The purpose of this study is to demonstrate that early reduction and internal fixation of axial wrist dislocations, decompression of coexistant nerve compression injuries, and early wound closure or coverage can result in a pain free or minimally painful,stable wrist joint with sufficient preservation of radiocarpal motion and hand strength to allow return to manual labor.

Three patients were seen and treated over 12 years. All 3 were males. Etiologies were 1 motor vehicle accident, 1 crush from a punch press, and 1 crush in a cotton press. The patients ages were 29 (painter), 47 (machinist), and 80 (farmer) years. Two injuries occured in dominant hands, 1 in the nondominant hand. Two patients had ulnar axial dislocations and 1 had a combined radial and ulnar axial dislocation (Garcia-Elias classification). Each of the patients had an additional intercalary injury within one of the carpal rows. Two had additional metacarpal fractures.

Canulated screws and Kirschner wires were used to stabilize the axial dislocations and carpal bone. The metacarpal fractures were fixed with mini plates. Two patients had nerve decompressions in the wrist. One required a dorsal flap coverage.

Two patients were followed for one year, the other had 5 years of follow-up. Each had reached maximum improvement. The Mayo Clinic modification of the Green and O'Brien Wrist score was used to evaluate their results. Each patient bordered on poor to fair overall results (average 60 points out of 100, range 55-65)due to loss of wrist motion and grip strength. Midcarpal motion was completely lost in each patient, but each patient retained functional radial carpal motion (60 degrees or more flexion-extension arc) However, 2 patients were pain-free and one had only mild occasional pain with heavy activity and each returned to their pre-injury job (1 machinist, 1 painter, 1 farmer) with slight modifications within 6 months from the date of injury. Two patients completely recovered median nerve function, while 1 had severe ulnar intrinsic muscle deficit due to ulnar motor branch crush.

We concluded that outcome in these injuries highly correlates with initial severity , but that it may also be favorably influenced in terms of wrist alignment and stability, pain control, and sufficient recovery of wrist and digital motion and grip strength to restore patients to independent activities of daily living and to gainful manual employment by early stable skeletal fixation, early nerve decompression, wound closure or coverage, and rehabilitation.