Volar Radiocarpal Ligament Repair with Suture Anchors for Radiocarpal Fracture Dislocations: Case Series

Abstract

Background Radiocarpal fracture dislocations cause significant intraarticular disruption and instability difficult to treat with traditional plating methods.

Description of Technique Suture anchor fixation of the volar radiocarpal ligaments through an extended carpal tunnel approach, supplemented with radial styloid fixation, restores stability to the radiocarpal joint.

Patients and Methods We performed a retrospective review of 14 consecutive radiocarpal fracture-dislocations (RCFDs) treated at two-level one trauma center from 2011 to 2015. In all cases, the volar radiocarpal ligaments were repaired to the distal radius with suture anchors.

Results We reviewed 14 Dumontier Group 2 RCFDs in 14 patients (10 males, four females) with an average age of 39 years (range 22–53 years). Final follow-up averaged 288 days (range 7–1,364 days). Surgeons performed volar ligament repair with suture anchors in all cases, radial styloid fixation in 79% (11/14), and dorsal plate fixation in 29% (4/14). Eight of 14 patients (57%) had a “flipped” volar lip fragment of the distal radius. Three patients had forearm compartment syndrome and two patients had acute carpal tunnel syndrome. No patients experienced radiocarpal subluxation after volar ligament repair.

Conclusion No recurrent subluxation or dislocation occurred after primary repair of the volar radiocarpal ligaments using suture anchors in this series of radiocarpal fracture dislocations. Volar radiocarpal ligament repair also addressed the “flipped” volar rim fragment that could not be addressed through a dorsal approach alone.

Level of Evidence: This is a Level IV, case series therapeutic study.

Keywords

distal radius fracture - ligament repair - radiocarpal dislocation

Publikationsverlauf

Eingereicht: 29. April 2020

Angenommen: 15. September 2020

Artikel online veröffentlicht:
04. November 2020

• References

• 1 Ilyas AM, Williamson C, Mudgal CS. Radiocarpal dislocation: is it a rare injury?. J Hand Surg Eur Vol 2011; 36 (02) 164-165
• 2 Apergis E, Palamidi A. Radiocarpal dislocations or fracture-dislocations. In: Sharareh B, Dunn J. eds. Fracture—Dislocations of the Wrist. Mailand: Springer-Verlag; 2013: 187-237
• 3 Dumontier C, Meyer zu Reckendorf G, Sautet A, Lenoble E, Saffar P, Allieu Y. Radiocarpal dislocations: classification and proposal for treatment. A review of twenty-seven cases. J Bone Joint Surg Am 2001; 83 (02) 212-218
• 4 Kamal RN, Bariteau JT, Beutel BG, DaSilva MF. Arthroscopic reduction and percutaneous pinning of a radiocarpal dislocation: a case report. J Bone Joint Surg Am 2011; 93 (15) e84
• 5 Nyquist SR, Stern PJ. Open radiocarpal fracture-dislocations. J Hand Surg Am 1984; 9 (05) 707-710
• 6 Potter MQ, Haller JM, Tyser AR. Ligamentous radiocarpal fracture-dislocation treated with wrist-spanning plate and volar ligament repair. J Wrist Surg 2014; 3 (04) 265-268
• 7 Mudgal CS, Psenica J, Jupiter JB. Radiocarpal fracture-dislocation. J Hand Surg [Br] 1999; 24 (01) 92-98
• 8 Bilos ZJ, Pankovich AM, Yelda S. Fracture-dislocation of the radiocarpal joint. J Bone Joint Surg Am 1977; 59 (02) 198-203
• 9 Ilyas AM, Mudgal CS. Radiocarpal fracture-dislocations. J Am Acad Orthop Surg 2008; 16 (11) 647-655
• 10 Yuan BJ, Dennison DG, Elhassan BT, Kakar S. Outcomes after radiocarpal dislocation: a retrospective review. Hand (N Y) 2015; 10 (03) 367-373
• 11 Girard J, Cassagnaud X, Maynou C. [Radiocarpal dislocation: twelve cases and a review of the literature]. Rev Chir Reparatrice Appar Mot 2004; 90: 426-433
• 12 Brown D, Mulligan MT, Uhl RL. Volar ligament repair for radiocarpal fracture-dislocation. Orthopedics 2013; 36 (06) 463-468