r~ 

FIG. 8. Rc 

;the patient 

i showing the : 

reduction ot 

tt- 

’ of the widen 

between the 

the lunate.

Clinical, 1985 


7. Anteroposterior 

lateral radiographs 

a volar radiocar- 

:IG, 5. Same case as 

fracture dislocation. 

. 4 showing the 

the severe displace- 

~ical reduction of 

of the lunate and 

ocation and the 

scaphoid volar to the 

g of the radial and the 7-mm 

:ture. 

~olunate gap. This is 

II dislocation. The 

~ material used for 

arthrography is still 

~,en on the radiograph. 

:valuation (Fig. 9)five ,~! ’ 

there was persistence i ~ it~i :. forearm. mdiocava Radiographs 1 fracture-dislocation of the hand revealed with severe a volar dis- 

~te inte~al with cystic ?~:~ placement of the lunate (Type II dislocation) (Fig. 

hfitic changes affe~ing .:~: 10). There was also a fracture of the radial styloid. 

:oral score was 75 and ~ Other system injuries revealed severe scalp lacer- 

: as a rancher. 

~ion. Attempt at closed reduction in the emergency 

le truck driver injured room under sedation was unsuccessful. The patient 

~volved in a truck ac- was taken to the operating room where open rented 

to the emergency duction was performed through both volar and 

,rmity of the right wrist .... dorsal incisions under general anesthesia. The find- 

he hand over the distal ing at surgery was volar dislocation of the lunate, 

:which was rotated 180 ° on the distal radius; the 

FIG. 6. Radiographs of 

; patient in Fig. 5 at folv-up 

evaluation show- 

~ the maintenance of 

; reduction and the ab- 

~ce of any arthritic 

tnges. 

FIG. 8. Radiographs of 

:~;the patient in Fig. 7 

showing the result of open 

of the dislocation. 

Note the persistence 

of the widening of the gap 

between the scaphoid and 

the lunate. 

Radiocarpal Dislocation 205 

lur~ate was still attached to the distal radius with 

its capsular structures. There was, however, a severe 

midcarpal tear between the lunate and the capitate, 

extending both radialward into the radiocapitate 

and radiolunate ligaments and ulnarward into the 

triquetrocapitate ligament. On the dorsal side there 

was severe hemorrhage and avulsion of the capsular 

ligaments between the radius and the scaphoid and 

lunate. The scapholunate intercarpal ligament was 

also completely disrupted. The radial styloid fracture 

was found to be comminuted. With difficulty, 

attempt at reduction was performed and the radial


styloid was fixed to the radius with bone grafting 

for comminution. Three pins were used to fix the 

radial styloid. Another pin was passed between the 

scaphoid and the lunate, and the torn ligaments 

were repaired. Postoperative radiographs showed 

foreshortening of the scaphoid and widening of the 

scapholunate interval, with residual volar subluxation 

of the lunate (Fig. 11). The patient was main- 

Clinical 


FIG. 9. Patient in 

7 at follow-up 


the widening of 

scapholunate interval 

the arthritic changes. 

tained in a long-arm cast and after six weeks both 

the cast and the pins were removed. 

Six months after the injury, (Fig. 12) this patieni 

scored the poorest in the group. His total score was 

only 10. He had persistence of the gap between the. 

scaphoid and the lunate, and his range of motion 

wa.s restricted with severe pain. Follow-up evaluanon 

two months later involved a proximal row 



showing a 

radiocarpal fracture dislocation. 

Note the complete 

dissociation between : 

the scaphoid and the lunate 

and the severe 

placement of the lunate. 

This is Type II dislocation. 

:~, 

1985 

11. Same c: 

10 showing t. 

of open redu. 

the persister., 

:widening betwe~ 

and the 1 

the residual 

~n of the 1 

Sever: 

icarpectomy the p 

fusion was pc 

)injury. The fusior 

12:distal carpal row. 

iwrist fusion. He 

idriver. 

FIG. 12. Patier. 

) at tbllow-up 

Note the se 

thritic and cystic 

the 

and d 

!dius.

FIG. 9. Patient in 

7 at follow-~ 


the widening of 

scapholunate " 

the arthritic chan 

1985 

qo. ll. Same case as 

10 showing the reof 

open reduction. 

the persistence of 

widening between the 

and the lunate 

the residual volar 

ion of the lunate. 

a cast and after six weeks both 

¢arpectomy. Several months after the proximal row 

Is were removed.. .... 

the injury (Fig. 12) ~nls panent 

: : 

’~,~wrisl 

~~;¢arpectomy the patient still had severe pain, and 

a the group. His total score wa~ ~ i~ i inju~yf.Us~-~a~ fusion was performed was between one year the after radius the and initial the 

sistence of the gap between the: " 

nate. and his range of motion :’i~ ~" distal carpal row. This resulted in solid, painless 

severe pain. Follow-up evalu. 

