Traumatic axial dislocation injuries of the wrist

Axial carpal dislocations and fracture dislocations have received mention in the hand and wrist surgery literature. Reference to these injuries in the radiology literature is scarce and anecdotal, resulting in somewhat limited awareness of these lesions among radiologists. These are rare injuries that result from severe, broad crushing or blast forces involving dorsopalmar compression of the wrist. This results in carpal splits, with either the ulnar or radial column stable with respect to the radius and with dislocation of the unstable column. Because of the intrinsic weaknesses in the carpal architecture, similar predictable injury patterns are observed. The most common of these include axial ulnar injuries (transhamate peripisiform axial ulnar fracture dislocation, perihamate peripisiform axial ulnar dislocation, and perihamate transtriquetrum axial ulnar fracture dislocation) and axial radial injuries (peritrapezoid peritrapezium axial radial dislocation, peritrapezium axial radial dislocation, and transtrapezium axial radial fracture dislocation). The radiologist's role in evaluating these injuries involves determining the injury path as it propagates through the carpus because surgical repair should address each component of this injury pathway. This review is presented to describe the radiographic findings of axial carpal disruptions in hopes of improving the recognition and successful therapy of these uncommon but often devastating injuries. This work is in accordance with the guidelines of the institutional review board.