Abstract
Dislocation and carpal fracture-dislocation are a rare injury, interesting capsula and ligaments, with a variable damage of the vascularization. Classification is difficult for the complexity on this lesion.
The aim of our work is to underline how the best final clinical result is achieved after an immediate treatment of reduction and stabilization of bone injury.
We considered two groups:
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A: 8 patients, who have been observed since july ’93 until 1996 ; all the patients were men who had work or car accidents, with outstretched upper extremity. The ages of the patients ranged from 19 to 34 years.. All patients were followed for an average of 8 years
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B: Another group is at short term is since luglio 2002 until today and is in 10 patients with 11 wrists with a total of 14 surgical treatment
1 is bilateral
3 wrists reoperated for lacking initial reduction or for the general initial condition
Assesment of the patients includeds clinical rating and roentgenografich analysis. The clinical scoring included pain, functional status, range of motion and grip strength.
Among the various classifications, we took into account the one proposed by Allieu, based on the radio-lunate ligament, consequently this classification offers an important prognostic factor.
In one of our cases there was assocciated a fracture of the radial stiloid, and in other one a posterior dislocation of the elbow.
We treated all the patients with a volar approach, the stabilitation of the carpus and scaphoid was achieved utilizing K wires in four cases, microscrew in two patients for scaphoid’s fracture and in other one the Herbert screw in the A group
In the B recent group we used in all cases K wiring, and herbert screw in 8 wrists, microscrews in one , and internal capsulodesis in the 2 last for perilunate isolated dislocation
The initial failing of reduction is due to an unstable reduction in very injured patient ( we use only k wire for the navicular)
10 patients in the second B group have been treated by the same first Author
After surgery treatment, the wrist was immobilizated in a splint for 6 weeks, then a careful mobilitation was started.
Finally we think that is necessary, to avoid the instability and pseudoartrosis on the scaphoid, to treat all the transcapho-lunate dislocation with open reduction and stabilitation, as agreed with literature.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
