Pediatric Traumatic Dorsal Nondissociative Carpal Instability Following a Distal Radius Fracture: A Case Report of a Rare Complication.

Distal radius fractures are among the most common pediatric injuries. While these fractures typically have a good prognosis with nonsurgical treatment, complications, such as ligamentous injuries, can occur even in well-aligned fractures, as seen in this case. We present a rare case of progressive dorsal midcarpal instability in a 12-year-old boy with a nondisplaced distal radius fracture treated conservatively. Despite maintaining fracture alignment, the patient experienced a progressive instability pattern over 6 weeks, confirmed by radiographs and magnetic resonance imaging, which revealed ligamentous injury. Surgical management, including open reduction, ligament repair with an anchor suture, and temporary K-wire (1.4mm) fixation, successfully restored carpal alignment and resulted in excellent functional recovery. This case underscores the importance of clinical vigilance for ligamentous injuries in pediatric distal radius fractures, even when initial radiographs appear normal. Prompt recognition and surgical intervention are critical to prevent long-term instability and functional impairment.