Treatment of purely ligamentous dorsoulnar radiocarpal dislo
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A 24-year-old man sustained an injury in a motorcycle accident. Plain radiographic findings revealed dorsoulnar radiocarpal dislocation without radial fracture. Carpal-ulnar distance ratio (CUDR) was used for measuring ulnar translation of the carpus.

A line was drawn between the longitudinal axis of the ulna and the center of the capitate head, and the length of this line was divided by the third metacarpal length. The patient's CUDR was 0.16 at initial radiographs. The patient had a mild tingling sensation and hypesthesia along the median nerve dermatome. The initial treatment was closed reduction and the radiocarpal joint reduced easily by manual traction.

(MRI) scans were performed to examine the radius fracture and intrinsic carpal ligament injuries in greater detail. The MRI scans showed the disruption of the dorsal ligaments and capsules and avulsed from the proximal insertion of the volar radiocarpal ligaments.

Subsequently, the patient was diagnosed with dorsoulnar radiocarpal dislocation with a purely ligamentous injury. Doctors decided to perform the surgery. An extensive palmar approach was selected because the radioscaphocapitate (RSC) and radiolunate (RL) ligaments were the key structures to prevent ulnar translation of the carpus. An approximately 8 cm sized zig–zag skin incision was made. Dissection, including carpal tunnel release, was performed toward the radiocarpal joint. RSC and RL ligaments were avulsed from the proximal insertion. The interposing chondral fragment (asterisk) was removed from the radiocarpal joint and the RSC and RL ligaments were repaired with the Jugger Knot Soft Anchor Suture. The wrist was found to be stable. Additional radiocarpal K-wires and an external fixator to maintain reduction and optimal ligament tension were applied (CUDR = 0.24).

After the K-wires and external fixator were removed at 8 weeks postoperative, the ulnar translation of carpal bone unfortunately recurred (CUDR = 0.16). Outpatient follow-up was observed without further surgery. The patient's condition gradually improved, and the ulnar translation of the carpus was no longer progressing. At 22 months postoperative, the patient had no pain, nearly normal strength, and nearly full active range of motion without instability (CUDR = 0.18). The patient has no problem continuing his current job as a machine builder. The modified Mayo wrist score was 95 and the score on the Disabilities of the Arm, Shoulder and Hand questionnaire was 5 points.