ulnar translocation

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PAPER 43

Traumatic Ulnar Translocation
of the Carpus: Diagnosis and
Treatment Strategies
Level 4 Evidence
􀁶 John C. Berschback, MD
􀁍 David M. Kalainov, MD
Sohail N. Husain, MD
􀁍 Thomas A. Wiedrich, MD
Mark S. Cohen, MD
􀁍 Daniel J. Nagle, MD
􀀩􀀺􀀱􀀰􀀵􀀩􀀦􀀴􀀪􀀴
Repair of injured structures in traumatic ulnar translocation of the
carpus does not ensure maintenance of normal radiocarpal alignment.
􀀮􀀦􀀵􀀩􀀰􀀥􀀴
Twelve patients, 13 cases, with traumatic ulnar translocation of
the carpus were identified: 8 cases were ligamentous injuries and
5 cases were ligamentous injuries in association with fractures.
Static x-rays revealed ulnocarpal translocation in 11 cases,
whereas stress views showed the instability pattern in 2 cases.
Treatment was initiated within 3.5 months of injury and included
wrist immobilization (2 cases), volar radiocarpal ligament repair
(5 cases), volar and dorsal radiocarpal ligament repair (1 case),
fracture fixation alone or in combination with volar radiocarpal
ligament repair (4 cases), and radioscapholunate fusion (1
case). Seven patients, 8 cases, were examined specifically for
the purpose of this study at a mean of 4.9 years after injury.
Information in 5 cases was obtained from medical records at a
mean of 10 months following injury. Radiocarpal and intercarpal
radiographic measurements were made using established
methods. Interobserver reliabilities of ulnocarpal translocation
measurements were calculated using Kendall's tau test.
􀀳􀀦􀀴􀀶􀀭􀀵􀀴
At final evaluation, 9 patients described intermittent wrist pain, and
3 patients reported no wrist pain. Each patient demonstrated loss
of normal wrist flexion and/or extension. A variable amount of ulnar
translocation was detected with static and/or dynamic radiographs
in 10 of 11 wrists with follow-up images. Degenerative arthritis
involving the radioscaphoid articulation developed in 5 of these
cases. There was good to excellent interobserver agreement for
measurements of ulnocarpal translocation.
􀀴􀀶􀀮􀀮􀀢􀀳􀀺􀀁􀀱􀀰􀀪􀀯􀀵􀀴
∙ Post-traumatic ulnar translocation of the carpus can result
from ligamentous injury alone or in association with fracture.
∙ Stress radiographs may be necessary for diagnosis.
∙ Restricted wrist motion is expected and intermittent wrist pain
may persist following surgical intervention.
∙ Early repair of radiocarpal ligaments does not ensure maintenance
of radiocarpal stability or preclude the development of arthrosis.





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