SCIENTIFIC ARTICLE Ulnar to Radial Dorsal Fracture-Dislocations of the Wrist: A Report of 2 Cases Diederik H. van Leeuwen, MD, Geert A. Buijze, MD, David Ring, MD, PhD This report describes 2 patients with apparent ulnar to radial dorsal fracture-dislocation: 1 had a transtriquetrum, translunate fracture dislocation and the other had a reverse stage 2 lesser arc perilunate dislocation with fracture of the ulnar styloid at its base. (J Hand Surg 2012;37A:500– 502. Copyright © 2012 by the American Society for Surgery of the Hand. All rights reserved.) T HE WRIST DISLOCATES dorsally around the lu- nate (midcarpal) more often than at the radio- carpal articulation. 1 Mayfield and colleagues 2 described a progression of dorsal perilunate wrist dis- locations from radial to ulnar, starting with rupture of the scapholunate ligament (stage 1), followed by capi- tate dislocation and opening of the space of Poirier (stage 2), then lunotriquetral injury (stage 3), and finally lunate dislocation, usually volar. The progression some- times seems to progress in the opposite direction, from ulnar to radial. Little has been written about these ap- parent ulnar to radial dorsal perilunate dislocations. 3,4 This report describes 2 patients with apparent ulnar to radial wrist fracture-dislocations, 1 of which was peri- lunate and the other of which was translunate. PATIENT 1 A 23-year-old man was an unrestrained driver in a rollover motor vehicle collision. Upon presenta- tion, the patient’s only symptom was pain in the right hand. He had tenderness, swelling, and de- formity of the right wrist and a 2-cm wound on the ulnar side of the wrist. Ulnar nerve dysfunction was diagnosed later but not noted initially. Using the image intensifier in the emergency department, a dorsal wrist fracture-dislocation was diagnosed and a manipulative reduction was performed. Ra- diographs and a computed tomography scan of the wrist after reduction revealed fractures of the ulnar styloid, pisiform, triquetrum, and lunate (Figs. 1, 2). We made a dorsal-ulnar approach incorporating the open wound. The extensor digiti quinti and the extensor carpi ulnaris tendons were ruptured. The ulnar nerve was intact and the ulnar artery was intact but throm- bosed. The scapholunate ligament was intact. Our im- pression was that the injury forces had pulled the wrist from ulnar to radial, tearing the skin, avulsing tendons, and fracturing the triquetrum and lunate. We fixed the lunate and triquetral fractures with 3.0-mm headless bone screws (Synthes, Ltd., Paoli, PA) (Fig. 3). We repaired the extensor digiti quinti and extensor carpi ulnaris with nonabsorbable sutures. After the surgery, a below elbow arm cast was applied for 4 weeks followed by active range of motion exercises. After 7 months, the patient had full range of motion of the digits and forearm, and wrist flexion and exten- sion were half-normal compared with the opposite, uninjured wrist. Ulnar nerve function was near normal. Radiographs showed union of the fractures and no signs of osteonecrosis (Fig. 3). PATIENT 2 A 27-year-old man visited the emergency department after a fall on his outstretched right hand the day before. The patient was experiencing increasing pain, swelling, and difficulty moving the right hand and elbow. There was an abrasion on the volar side of the wrist. There From the Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA. Received for publication September 4, 2010; accepted in revised form December 14, 2011. D.R. is a consultant for Acumed, Biomet, and Tornier and receives royalties from Biomet. Corresponding author: David Ring, MD, PhD, Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114; e-mail: dring@partners.org. 0363-5023/12/37A03-0015$36.00/0 doi:10.1016/j.jhsa.2011.12.029 500  ©  ASSH  Published by Elsevier, Inc. All rights reserved.