Uncommon Dorsal Radiocarpal Fracture Dislocation Complicated With Median Nerve Palsy: Case Report, Review of the Literature, and a New Classification System Guiding the Management

We report the case of a 36-year-old lorry driver who sustained left dorsal radiocarpal fracture dislocation and left median nerve injury in a traffic accident in 2010. Emergency operation of closed reduction, cross-wrist-bridging external fixation, percutaneous transradial styloid Kirschner wire fixation, decompression of left median nerve, and repair of the partially torn palmar radiocarpal ligament were performed under general anaesthesia. Because of the persistent depressed dorsal articular rim fracture of left distal radius, another operation of open reduction, corticocancellous bone grafting, and dorsal buttress plating was performed 5 days after the initial operation. Six months after the operation, the patient enjoyed good range of wrist motion but weak twisting power, especially in supination. There was no radiological feature of radiocarpal subluxation.

中文摘要本文報告一名三十六歲貨車司機在二零一零年一宗交通意外中遭受左手手腕橈骨及尺骨莖突骨折與橈腕關節背側脫位和正中神經受傷。他接受緊急正中神經減壓手術，橈骨莖突骨折復位及以鋼針內固定，橈腕關節背側脫位復位後並且以外固定支架固定，我們並將部份撕脫了的橈腕掌側韌帶修補。因橈骨背關節面邊緣仍然下陷，五天之後，他接受了第二次手術，我們以開放式復位方法、植骨、及以支持鋼板作內固定。手術後六個月他的左手手腕活動能力恢復良好，但是手腕的旋後力量較弱。X光顯示沒有橈腕關節半脫位的情況。