Radiocarpal Fracture-Dislocations

Radiocarpal Fracture-Dislocations

Chris J. Williamson

Asif M. Ilyas


  • The average arc of motion in a normal wrist ranges from 68 degrees of flexion to 50 degrees of extension.10

  • Radiocarpal joint stability is provided by both the osseous joint articulation between the scaphoid and lunate bones and their corresponding fossae of the distal radius, along with the extrinsic radiocarpal ligaments and the wrist capsule (FIG 2).

  • Among the various volar radiocarpal ligaments, the primary ligaments important to radiocarpal stability are the short radiolunate and the radioscaphocapitate ligaments.

    • The short radiolunate ligament originates from the stout margin of the lunate facet of the volar distal radius and serves as the primary restraint against volar translation of the carpus.

    • The stout radioscaphocapitate ligament originates from the radial styloid and resists ulnar translation of the carpus.

  • The ulnocarpal ligaments, including the ulnolunate and the ulnotriquetral ligaments, take their origin from the ulnar styloid. Along with the triangular fibrocartilage complex (TFCC), they assist in providing radiocarpal and ulnocarpal joint stability.

  • The dorsal radiocarpal ligaments are highly variable12 and also assist in imparting stability to the radiocarpal joint, although to a much lesser extent than the volar radiocarpal ligaments.


  • Radiocarpal dislocations can occur in either a volar or dorsal direction, with dorsal being far more common (˜85%).4

  • The injury requires pronation and hyperextension of the wrist with a shear force across the joint. With increasing amounts of supination, the risk of a perilunate dislocation rather than a radiocarpal dislocation increases.11

  • Disruption of the radiocarpal ligaments, the most critical of which are the radioscaphocapitate and the short radiolunate, is necessary to dislocate the radiocarpal joint.

  • A pure dislocation without a bony injury is less common. More often, a fracture of the radial styloid, volar marginal rim, or ulnar styloid is identified representing an avulsion of the origin of the radioscaphocapitate, short radiolunate, or ulnocarpal ligaments, respectively.

FIG 2 • The extrinsic volar radiocarpal ligaments of the wrist include radioscaphocapitate (RSC), long radiolunate (LRL), short radiolunate (SRL), ulnolunate (UL), ulnotriquetral (UT) ligaments.


  • Radiocarpal dislocations are high-energy injuries most often seen in males aged 20 to 40 years.4,9

  • Mechanisms of injury are typically falls from a height, industrial injuries, and motor vehicle accidents.

  • The incidence of radiocarpal dislocations has been published to be as low as 0.2%5 of all hand and wrist dislocations.5 More recent studies have found incidence of radiocarpal dislocations to be as high as 2.7% of all distal radius fractures and wrist dislocations.9

  • Due to the high-energy nature of these injuries, there is a high association of associated injuries including neurologic injuries, vascular injuries, and open wounds.1,4,13

  • Residual radiocarpal instability and posttraumatic wrist degeneration is common, particularly with purely ligamentous injuries (Dumontier type 1).4


  • Radiocarpal dislocations typically present with a very swollen and painful wrist, with likely deformity (FIG 3).

  • Physical examination should include a thorough neurologic, vascular, and tendon examination.

    • Neurologic deficits, particularly of the median nerve, are common with displaced radiocarpal dislocations.

      FIG 3 • Typical deformity following a dorsally displaced radiocarpal dislocation.

    • Vascular embarrassment to the hand may occur with prolonged displacement and swelling.

    • Incarceration of the dorsal extensor tendons can occur pre- and postreduction.

  • Close inspection of the skin should also be performed, as open wounds can also be present possibly signifying an open arthrotomy of the wrist or an associated open fracture.16

  • A full secondary survey is mandatory, as these injuries are typically high-energy and may be associated with concomitant fractures of other limbs and visceral injuries,14 which have been reported to occur in 58% and 37% of cases, respectively.4


Jul 22, 2016 | Posted by in ORTHOPEDIC | Comments Off on Radiocarpal Fracture-Dislocations

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