Radiocarpal Dislocation Classification Rationale for Management and

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$fracture dislocations of the proximal ... - Northwestern University$

204 Moneim et al. 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 and Related 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
Page 1 and 2: , with absorption and ~~:~ en lorgn
Page 3 and 4: TABLE 1. Radiocarpal Dislocation: M
Page 5: FIG. 1. and lateral rad showin of t
Page 9 and 10: FIG. 9. Patient in 7 at follow-~ No
Page 11: Clinical and Related ,cation there

Radiocarpal Dislocation Classification Rationale for Management and

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