PRESENTASI JOURNAL READING

Traumatic Axial Dislocation Injuries of the

Wrist

Oleh:
Atika Rinda Saleh 1710221050
{
Pembimbing :
dr. Novita Elyana R, Sp.Rad

KEPANITERAAN KLINIK DEPARTEMEN RADIOLOGI

RUMAH SAKIT UMUM DAERAH AMBARAWA
UNIVERSITAS PEMBANGUNAN NASIONAL “VETERAN” JAKARTA
FAKULTAS KEDOKTERAN
2018
Anatomy of wrist
 Wrist muscles:
 Thenar muscle (musculus abductor pollicis
brevis, musculus flexor pollicis brevis, and
musculus opponens pollicis)
 Hypothenar muscle
 Adductor pollicis muscle
 Short muscles (musculi lumbricales and musculi
interossei between ossa metacarpi)
 Hand vascularization:
 Ulnar artery
 Radial artery
  Carpal dislocations and fracture dislocations
are infrequent injuries that usually result from
high-energy trauma such as motor vehicle
collisions, falls, or industrial accidents.
 These occur mostly in men in the 3rd and 4th
decades of life

Definition
 Axial carpal dislocations and fracture
dislocations result from high-energy
dorsopalmar compression of the wrist,
producing combined derangement of the distal
carpal row and metacarpal arch with resultant
flattening of the proximal and distal transverse
arches of the wrist.
  The nomenclature for these axial carpal
dislocations uses the prefix “peri-” to denote
that the dislocation is around a bone and
“trans-” to indicate the dislocation is associated
with a fracture through that bone.

 In this journal there are two injuries that the

writer discussed:
 Axial Ulnar Carpal Injuries
 Axial Radial Carpal Injuries

Classification
 Axial Ulnar Carpal Injuries
 The three most common axial ulnar carpal
injuries are the transhamate peripisiform axial
ulnar fracture dislocation, the perihamate
peripisiform axial ulnar dislocation, and the
perihamate transtriquetrum axial ulnar fracture
dislocation
 A less-extensive variant is the transhamate axial
ulnar fracture dislocation, which has a distal
hamate fracture that is dislocated or subluxed
with the fourth and fifth metacarpals without
pisiform displacement (fig 4)
 Axial Radial Carpal Injuries:
 The three most common axial radial carpal
injuries are the peritrapezoid peritrapezium axial
radial dislocation, the peritrapezium axial radial
dislocation, and the transtrapezium axial radial
fracture dislocation
  The role of the radiologist in evaluating a
patient with an axial carpal dislocation or axial
fracture dislocation should focus on
determining the injury path as it propagates
through the carpus
 In less severe cases, fluoroscopy with dynamic
motion examination, computed tomography
(CT), or magnetic resonance imaging may
supplement these views because dislocation
may not be obvious on radiographs despite a
significant internal derangement.

Radiographic evaluation
 The diagnosis is aided by knowledge of normal
carpal anatomy, as well as an understanding of
the normal parallelism between articulating
structures in the wrist
  Open axial carpal dislocations and fracture
dislocations are surgical emergencies
 Surgical exploration by means of a palmar
approach is customary
 All damaged structures are repaired or grafted
primarily or are covered with local or distant
flaps if the injured structures cannot be
repaired primarily

Treatment
 Thorough debridement of contaminated and/or
nonviable tissue is a usual next step
 Patients should be evaluated for compartment
syndrome
  We have discussed radiographic findings of axial
carpal disruptions and explained the role of the
radiologist in the diagnosis and management ofthese
uncommon but often severe injuries
 Determining the exact path of the injury and
identifying associated soft-tissue injury are important
in helping to achieve a favorable outcome for the
patient
 This review includes the six most common types of
axial ulnar and axial radial carpal injuries and some of
their variations
 As radiologists become more familiar with these
injuries, more types of these radial and ulnar axial
dislocations and fracture dislocations may be
identified.

Conclusion