Abstract
Radiocarpal fracture-dislocations are the most debatable of carpal dislocations. The term radiocarpal fracture-dislocations has been used incorrectly for many previously reported cases. Thus, many questions arise concerning their incidence, terminology and classification. In this chapter, an attempt is made to determine the criteria based on which an injury can be classified as radiocarpal fracture-dislocation. Additionally, the surgical treatment of radiocarpal fracture-dislocations with combined access, allows for a relatively accurate description of osteoligamentous injuries, both on the palmar and on the dorsal side of the wrist. Four types of injuries in the dorsal and two types of injuries in the palmar dislocations are portrayed. Furthermore, a new classification is proposed based on five parameters: those of chronicity, pathoanatomy, direction, associated injuries and complexity. The staged-reconstruction, the outcome and potential complications of this rare type of injuries are also analyzed with great emphasis on ulnar translation, for which a method of reconstruction using a tendon graft in cadavers is described.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
Fernandez DL, Jupiter JB (2002) Fracture of the distal end of the radius: a historical perspective. In: Fernandez DL, Jupiter JB (eds) Fractures of the distal radius. A practical approach to management, Chap 1, 2nd edn. Springer, New York, pp 1–22
Ilyas A, Mudgal C (2008) Radiocarpal Fracture-dislocations. J Am Acad Orthop Surg 16:647–655
Destot E (1926) Injuries of the wrist: a radiological study. Hoeber, New York
Gui L (1957) Fratture e lussazioni. Edizioni scientifiche Instituto Ortopedico toscano, Firenze, p 510
Rosado AP (1966) A possible relationship of radiocarpal dislocation and dislocation of the lunate bone. J Bone Joint Surg Am 48:504–506
Dunn AW (1972) Fractures and dislocations of the carpus. Surg Clin North Am 52:1513–1518
Bilos ZJ, Pankovich AM, Yelda S (1977) Fracture-dislocation of the radiocarpal joint. J Bone Joint Surg Am 59:198–203
Dumontier C, Lenoble E, Saffar P (1995) Radiocarpal dislocations and fractures-dislocations. In: Saffar P, Cooney WP (eds) Fractures of the distal radius. Martin Dunitz, London, pp 267–278
Moneim MS, Bolger JT, Omer GE (1985) Radiocarpal dislocation–classification and rationale for management. Clin Orthop 192:199–209
Ilyas AM, Williamson C, Mudgal CS (2011) Radiocarpal dislocation: is it a rare injury? J Hand Surg [Eur] 36(2):164
Bellinghausen HW, Gilula LA, Young LV et al (1983) Post-traumatic palmar carpal subluxation. Report of two cases. J Bone Joint Surg Am 65:998–1006
Le Nen D, Riot O, Caro P et al (1991) Luxation-fractures of the radiocarpal joint. Clinical study of 6 cases and general review. Ann Chir Main Memb Super 10:5–12
Mourikis A, Rebello G, Villafuente J et al (2008) Radiocarpal dislocations: review of the literature with case presentations and a proposed treatment algorithm. Orthopedics 31:386
Naranja RJ, Bozentka DJ, Partington MT et al (1998) Radiocarpal dislocation: a report of two cases and a review of the literature. Am J Orthop 27(2):141–144
Schoenecker PL, Gilula LA, Shively RA et al (1985) Radiocarpal fracture-dislocation. Clin Orthop 197:237–244
Apergis E, Dimitrakopoulos K, Chorianopoulos K (1996) Late management of post-traumatic palmar carpal subluxation: A case report. J Bone Joint Surg Br 78:419–421
Arslan H, Tokmak M (2002) Isolated ulnar radiocarpal dislocation. Arch Orthop Trauma Surg 122:179–181
Ayekoloye CI, Shah N, Kumar A et al (2002) Irreducible dorsal radiocarpal fracture dislocation with dissociation of the distal radioulnar joint: a case report. Acta Orthop Belg 68(2):171–174
Dodd CA (1987) Triple dislocation in the upper limb. J Trauma 27:1307
Fehring TK, Milek MA (1984) Isolated volar dislocation of the radiocarpal joint. A case report. J Bone Joint Surg Am 66:464–466
