A Clinical Study of Fractures and Dislocations of the Carpus

Chang, Jun Dong; Shin, Sung Il; Chang, Kyun Ho

Abstract

In the fractures and dislocations of the carpus, prompt and accurate diagnosis is the prime prerequisite for restoring function to this most complicated joint in the body. And then, early precise reduction and continuous maintenance of the reduced position until ligamentous and bone healing is complete provide the best chance of achieving a satisfactory restoration of function. We analysed forty five cases of fractures and dislocations of the carpus which were treated for 5 years from Jan. 1984 to Dec. 1988 at the Department of Orthopedic Surgery, College of Medicine, Hallym University. The following results were obtained; l. Of the total 45 injuries, scaphoid fractures were seen in 32(71.1%), other carpal bone fractures except scaphoid in 13 patients(28.9%), and carpal bone dislocation and fracture- dislocations in 11 patients(24.4%). 2. Carpal scaphoid fracture 1) 19 of the 32 patients(59.4%) had an associated ipsilateral upper extremity injury. 2) This fracture was common in the young male. 3) A union rate(95.6%) was achieved using a usual conservative treatment for undisplaced racture(14), operative treatment for displaced(18). 4) The mean time to radiological union for all fractures was 11.1 weeks. Old fracture by SotoHall classification took the longest time to union(18.2 weeks), subacute fracture 13 weeks, and acute fracture 9 weeks. 5) 10 cases were treated for nonunion, 5 of 10 nonunions were classified as type (50%). 2 cases showed ultimately nonunion in spite of various sorts of treatment, which belonged to waist fracture. 3. Other carpal bone fractures except scaphoid were seen in 13(15 bones) of 45 injuries, and pisiform(4) and triquetrum(4) fractures were common. 4. Carpal dislocation and fracture-dislocations were seen in 11 of the 45 injuries and dorsal transscaphoid perilunate dislocations(4) were common. These were treated by C.R. and cast immobilization or O.R. and K-wire fixation relatively good results were obtained.