The volar shearing distal radius fractures associated with subluxation or dislocation of the carpus were first described by Barton in 1838. To our knowledge there is no literature regarding spontaneous radiocarpal dislocation during an osteosynthesis recovery of a Barton's fracture. This article describes the treatment and outcome of a case of a patient submitted to radius osteosynthesis with an anatomic volar distal radius plate. After the cast removal he started to feel pain, with no history of associated trauma. Imaging showed a Dumontier type II dorsal radiocarpal dislocation. It was reduced through a double approach of the radius, and a radiocarpal fixation with 3 Kirschner wires was performed. There were no perioperative complications. The imobilization and the kirschner wires were maintained for 7 weeks. After removing the cast and the kirschner wires, the patient presented flexion of 20°and extension of 15°, which improved up to flexion 30° and extension 60°, supination 60°, with preserved pronation, 24 months after the trauma. At this time, the patient reports no pain, feeling of instability or signs of nerve compression. The DASH disability score result was 3, 1 and the Mayo Wrist Score was 93. The radiograph control did not show any relevant alteration. In the presence of a comminuted distal radius fracture two-dimensional and even three-dimensional computed tomographic scans may well provide important additional information preoperatively and in selected cases a temporary external fixation may prevent displacement of volar fragment.
http://www.lupinepublishers.com/orthopedics-sportsmedicine-journal/abstracts/radiocarpal-dislocation-a-complication-after-distal-radius-osteosynthesis.ID.000104.php
http://www.lupinepublishers.com/orthopedics-sportsmedicine-journal/pdf/OSMOAJ.MS.ID.000104.pdf
http://www.lupinepublishers.com/orthopedics-sportsmedicine-journal/fulltext/radiocarpal-dislocation-a-complication-after-distal-radius-osteosynthesis.ID.000104.php
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