Fennell CW, McMurtry RY, Fairbanks CJ (1992) Multidirectional radiocarpal dislocation without fracture: a case report. J Hand Surg [Am] 17:756–761
Fernandez DL (1981) Irreducible radiocarpal fracture-dislocation and radioulnar dissociation with entrapment of the ulnar nerve, artery and flexor profundus II-V-case report. J Hand Surg [Am] 6:456–461
Freeland A, Ferguson CA, McCraney WO (2006) Palmar radiocarpal dislocation resulting in ulnar radiocarpal translocation and multidirectional instability. Orthopedics 29(7):604–608
Freund LG, Ovesen J (1977) Isolated dorsal dislocation of the radiocarpal joint. J Bone Joint Surg Am 59:277
Hardy P, Welby F, Stromboni M et al (1999) Wrist arthroscopy and dislocation of the radiocarpal joint without fracture. Arthroscopy 15(7):779–783
Howard RF, Slawski DP, Gilula LA (1997) Isolated palmar radiocarpal dislocation and ulnar translocation: a case report and review of the literature. J Hand Surg [Am] 22(1):78–82
Jebson PJL, Adams BD, Meletiou SD (2000) Ulnar translocation instability of the carpus after a dorsal radiocarpal dislocation; a case report. Am J Orthop 29(6):462–464
Matthews MG (1987) Radiocarpal dislocation with associated avulsion of the radial styloid and fracture of the shaft of the ulna. Injury 18:70–71
Moore DP, McMahon BA (1988) Anterior radio-carpal dislocation: an isolated injury. J Hand Surg [Br] 13:215–217
Penny WH III, Green TL (1988) Volar radiocarpal dislocation with ulnar translocation. J Orthop Trauma 2:322–326
Reynolds ISR (1980) Dorsal carpal dislocation. Injury 12:48–49
Tanzer TL, Horne JG (1980) Dorsal radiocarpal fracture dislocation. J Trauma 20:999–1000
Thomsen S, Falstie-Jensen S (1989) Palmar dislocation of the radiocarpal joint. J Hand Surg [Am] 14:627–630
Varodompun N, Limpivest P, Prinyaroj P (1985) Isolated dorsal radiocarpal dislocation: case report and literature review. J Hand Surg [Am] 10:708–710
Nyquist SR, Stern PJ (1984) Open radiocarpal fracture-dislocations. J Hand Surg [Am] 9:707–710
Mudgal CS, Psenica J, Jupiter JB (1999) Radiocarpal fracture-dislocation. J Hand Surg [Br] 24:92–98
Girard J, Cassagnaud X, Maynou C et al (2004) Radiocarpal dislocation: Twelve cases and a review of the literature. Rev Chir Orthop 90:426–433
Dumontier C, Zu Reckendorf GM, Sautet A et al (2001) Radiocarpal dislocations: classification and proposal for treatment (a review of twenty-seven cases). J Bone Joint Surg Am 83:212–218
Taleisnik J (1985) The wrist. Churchill Livingstone, New York
Kapandji IA (1991) Etude du carpe au scanner a trois dimensions sous contraintes de pronosupination. Ann Chir Main 10:36–47
Ritt MJPF, Stuart PR, Berglund LJ et al (1995) Rotational stability of the carpus relative to the forearm. J Hand Surg [Am] 20(2):305–311
Roux JL (1992) La rotation longitudinale radio-metacarpienne. Thesis. Montpellier, France
Taleisnik J (1978) Wrist: anatomy, function, and injury. AAOS Instr Course Lect 27:61–68
Gupta A, Moosawi NA (2005) How much can carpus rotate axially? An in vivo study. Clin Biomech 20(2):172–176
Heras-Palou C (2009) Midcarpal instability. In: Slutsky DJ, Osterman AL (eds) Fractures and injuries of the distal radius and carpus. The Cutting edge. Saunders, Philadelphia, pp 417–423
Katz DA, Green JK, Werner FW et al (2003) Capsuloligamentous restraints to dorsal and palmar carpal translation. J Hand Surg [Am] 28(4):610–613
Berger RA, Landsmeer JM (1990) The palmar radiocarpal ligaments: a study of adult and fetal human wrist joints. J Hand Surg [Am] 15:847–854
Berger RA (1997) The ligaments of the wrist. Hand Clin 13(1):63–82
Garcia-Elias M (1997) Kinetic analysis of carpal stability during grip. Hand Clin 13:151–158
Viegas SF, Patterson RM, Ward K (1995) Extrinsic wrist ligaments in the pathomechanics of ulnar translation instability. J Hand Surg [Am] 20:312–318
Werner FW, Sutton LG, Allison MA et al (2010) Scaphoid and lunate translation in the intact wrist and following ligament resection: a cadaver study. J Hand Surg [Am] 36(2):291–298
