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A.E. Freeland, and J.E. Torres, Jackson , MS
Introduction
A small cohort of wrist dislocations may be irreparable due to comminuted, devascularized, or irreducible components. The purpose of this paper is to demonstrate that favorable outcomes may be achieved with primary treatment with proximal row carpectomy.
Clinical Material and Methods
Twelve such patients were treated with primary proximal row carpectomy over a 4-year period. There were 9 men and 3 women. Patient age averaged 45 years. The injuries occurred in the non-dominant hand of 8 patients and in the dominant hand of 4 patients. Injuries 7 complete lunate dislocations (4 palmar and 3 dorsal), 2 transscaphoid perilunate dislocations with a completely devascularized proximal scaphoid fragment, 1 palmar scaphoid dislocation, 1 transscaphoid transcapitate perilunate dislocation, and 1 complete perilunate dislocation. Eight injuries were caused by motor vehicle accidents, 3 by falls, and 1 by a punch press.
Results
Patients were followed at least until they reached maximum improvement (10 patients) or until they dropped out of treatment (2 patients). Follow-up averaged 2 years. Patients were evaluated for residual pain, return to work or activity, wrist motion, and grip strength using the modified Green and O'Brien scale. There were 6 good, 5 fair, and 1 poor results. Six had no pain and 6 had mild intermittent pain. Eight of 10 manual workers returned to full or modified employment. Patients averaged 68% of their normal wrist motion and 62% of their normal grip strength. No patient required a secondary wrist procedure during the course of this study.
Conclusions
Primary or early proximal row carpectomy is a reliable and relatively uncomplicated method for treating these severe wrist injuries. |
