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Radiocarpal Fracture Dislocations: Just Another Wrist Fracture?
Stephanie A. Kwan, DO
1, Ryan Curto, MD
1, Julia L Conroy, BS
2, Christopher G Langhammer, MD, PhD
3, Joshua M Abzug, MD
4; Raymond Pensy, MD
4(1)University of Maryland Medical Center, Baltimore, MD, (2)University of Maryland School of Medicine, Hunt Valley, MD, (3)R Adams Cowley Shock Trauma Center, Baltimore, MD, (4)University of Maryland School of Medicine, Baltimore, MD
Introduction
Radiocarpal fracture dislocation (RCFD) are an uncommon orthopaedic injury. They remain an understudied and challenging injury pattern. This study aims to investigate the incidence, patient demographics, and injury patterns of radiocarpal fracture dislocations.
Materials & Methods
We performed a retrospective review of all distal radius fractures (DRF) treated at a single Level I trauma center from 2014 to 2024 by seven fellowship trained, orthopaedic hand surgeons. The department clinical database was queried using Current Procedural Terminology (CPT) codes 25670, 25608, and 25609 to identify all distal radius injuries and a total of 1,230 patients were identified. Electronic medical records were reviewed to identify whether they sustained a RCFD. Patient demographics, injury patterns, and associated injuries were also collected.
Results
Nine hundred and sixty-one patients (92%) sustained DRF and 85 patients (8%) sustained RCFD. The average age of the RCFD group was 37 years compared to 47 years for the DRF group. Eighty percent of RCFD group were male compared to 60% in the DRF group. In the RCFD group, two patients (2%) had thyroid disease and one patient (1%) had diabetes, however, none of the patients had osteoporosis. In comparison, the DRF group had 9/961 (1%) with thyroid disease, 61/961 (6%) with diabetes, and 30/961 (3%) with osteoporosis. The majority of the RCFD (95%) were sustained due to high energy mechanisms. Injuries associated with RCFD included intrinsic ligament injury (26/85), ulnar styloid fracture (52/85), scaphoid fracture (9/85), carpal fracture (8/85), and distal radioulnar joint disruption (25/85). Seventy-three of the patients (86%) had additional orthopaedic injuries. In the RCFD, 12/85 were treated with a palmar approach, 50/85 were treated with a dorsal approach, and 23/85 were treated with both a palmar and dorsal approach. Ninety-five percent of the patients required multiple types of fixation including external fixation, fragment specific plating, pinning, headless compression screw fixation and ligament repair.
Conclusions
Radiocarpal fracture dislocations are a rare orthopaedic injury caused by a high energy mechanisms typically in young, healthy, male patients. Often, these injuries are associated with additional upper extremity pathology including ligamentous injury and other fractures requiring multiple types of fixation.
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