The Treatment Of Traumatic Carpal Axial Fracture And Dislocation

Objective : To discuss treatment, complication and prognosis of Traumatic axial carpal fracture and dislocation.Methods:A retrospective review was conducted of 8 patients with traumatic axial carpal fracture and dislocation were treated(five men and three women, from November 2004 to March 2016). Mean age was 36 years(range 32 to 48 years). 4 patients injured their right limbs, while the others injured their left limbs. Crush mechanism is usually responsible for the lesion(6 with wringer-type machine and 2 injured by a crashing object). According to Garcia-Elias, there were axial ulnar injuries in 6 patients, axial radial injuries in 1 patient and axial-radial-ulnar in 1 patient. Among them, 2 cases with intact skin treated by open reduction, internal fixation, nerve decompression and fasciotomy; other 4 cases with patulous injury underwent debridement, open reduction, internal fixation, one-stage repair of ligaments and nerves, then, 1 case was needed further treating by abdominal pedicle flap to resurface defective skin soft tissue and 1 case was needed further remedy with arthrodesis; the last 2 cases with severe patulous injury also treated by debridement, open reduction, internal fixation, one-stage repair of ligaments and nerves, and amputation, at last, due to complication, such as infection.Results : Postoperative follow-up ranged from 4 to 113 months(average 73 months).Recovery of the hand function was evaluated using the criteria issued by the Hand Surgery Society of the Chinese Medical Association and was rated as excellent in 2 cases, good in 1 case,moderate in 2 cases and poor in 3 cases.Conclusion:Traumatic axial carpal fracture and dislocation is a special type of wrist injures. The injury degree of soft tissue is more important than that of bones and joints. As to the treatment of closed axial injury, Osteofascial Compartment Syndrome and Carpal Tunnel Syndrome should be taken precautions against; while open axial injury should attach importance to soft tissue injury, which contribute to the function recovery of wrist.