! wrist fusion. He is now back to work as a truck 

ater involved a proximal 

lriver. 

FIG. 10. Ante~oposterior 


showing a volar. 

radiocarpal fracture dislocation. 

Note the com, 

plete dissociation between 

the scaphoid and the lunate 

and the severe displacement 

of the lunate. 

This is Type II dislocation. 

FIG. 12. Patient in Fig. 

10 at follow-uP evaluation. 

Note the severe arthritic 

and cystic changes 

the lunate, 

and distal ra- 


DISCUSSION 

207 

Radiocarpal dislocations are rare injuries 

and their management can be difficult. Four 

of seven patients in the authors’ series had 

severe injuries to other parts of their bodies.


No uniformity of opinion exists in the literature 

with regard to the indications for either 

closed or open reduction. Factors that affect 

the prognosis are not well outlined in the literature. 

Bohler in t9302 reported on a group of patients 

with radiocarpal dislocation and recommended 

skeletal traction to regain length 

with a nail through the metacarpals and another 

through the olecranon with the arm 

stretched in a screw-extension apparatus. He 

also used this method in conjunction with 

open reduction for lunate and scaphoid dislocations. 

One of his cases was a volar radiocarpal 

dislocation, similar to Case 1, that had 

a recurrence of the volar dislocation soon after 

a successful closed reduction. Dunn 4 reported 

on five cases with radiocarpal dislocation that 

were treated by closed reduction and additional 

skeletal fixation for unstable cases. On 

follow-up evaluation only one patient had recovered 

painless motion; however, the other 

four had some limitation and some pain at 

follow-up study. Fahey5 reported a single case 

of volar radiocarpal dislocation with a fracture 

of the radial styloid that was treated by closed 

reduction with a good result at two years of 

follow-up study. The carpus was dislocated as 

one 6 unit in this case. Freund and Ovesen 

reported on a case of dislocation of the radiocarpal 

joint. This dislocation was dorsal without 

an associated fracture of the radius and 

was treated by closed reduction with good result 

at 12 months. In this case also, the carpus 

was dislocated as one unit without any intercarpal 

instability. Recently, Bilos et. al., ~ reported 

on five cases ofradiocarpal dislocation. 

Four were treated by open reduction and 

closed reduction was performed in one. They 

recommended early open reduction with internal 

fixation of the fracture and repair of all 

torn ligaments. 

The classification given here is based on the 

extent of the injury and can be used to predict 

the outcome in a given case. One can also 

formulate a plan of management depending 

on that classification. 

Clinical 


In Type I dislocation there is less 

and the ligamentous disruption is between 1 

distal radius and the carpus, as one unit. 

the one case of dorsal dislocation treated 

open reduction, the tear affected the volar ra.: 

diolunate ligament and extended 

to affect the radioulnar lunate capsular 

There was also a fracture of the volar 

the radius. Type I dislocation should be 1 

by closed reduction and plaster immoi 

tion for six weeks. During the first four 

a long-arm cast is applied and is then changN 

to a short-arm cast for two weeks. Open 

duction is reserved for cases where closed 

duction fails because of interposition in 

joint of bony fragments or for ’ " 

anatomical reduction of the radial styloid. 

can expect a good result in these cases. If the 

reduction is unstable, one can consider 

pinning of the radiocarpal joint to prevent 

future subluxation, as in Case 1. 

In Type II dislocation, the trauma is severe 

and the ligamentous disruption involves several 

areas. The authors found a dorsal tear 

affecting the dorsal capsular ligaments between 

the radius and the scaphoid and lunate, and 

an extensive volar midcarpal tear between the 

lunate and the capitate that extended radially 

into the radiocapitate and radiolunate ligaments 

and ulnarly into the triquetrocapitate 

ligament. The scapholunate intercarpal ligament 

was also torn. In contrast to other published 

reports,1 all cases of Type II dislocation 

:in the authors’ series were volar dislocations. 

The lunate was severely displaced volarly in 

all cases. The authors agree with others I that 

the proper management of these severe dislocations 

is open reduction through both volar 

and dorsal approaches. The radial styloid 

should be pinned in anatomic position to 

achieve radiocarpal stability. Then the scaph-i 

old should be pinned to the lunate to achieve : 

midcarpal stability. Any other large fragments 

of bone are also pinned and all torn ligamentous 

structures repaired. Even then the 

nosis is guarded in these patients. If secondary 

procedures are deemed necessary because .... 

