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J Wrist Surg
DOI: 10.1055/s-0044-1791760
Case Report

Arthroscopic Management of an Extremely Rare Wrist Fracture-Dislocation Pattern

Fernando Corella 
1   Orthopedic and Trauma Department, Hospital Universitario Infanta Leonor, Madrid, Spain
2   Hand surgery unit, IOTAM group. Hospital Universitario Quironsalud Madrid, Madrid, Spain
3   Surgery Department, School of Medicine, Universidad Complutense de Madrid, Spain
,
Montserrat Ocampos 
1   Orthopedic and Trauma Department, Hospital Universitario Infanta Leonor, Madrid, Spain
2   Hand surgery unit, IOTAM group. Hospital Universitario Quironsalud Madrid, Madrid, Spain
,
Carlos Collado
1   Orthopedic and Trauma Department, Hospital Universitario Infanta Leonor, Madrid, Spain
2   Hand surgery unit, IOTAM group. Hospital Universitario Quironsalud Madrid, Madrid, Spain
,
Rafael Laredo
2   Hand surgery unit, IOTAM group. Hospital Universitario Quironsalud Madrid, Madrid, Spain
4   Head of Orthopedic and Trauma Department, Quironsalud Toledo, Toledo, Spain
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Abstract

Background Axial dislocation involves the displacement of carpal bones along the longitudinal axis of the wrist joint. There are three major groups: (1) axial ulnar, (2) axial radial, and (3) combined. On the other hand, radiocarpal dislocation entails disruption of the articulation between the radius and carpal bones. There are two groups: (group 1) it is either a pure radiocarpal dislocation or a minor avulsion of the radial styloid and (group 2) a fracture-dislocations characterized by a significant radial styloid fragment.

Case Description The patient, a 66-year-old female involved in a car accident, underwent imaging studies and arthroscopic exploration, revealing a transcapitate perihamate translunate fracture-dislocation, associated with a radiocarpal dislocation type 1. Arthroscopic treatment was performed through common dorsal radiocarpal and midcarpal portals, along with the volar radial portal. Anatomical reduction of the joints and fractures was achieved under arthroscopic control, along with suturing of the volar radiocarpal ligaments.

Literature Review The simultaneous occurrence of axial dislocation and radiocarpal dislocation, as observed in our case, is exceedingly rare and lacks comprehensive documentation in the existing literature. Furthermore, the specific type of axial dislocation (transcapitate perihamate translunate) has not been previously reported.

Various treatment approaches, including closed reduction, open reduction, and external fixation, have been described for these types of complex pathologies, but few reports describe their arthroscopy management.

Clinical Relevance This case report describes a rare occurrence of axial ulnar dislocation associated with radiocarpal dislocation of the wrist, which is exceptionally uncommon and not reported previously in the literature. This arthroscopic approach yielded excellent results, avoiding the need for multiple open approaches to address several fractures and ligament injuries.

Keywords

axial dislocation - radiocarpal dislocation - wrist arthroscopy.


Publication History

Received: 01 April 2024

Accepted: 05 September 2024

Article published online:
08 November 2024

© 2024. Thieme. All rights reserved.

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