Rayhack JM, Linscheid RL, Dobyns JH et al (1987) Posttraumatic ulnar translation of the carpus. J Hand Surg [Am] 12:180–189
Munk B, Jensen SL, Olsen BS et al (2005) Wrist stability after experimental traumatic triangular fibrocartilage complex lesions. J Hand Surg [Am] 30(1):43–49
Wiesner L, Rumelhart C, Pham E et al (1996) Experimentally induced ulno-carpal instability. A study on 13 cadaver wrists. J Hand Surg [Br] 21(1):24–29
Allieu Y, Garcia-Elias M (2000) Dynamic radial translation instability of the carpus. J Hand Surg [Br] 25(1):33–37
Yin Y, Mann FA, Hodge JC et al (1996) Roentgenographic interpretation of ligamentous instabilities of the wrist. In: Gilula LA, Yin Y (eds) Imaging of the wrist and hand. WB Saunders, Philadelphia, pp 203–224
Moritomo H, Murase T, Arimitsu S et al (2008) Change in the length of the ulnocarpal ligaments during radiocarpal motion: possible impact on triangular fibrocartilage complex foveal tears. J Hand Surg [Am] 33(8):1278–1286
Iwamoto A, Morris RP, Andersen C et al (2006) An anatomic and biomechanic study of the wrist extensor retinaculum septa and tendon compartments. J Hand Surg [Am] 31(6):896–903
Hagert E, Persson JKE, Werner M et al (2009) Evidence of wrist proprioceptive reflexes elicited after stimulation of the scapholunate interosseous ligament. J Hand Surg [Am] 34:642–651
An KN, Horii E, Ryu J (1991) Muscle function. In: An KN, Berger EJ, Cooney WP (eds) Biomechanics of the wrist joint. Springer, New York, pp 157–169
Brand PW (1981) Relative tension and potential excursion of muscles in forearm and hand. J Hand Surg [Am] 6:209–219
Hagert E, Forsgren S, Ljung BO (2005) Differences in the presence of mechanoreceptors and nerve structures between wrist ligaments may imply differential roles in wrist stabilization. J Orthop Res 23:757–763
Salva-Coll G, Garcia-Elias M, Leon-Lopez MT (2011) Effects of forearm muscles on carpal stability. J Hand Surg [Eur] 36(7):553–559
Berger RA, Amadio PC (1994) Predicting palmar radio-carpal ligament disruption in fractures of the distal articular surface of the radius involving the palmar cortex. J Hand Surg [Br] 19:108–113
Siegel DB, Gelberman RH (1991) Radial styloidectomy: an anatomical study with special reference to radiocarpal intracapsular ligamentous morphology. J Hand Surg [Am] 16:40–44
Mandziak DG, Watts AC, Bain GI (2011) Ligament contribution to patterns of articular fractures of the distal radius. J Hand Surg [Am] 36(10):1621–1625
Giunta R, Lower N, Kierse R et al (1997) Stress on the radiocarpal joint. CT studies of subchondral bone density in vivo. Handchir Mikrochir Plast Chir 29:32–37
Fernandez DL, Jupiter JB, Ghillani R (2002) Radiocarpal fracture-dislocation. In: Fernandez DL, Jupiter JB (eds) Fractures of the distal radius. A practical approach to management, Chap 8, 2nd edn. Springer, New York, pp 253–264
Ilyas A, Mudgal C, Jupiter J (2009) Volar rim and Barton’s fracture. In: Slutsky DJ, Osterman AL (eds) Fractures and injuries to the distal radius and carpus, Chap 14. Saunders Elsevier, pp 157–163
Bohler L (1930) Verrenkungen der Handgelenke. Acta Chir Scand 67:154–177
Weiss C, Laskin RS, Spinner M (1970) Irreducible radiocarpal dislocation. J Bone Joint Surg Am 52:562–564
Bohler L (1956) The treatment of fractures. Grune & Stratton, New York, pp 826–854
Graham TJ (2003) The inferior arc injury: an addition to the family of complex carpal fracture-dislocation patterns. Am J Orthop 32(9):10–19
Sivan M, Davies N, Archibald C et al (2005) An unusual combination of radiocarpal fracture dislocation, scaphoid fracture and posteromedial elbow dislocation. Injury Extra 36:312–315
Watanabe K, Nishikimi J (2001) Transstyloid radiocarpal dislocation. Hand Surg 6(1):113–120
Oberladstätter J, Arora R, Dallapozza C et al (2010) Radiological radio-carpal and mid-carpal motion after operative treatment of dorsal radio-carpal fracture dislocations. Arch Orthop Trauma Surg 130:77–81
Jupiter JB, Fernandez DL, Toh CL et al (1996) Operative treatment of volar intra-articular fractures of the distal end of the radius. J Bone Joint Surg Am 78(12):1817–1828
