Wrist Dislocation

Wrist Dislocation

Brooks Ficke

Nileshkumar M. Chaudhari


  • Definition

    • Dislocation of the radiocarpal joint, with or without

      • Radial styloid fracture

      • Dorsal or volar rim avulsion fractures

    • In the category of carpal instability nondissociative

    • This topic does not include articular shear fractures (“Barton” variants), perilunate dislocations, or instability related to distal radius malunion or rheumatoid arthritis.

  • Pathoanatomy

    • Proximal carpal row linked to distal radius by the volar (radioscaphocapitate [RSC], short radiolunate [SRL], long radiolunate[LRL]) and dorsal (dorsal radiocarpal [DRC]) extrinsic wrist ligaments

    • Radiocarpal dislocation requires either near-global ligament disruption or a fracture that disrupts the stability of the osseous insertion of the ligaments.

      • Volar ligaments are typically avulsed from their origin on the distal radius.

        • One report of avulsion distally from the carpal insertions1

      • If a radial styloid fracture is greater than one-third the width of the scaphoid fossa, the RSC and LRL origins usually remain attached to the fractured fragment.2

      • DRC and capsule may avulse small fragments from the dorsal distal radius.

    • Role of extrinsic wrist ligaments

      • Palmar structures provide majority of restraint against dorsal (61%) and volar (48%) translation of the carpus.3

      • SRL is the primary stabilizer against volar translation.4

      • RSC is primary stabilizer against ulnar translation,4,5 but alone is unable to prevent ulnar translation. RSC/LRL together can resist ulnar translation.6

    • Dorsal intercalated segment instability may predispose to dislocation.7,8,9

    • Associated injuries

      • Intercarpal ligament injury

      • Ulnar styloid fracture

      • Distal radioulnar joint (DRUJ) disruption

    • Secondary ulnar translation

      • Distal radius osteology (inclination, volar tilt) creates a tendency for ulnar and palmar translation, which is normally restrained by radiocarpal ligaments.6

      • Typically develops after wrist immobilization has been discontinued

      • Associated with radiocarpal arthritis and limited range of motion2

  • Mechanism of injury

    • Typically high-energy injuries

    • Axial load on hyperextended wrist, with aspects of shearing and rotation10,11

      • Additional pronation and torsion can lead to DRUJ disruption.2,12

      • The radial-based extrinsic ligaments (RSC, SRL, LRL), typically torn during radiocarpal dislocation, tighten with and resist pronation, suggesting that forceful pronation is a part of the injury mechanism.2

  • Epidemiology

    • Most frequent in young active men13

    • Direction of dislocation

      • Dorsal more common, volar quite rare (only 24 reported in literature)14

        • Ulnar extremely rare15,16

    • Pure ligamentous dislocation without any fractures is uncommon

    • Open injuries are rare, but have high (70%) incidence of neurovascular injury17


May 7, 2019 | Posted by in ORTHOPEDIC | Comments Off on Wrist Dislocation
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