Traumatic axial dislocations of the carpus

Area of Science:

• Orthopedics
• Trauma Surgery
• Hand Surgery

Background:

• Carpal fractures, dislocations, and subluxations are common hand injuries.
• Traumatic axial disruptions of the carpus and metacarpus represent a rare but severe subset of these injuries.
• Previous literature often suggests optimistic outcomes for carpal injuries.

Purpose of the Study:

• To investigate the incidence, classification, treatment, and prognosis of traumatic axial disruptions of the carpus and metacarpus.
• To compare outcomes with existing literature and identify key prognostic factors.

Main Methods:

• Retrospective review of 1140 patients treated for carpal injuries over 16 years.
• Identification and classification of 16 patients with traumatic axial disruption of the carpus and metacarpus.
• Classification based on the direction of instability: axial-ulnar, axial-radial, and combined axial-radial-ulnar.
• Surgical treatment involved open reduction and percutaneous Kirschner-wire fixation for most cases.
• Average follow-up period of 61 months.

Main Results:

• 16 (1.4%) patients presented with traumatic axial disruption of the carpus and metacarpus, often from crush or blast injuries.
• The majority of cases were axial-radial disruptions (11 patients), followed by axial-ulnar (4 patients) and one combined case.
• Treatment outcomes were less optimistic than anticipated, with prognosis strongly influenced by associated soft tissue injuries.

Conclusions:

• Traumatic axial disruptions of the carpus and metacarpus are infrequent but serious injuries.
• Soft tissue integrity plays a more critical role in patient prognosis than the carpal bone derangement alone.
• Comprehensive management addressing both skeletal and soft tissue components early is crucial for optimal outcomes.