Helm RH, Tonkin MA (1992) The chauffeur’s fracture. Simple or complex? J Hand Surg [Br] 17(2):156–159
Apergis E, Darmanis S, Theodoratos G et al (2002) Beware of the ulno-palmar distal radial fragment. J Hand Surg [Br] 27:139–145
Harness NG, Jupiter JB, Orbay JL et al (2004) Loss of fixation of the volar lunate facet fragment in fractures of the distal part of the radius. J Bone Joint Surg Am 86(9):1900–1908
Cohen MS, McMurtry RY, Jupiter JB (1998) Fractures of the distal radius. In: Browner BD, Jupiter JB, Levine AM, Trafton PG (eds) Skeletal Trauma, 2nd edn. WB Saunders, Philadelphia, p 1385
Fernandez DL, Jupiter JB (2002) Articular marginal shearing fractures. In: Fernandez DL, Jupiter JB (eds) Fractures of the distal radius. A practical approach to management, Chap 6, 2nd edn. Springer, New York, pp 188–212
King RE (1959) Barton’s enigma. J Bone Joint Surg Am 41:753–769
Lozano-Calderón SA, Doornberg J, Ring D (2006) Fractures of the dorsal articular margin of the distal part of the radius with dorsal radiocarpal subluxation. J Bone Joint Surg Am 88(7):1486–1493
Stoffelen D, Fortems Y, De Smet L et al (1996) Dislocation of the distal radioulnar joint associated with a transstyloid radiocarpal fracture dislocation a case report and review of the literature. Acta Orthop Belg 62(2):52–55
Idler RS (2001) Carpal dislocations and instability. In: Watson HK, Weinzweig J (eds) The Wrist, vol 1. Lippincott Williams & Wilkins, pp 203–229
Capo JT, Armbruster ED, Hashem J (2010) Proximal carpal row dislocation: a case report. Hand 5:444–448
Klein A, Bohrer SP, Martin W III (1986) Dorsal dislocation of the radiocarpal joint with associated dorsal perilunar dislocation. Can Assoc Radiol J 37(3):201–202
Maschke S, Means KR, Parks BG et al (2010) A radiocarpal ligament reconstruction using brachioradialis for secondary ulnar translation of the carpus following radiocarpal dislocation: a cadaver study. J Hand Surg [Am] 35(2):256–261
Kamal RN, Bariteau JT, Beutel BG et al (2011) Arthroscopic reduction and percutaneous pinning of a radiocarpal dislocation. A case report. J Bone Joint Surg [Am] 93(15):1–5
Campbell DA (2009) Ulnar head and styloid fractures. In: Slutsky DJ, Osterman AL (eds) Fractures and injuries to the distal radius and carpus. The cutting edge, Chap 28. Saunders, Philadeiphia, pp 297–308
Nakamura T, Moy OJ, Peimer CA (2003) Relationship between the ulnar styloid fracture and DRUJ instability. J Hand Surg [Br] 28(1):48
Gabl M, Lener M, Pechlaner S (1993) Destabilization of the discus articularis with rupture of the ulnar styloid apex in distal radius fracture. Diagnosis with dynamic MR. Unfallchirurgie 19:108
Lindau T, Adlercreutz C, Aspenberg P (2000) Peripheral tears of the triangular fibrocartilage complex cause distal radioulnar joint instability after distal radial fractures. J Hand Surg [Am] 25(3):464–468
Souer JS, Ring D, Matschke S et al (2009) Effect of an unrepaired fracture of the ulnar styloid base on outcome after plate-and-screw fixation of a distal radial fracture. J Bone Joint Surg Am 91(4):830–838
May MM, Lawton JN, Blazar PE (2002) Ulnar styloid fractures associated with distal radius fractures: incidence and implications for distal radioulnar joint instability. J Hand Surg [Am] 27(6):965–971
Atzei A, Luchetti R (2011) Foveal TFCC tear classification and treatment. Hand Clin 27(3):263–272
Bozentka DJ, Beredjiklian PK (2001) Classification of radiocarpal dislocations and appropriate treatment. J Bone Joint Surg Am 83(10):1587–1588
Hofmeister EP, Fitzgerald BT, Thomson MA et al (2008) Surgical reconstruction of a late-presenting volar radiocarpal dislocation: a case report. Am J Orthop 37(2):96–99
Takase K, Yamamoto K, Yoshino S et al (2004) Palmar dislocation of the radio-carpal joint: a case report. J Orthop Surg 12(2):258–262
Gilula LA (1979) Carpal injuries: analytic approach and case exercises. Am J Roentgenol 133:503–517