192 

19~ 

results, tl 

~ion rather ttlatter 

pr( 

lction of t! 

~as a result oft 

ses had assc 

joi 

of fractu: 

carpal and di 

terposition ir 

i fra,,g, ment fro 

iclosed reduc: 

,’ur. I 

pai: 

The authors 

Thomas Flemim 

in this report. 

t. Bilos, 

Z, J.. 

dislocation 

of five case

Clinical 


,cation there is less traui ~ us disruption is between ~ 

the carpus, as one unit 

orsal dislocation treated 

~e tear affected the volar 

It and extended 

alnar lunate capsular 

fracture of the volar 

or results, the author~ recommend wrist fu- 

~on rather than proximal row carpectomy. 

:The latter procedure will fail because of degruction 

of the distal radial articular surface 

a result of the injury) ~ None of the authors’ 

had associated dislocation of the inferior 

nt. Weiss et al. ~3 reported on a 

lp lff~ of fracture-dislocation of both the radio- 

:tislocation should be |~:camal and distal radioulnar joints. Bony in- 

)n and plaster imnaobil~ 

L~ terposition ~n the joint of an osteochondra 

During the first four ~fragment from the distal radius prevented 

applied and is then 

N~’:elosed reduction. Open reduction resulted in 

st for two weeks. Open good result at 14 months of follow-up study. 

d for cases where closed Residual pain at the distal ulna can, however, 

ruse of interposition in the 

~qents or for those 

ion of the radial 

ACKNOWLEDGMENTS 

! result in these cases. If the The authors wish to thank Drs. Robert Turner and 

ble, one can consider cross- Thomas Fleming for contributing two of the cases included 

tdiocarpal joint to 

in this report. 

a, as in Case 1. 

REFERENCES 

,cation, the trauma is severe 

)us disruption involves sev- 1. Bilos, Z. J.. Pankovich, A. M.. and Yelda. S.: Fracturedislocation 

of the radiocarpal joint. A clinical study 

uthors found a dorsal tear of five cases. J. Bone Joint Surg. 59A:198, 1977. 

[ capsular ligaments between 

e scaphoid and lunate, and 

’ midcarpal tear between the 

~itate that extended radially 

,kate and radiolunate ligay 

into the triquetrocapitate 

lpholunate intercarpal liga-, 

n. In contrast to other pubcases 

of Type II dislocation 

des were volar dislocations. 

,~verely displaced volarly in : 

hors ~ agree with others that 

;ement of these severe diseduction 

through both volar 

)aches. The radial 

1 in anatomic position to 

al stability. Then the scaphned 

to the lunate to 

¢. Any other large fragments i 

inned and all torn ligamen- 

~aired. Even then the prog- 

. these patients. If secondary 

:emed necessary because of 

1985 


209 

2. Bohler, L.: Verrenkungen der Handgelenke. Acta Chit. 

Scand. 67:154, 1930. 

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dislocations of the wrist. In Rockwood, C. A. Jr., and 

Green, D. P.(eds.): Fractures, vol. 1. Philadelphia, 

J. B. Lippincott, 1975, pp. 345-440. 

4. Dunn, A. W.: Fractures and dislocations of the carpus. 

Surg. Clin. North Am. 52:1513, 1972. 

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wrist. Surg. Clin. North Am. 37:19, 1957. 

6. Freund, L. G., and Ovesen, J.: Isolated dorsal dislocation 

of the radiocarpat joint: A case report. J. 

Bone Joint Surg. 59A:277, 1977. 

7. Green, D. P., and O’Brien, E. T.: Open reduction of 

carpal dislocations--lndications and operative techniques. 

J. Hand Surg. 3:250, 1978. 

8. Gui, L.: Fratture e lussazioni. Firenze. Edizioni scientifiche 

Instituto ortopedico toscano, 1957, p. 510. 

9. Lourie, J. A.: An unusual dislocation of the lunate 

of the wrist. J. Trauma 22(I 1): 966, 1982. 

10. Mullan, G. B., and Lloyd, G. J.: Complete carpal 

disruption of the hand. Hand 12:39, 1980. 

11. Neviaser, R. J.: Proximal row carpectomy for posttraumatic 

disorders of the carpus. J. Hand Surg. 8:30 l, 

1983. 

12. Rosado, A. P.: A possible relationship of radiocarpal 

dislocation and dislocation of the lunate bone. J. Bone 

Joint Surg. 48B:504. 1966. 

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radiocarpal dislocation: A case report. J. Bone Joint 

Surg. 52:562, 1970.

Radiocarpal Dislocation Classification Rationale for Management and

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