The main problem, in the follow up results is a lack of pronosupination that stresses the importance of a perfect reduction of distal radioulnar joint to begin early a phisiotherapy
We believe that a combination of the two fixation system allow an optimal external stabilization in the first week (So the therapist can move the patients in intensive care room). Secondary the internal fixator allows an anatomical reduction with a stable fixation in the secondary kinesiterapeutic time.
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: A: 13 patients, who have been observed since 1991 until 1998: B: Another group is at short term is since July 2002 until 2005 and is in 20 patients with 21 wrists 1 is bilateral. Finally we think that is necessary, to avoid the instability and pseudoartrosis on the scaphoid, to treat all the transcapholunate dislocation with open reduction and stabilisation, as agreed with literature.
4 patients bilaterally, 3 patients have substained a secondary reprease for lacking the initial reduction and 2 in two programmed timing. 46 wrists with radial internal fixation single or double plate (in one case trhee plate) 12 plate with pin or single screw in augmentation 3 cases with only screw artroscopically assisted 14 cases with only external fixator with or without pin 18 wrist with a combination of radial internal fixation (plate) and external fixation with Pennig, in complex distal radial-ulna fracture (2 exposed) In 5 wrists there were associated and treated navicular fracture or intracarpal ligaments injury 1 pazient have sustained an ipsilateral forearm fracture, epiphiseal distal radial fracture, trans scapho-lunate dislocation and controlateral transcapho-lunate dislocation 1 patient have sustained ipsilateral navicular-fisrt metacarpal-radial and ulna fracture The most patients (...) have been treated from the first Author. The patients were controlled from minimum of 6 month up a maximum of 39 months We have adapted in our evaluation the Dash score system The main problem, in the follow up results is a lack of prono-supination that stresses the importance of a perfect reduction of distal radio-ulnar joint to begin early a phisiotherapy
We believe that a combination of the two fixation system allow an optimal external stabilization in the first week (So the terapist can move the patients in intensive care room). Secondary the internal fixator allows an anatomical reduction with a stable fixation in the secondary kinesiterapeutic time protocol of high energy trauma to distal forearm, in particular in politraumatized patients is:
- closed reduction and short cast or external fixator if exposed or severe instable, on the day of injury during or just following generally stabilization - if possible e Tc 3D dimensional scan (our patients have substained a lot of tc scan for other trauma) - internal reduction and stabilitation a fews days later when the local swelling or skin damage and general condition allow it (from 2 to 7) - removal of external fixator between 3–4 week and begin a complete fkt
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:
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 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.
