INTER-CARPAL DISLOCATIONS AND FRACTURE-DISLOCATIONS

¹ The Fracture and Orthopaedic Service of the Royal Air Force, the Victoria Infirmary, Glasgow, Glasgow, Scotland

1. Fifty-nine patients with various inter-carpal dislocations have been reviewed.

2. In this series trans-scapho-perilunar fracture-dislocation was the commonest injury. Early cases can be reduced by closed manipulation but in late cases operative reduction is usually advisable. When the injury is more than three months old, arthrodesis of the wrist joint is indicated.

3. When trans-scapho-perilunar fracture-dislocation was complicated by avascular necrosis of the proximal scaphoid fragment, the results in a small series treated by early excision were approximately equal to those treated by continued immobilisation. The results of grafting the scaphoid were poor.

4. Dislocations of the lunate seen within ten days of injury could usually be reduced with good results; no such case developed Kienböck's disease within the period of review. In late cases excision gave satisfactory results.

5. Forward dislocation of the lunate with half the scaphoid gave good results when manual reduction succeeded, but the results of excision of fragments were less satisfactory.

6. There was one case of forward dislocation of the lunate together with the distal half of the scaphoid.

7. Subluxation of the scaphoid is disclose in antero-posterior radiographs by a typical gap between it and the lunate bone. The subluxation may become recurrent and present a characteristic syndrome.

8. Other rare dislocations of the carpal bones are described.