Lipton HA, Jupiter J (2001) Open reduction and internal fixation of distal radius fractures. In: Watson HK, Weinzweig J (eds) The wrist. Lippincott Williams & Wilkins, pp 333–335
Antuna SA, Mendez JG, Paz Jimenez J (1994) Displaced radiocarpal dislocation with multiple associated fractures. Acta Orthop Belg 60:430–431
Lourie JA (1982) An unusual dislocation of the lunate and the wrist. J Trauma 22:966–967
Berger RA, Weiss AP (2004) Hand Surgery. Lippincott Williams & Wilkins
Cooney WP, Linscheid RL, Dobyns JH (1998) The Wrist. Diagnosis and operative treatment. Mosby, St. Louis
Watson HK, Weinzeig J (2001) The Wrist. Lippincott Williams & Wilkins
Chin KR, Jupiter JB (1999) Wire-loop fixation of volar displaced osteochondral fractures of the distal radius. J Hand Surg [Am] 24:525–533
Obafemi A, Pensy R (2012) Palmar radiocarpal dislocation: a case report and novel treatment method. Hand 7:114–118
Schweitzer G (1987) Radiocarpal fracture-dislocation [letter]. Clin Orthop 216:298–299
Patee G, Thomson G (1988) Anterior and posterior marginal fracture-dislocations of the distal radius. An analysis of the results of treatment. Clin Orthop 231:183–195
Knirk JL, Jupiter JB (1986) Intra-articular fractures of the distal end of the radius in young adults. J Bone Joint Surg Am 68(5):647–659
Dobyns JH, Linscheid RL, Chao EYS et al (1975) Traumatic instability of the wrist. In: AAOS instructional course lectures, vol 24. CV Mosby, St Louis, pp 182–199
Berschback JC, Kalainov DM, Husain SN et al (2012) Traumatic ulnar translocation of the carpus: early recognition and treatment. J Hand Surg [Eur] 37(8):755–764
Mulier T, Reynders P, Broos P et al (1992) Posttraumatic ulnar translation of the carpus. Acta Orthop Scand 63(1):102–103
Schernberg F (1996) Ulnar translation of the carpus: a rare type of wrist instability. In: Buchler U (ed) Wrist instability, Chap 23. Martin Dunitz, Philadelphia, pp 175–179
Garcia-Elias M (1999) Carpal instabilities and dislocations. In: Green DP, Hotchkiss RN, Pederson WC (eds) Green’s operative hand surgery,Chap 28, vol 1. Churchill Livingstone, New York, pp 865–928
Rettig AC, Rettig LA, Jelinek JA (2010) Ulnar translocation of the wrist in a professional quarterback: a case report. Am J Sports Med 38(3):608–612
Rutgers M, Jupiter J, Ring D (2009) Isolated posttraumatic ulnar translocation of the radiocarpal joint. J Hand Microsurg 1(2):108–112
Stabler A, Baumeister RGH, Szeimies U et al (1994) Rotatory palmar subluxation of the lunate in post-traumatic ulnar carpal translocation. Skeletal Radiol 23:103–106
Chamay A, Della Santa D, Vilaseca A (1983) Radiolunate arthrodesis. Factor of stability for the rheumatoid wrist. Ann Chir Main 2:5–17
DiBenedetto MR, Lubbers LM, Coleman CR (1990) A standardized measurement of ulnar carpal translocation. J Hand Surg [Am] 15:1009–1010
McMurtry RY, Youm Y, Flatt AE et al (1978) Kinematics of the wrist. II. Clinical applications. J Bone Joint Surg Am 60:955–961
Bouman HW, Messer E, Sennwald G (1994) Measurement of ulnar translation and carpal height. J Hand Surg [Br] 19:325–329
Gilula LA, Weeks PM (1978) Post-traumatic ligamentous instabilities of the wrist. Radiology 129:641–651
Schuind FA, Linscheid RL, An KN et al (1992) A normal data base of posteroanterior roentgenographic measurements of the wrist. J Bone Joint Surg Am 74:1418–1429
Apergis E (2004) καταγματα-εξαρθρήματα του καρπου. Konstantaras Medical Books, Athens
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
Copyright information
© 2013 Springer-Verlag Italia
About this chapter
Cite this chapter
Apergis, E., Palamidi, A. (2013). Radiocarpal Dislocations or Fracture-Dislocations. In: Fracture-Dislocations of the Wrist. Springer, Milano. https://doi.org/10.1007/978-88-470-5328-1_8
Download citation
DOI: https://doi.org/10.1007/978-88-470-5328-1_8
Published:
Publisher Name: Springer, Milano
Print ISBN: 978-88-470-5327-4
Online ISBN: 978-88-470-5328-1
eBook Packages: MedicineMedicine (R0)