Unilateral non-traumatic radiocarpal volar dislocation in a child. A long-term evolution

Area of Science:

• Pediatric Orthopedics
• Genetics
• Rheumatology

Background:

• A case of an eight-year-old female with trisomy 21 presenting with wrist mobility limitations.
• The patient had a prior diagnosis and treatment for polyarticular juvenile chronic arthritis.

Observation:

• Clinical and radiological evaluation revealed a volar radiocarpal dislocation of the left wrist.
• Surgical treatment involving open reduction and K-wire fixation was performed, followed by six weeks of immobilization.
• The dislocation recurred post-surgery, although the joint remained asymptomatic.

Findings:

• One year after surgery, the patient exhibited limited wrist flexion and extension but remained pain-free.
• Despite the residual limitations, the patient and her family reported a normal, unrestricted life, declining further treatment.
• Eight years later, the patient remained asymptomatic and lived a normal life without functional limitations.

Implications:

• The failure of surgical intervention in this case suggests that non-operative management (abstention) may be a more suitable approach for radiocarpal dislocations in immature patients, particularly those with genetic syndromes.
• This case underscores the importance of considering patient-reported outcomes and quality of life over purely radiological findings in pediatric orthopedic treatment decisions.
• Further research into the long-term outcomes of conservative management for pediatric wrist dislocations in patients with chromosomal abnormalities is warranted.