Open Radiocarpal Fracture Dislocation with Neurological Deficit Treated with Standalone External Fixation and Kirshner-Wires: Evaluation of Functional and Radiological Outcomes in a 4-Year Follow-Up: A Rare Case Report.

Background and Clinical Significance: Radiocarpal fracture dislocations (RCFDs) are rare injuries of the wrist, while open RCFDs represent a small subgroup of these injuries. Limited data exists regarding the optimal method for their management. Our study's objective is to present a rare case of an open (Gustilo-Anderson type II) dorsal radiocarpal dislocation in combination with fracture of the radial and ulnar styloid and neurologic deficits (superficial radial, median and ulnar nerve), which was treated with external fixation and Kirshner wire pinning. External fixation and Kirshner wire pinning could be a viable surgical option for complicated open RCFD. Case Presentation: Adequate reduction and ligamentotaxis using an external fixation were achieved, while the radial styloid fracture and the distal radioulnar joint (DRJ) were stabilized with Kirshner wires. Postoperative radiographs and clinical evaluation confirmed satisfactory reduction in the right wrist, without signs of intercarpal instability. Total nerve recovery was observed 6 months postoperatively and the patient was able to return to his previous occupation. At the final follow-up (4 years), the Visual Analogue Scale score was 1/10 and the Quick Dash score was 11/100 with good range of motion (flexion: 0-75°, extension: 0-70°, pronation: 0-80°, supination: 0-80°) of the affected wrist, although progressive wrist arthritis and ulnar migration was seen in the plain X-rays.

Conclusions

Surgical treatment of RCFDs is required for complex or unstable fractures/dislocations to avoid possible complications, such as intercarpal instability.