Surgical treatment of the dislocations and fracture dislocations of carpal bones

Abstract

The aim: Dislocations and fractures - dislocations of the carpal bones of the wrist are serious injuries. The problems of diagnosis and treatment of the these lesions are discussed extensively in specialty literature, but the diagnostic mistakes committed during the acute dislocation and fracture-dislocations of the carpal bones reaches 60%, a fact which shows the increasing number of outdated injuries difficulties in treatment and unfavorable functional outcomes. Materials and methods: In department of the Hand surgery CHTO for 2006-2015 were found on stationary treatment 89 patients with dislocations and fracture-dislocations of the carpal bones. The most frequent were traumatized in the period of working age - to 40 years - 70 (79%) patients. The analysis of clinical cases demonstrated that causes of the outdated injuries were diagnostic errors to 43 (50%) patients, treatment errors in 18 (20%) patients and the associated concomitant injuries 22 (25%). As the surgical treatment, indications were failures orthopedic reduction of the dislocation and fracture - dislocations of the carpal bones, fragments displacements scaphoid bone and outdated perilunat injuries. Results: Open reduction of dislocation and fracture-dislocations of the carpal bones was performed in 78 (87.6%) patients, of whom 36 (40.4%) open reduction was performed in one-step, but in others 42 (47, 2%) patients open reduction was performed in two stages with the use of preventive external fixator for ligamento-capsulo-taxis of the wrist. On 8 (9%) patients with outdated perilunate fracture-dislocations have been performed selective arthrodesis by 4 carpal bones with excision the fragments scaphoid bone. In a patient with degree V of perilunate dislocation - with enucleation lunate bone in the forearm was performed replanting of lunate bone, and in another patient was performed excision lunate bone. Conclusions: The procedures of the surgical treatment of dislocation and fractures-luxations of the carpal bones have facilitated the obtaining of positive results in 81 (91%) patients.