Traumatic axial dislocations of the carpus

Among 1140 patients treated in the last 16 years for any type of carpal fracture, dislocation, or subluxation, 16 (1.4%) patients seen with a traumatic axial disruption of both the carpus and metacarpus were identified. Most of these were crush or blast injuries. According to the direction of instability, the cases were classified into three groups: axial-ulnar disruptions (4 patients), axial-radial disruptions (11 patients), and combined axial-radial-ulnar disruption (1 patient). Treatment consisted of open reduction and percutaneous Kirschner-wire fixation in most cases. The results were less optimistic than suggested in the literature. An average follow-up of 61 months showed that prognosis was determined more by the associated soft tissue injuries than by the carpal derangement itself. Early management of both the skeletal and soft tissue components of the injury seems most effective.