The Clinical Study Of Repairing Articular Capsule And Ligament In The Carpal Dislocations And Fracture-dislocations

Objective: To investigate the clinical effect and the importance of repairing articular capsule and ligament in treating carpal dislocations and fracture-dislocations.Carpal dislocations were divided into simple and complex dislocation,complex dislocations were often associated with other carpal fractures,such as the fracture of styloid and scaphoid.No matter what kind of dislocation,was caused by high-energy trauma,the articular capsule and ligament injured seriously,reduced incompletely and fixed infirmly can be transferred to the wrist instability,and then lead to joint movement dysfunction[1].The stability of the wrist depends on the articular capsule,ligament and the surrounding tendon,and the articular capsule and ligament play an important role.Therefore,repaired the articular capsule and ligament is particularly important in the treatment of carpal dislocations and fracture-dislocations.In this paper,all patients were treated with open reduction and internal fixation with screws or K-wires,combined with bone anchor repair for articular capsule and ligament,the assessment of the wrist joint function and stability have been followed up for a long time.The aim of the research is to pay attention to the surgical repairment of articular capsule and ligament,and provide a more effective surgical method for the clinical treatment of carpal dislocations and fracture-dislocations.Methods: Six cases of carpal dislocations and fracture-dislocations were treated in our department between February 2014 and September 2015,the patients included two palmar lunate dislocations,two dorsal trans-scaphoid perilunate fracture-dislocations,one dorsal perilunate dislocation and one dorsal trans-styloid perilunate fracture-dislocation;They are all males,aged 24-42 years old,the mean age of the patients was 32.7 years old;3 right-wrist cases and 3 left-wrist cases;Injury factors: 4 cases caused by falling from height,1 case caused by traffic accident,1 case caused by fall injury;The average time between injury and surgery was 12 days(rang 3-28d).All the patients were treated with open reduction and internal fixation with screws or K-wires,combined with bone anchor repair for articular capsule and ligament.The wrist was immobilized with a short arm cast,which allowed gentle movement of the metacarpophalangeal joints in all digits except the thumb,all patients were usually treated with anti-inflammatory drugs.The K-wires were removed during postoperative weeks 4 to 6.Patients were encouraged to begin gentle mobilization of the wrist and fingers without plaster at one month post-surgery,except for 2 cases of trans-scaphoid perilunate fracture-dislocations,which were depended on the healing of the scaphoid fractures when taken X-rays examination during 10 to 12 weeks.Postoperative follow-up is taken on all the cases,the clinical evaluation was with Mayo wrist score which evaluated pain,functional status,rang of motion and grip strength.Standard lateral and PA X-rays were used for the radiological evaluation,in which the scapholunate angle,radiolunate angle and size of the scapholunate gap were assessed,and observed for nonunion,redislocation,traumatic arthritis and avascular necrosis of lunate.Results: The mean follow-up period was 11.5 months(rang 6-18 months),no patient was lost to follow-up evaluation,all incisions heal completely by first intention.During the follow-up period,there was no nonunion and redislocation,no avascular necrosis of lunate.1 patient complained of mild wrist pain only after heavy use,relieved by analgesic drug;1 patient with median nerve injury symptom disappeared 2 months after operation.According to the modified Mayo wrist scoring system,which were excellent in 3 cases,good in 2 cases,fair in 1 case,and none poor case,and the excellent and good rate was 83.3%.At the latest follow-up,the mean grip strength was 80.1 % of the contralateral wrist,the mean flexion was 65.2°,the mean extension was 53.7°,the mean radial deviation was 18.7°and the mean ulnar deviation was 27.0°.The mean scapholunate angle was 51.0°,the mean radiolunate angle was 7.8°and the mean scapholunate gap was 1.4mm at the final follow-up.Conclusion:1 Carpal dislocations and fracture-dislocations often associated with serious articular capsule and ligament injuries,in addition to reducing and fixing the fractures and dislocations,more attention should be paid to the repairment and reconstruction of articular capsule and ligament,to enhance the stability of wrist joint.2 For the articular capsule and ligament avulsed from the insertions,reconstruction of the insertions with bone anchor is a kind of ideal materials and methods.3 Open reduction and internal fixation with screws or K-wires,combined with bone anchor repair for articular capsule and ligament in treating carpal dislocations and fracture-dislocations can achieve anatomical reduction,reduce the risk of avascular necrosis of lunate and decrease the incidence of traumatic arthritis and carpal instability.The surgical method can also get early movement and good recovery of wrist joint function and stability.