Taleisnik J, Watson H K
J Hand Surg Am. 1984 May;9(3):350-7. doi: 10.1016/s0363-5023(84)80222-1.
Thirteen patients with malunited fractures of the distal radius developed symptoms of pain and instability of the midcarpal joint. In six cases, a recurrent voluntary midcarpal subluxation was also present during ulnar deviation. These symptoms were first noticed several weeks, and at times several months, after all immobilization for the treatment of the original fracture had been discontinued. We believe that the loss of the normal palmar tilt of the distal articular surface of the radius prepositions the carpus in a dorsal collapse alignment, which enables this instability to develop. Although the instability is localized to the midcarpus , it is treated best, in our opinion, by a corrective osteotomy of the distal radius. In nine patients, osteotomies resulted in relief of preoperative symptoms and correction of midcarpal instability. In one patient, osteotomy of the radius was deemed unnecessary because the loss of palmar tilt of the radius was minimal. Instead the midcarpal ( triquetrohamate ) joint was stabilized by ligament reconstruction. Only transient correction was obtained, with later recurrence of the voluntary midcarpal subluxation.
13例桡骨远端骨折畸形愈合患者出现腕中关节疼痛和不稳定症状。6例患者在尺偏时还存在复发性的腕中关节半脱位。这些症状在最初治疗骨折的所有固定措施停止数周，有时数月后首次出现。我们认为，桡骨远端关节面正常掌倾角的丧失使腕骨处于背侧塌陷对线，从而导致这种不稳定的发生。尽管这种不稳定局限于腕中关节，但我们认为，最好通过桡骨远端截骨术进行治疗。9例患者截骨术后术前症状缓解，腕中关节不稳定得到纠正。1例患者因桡骨掌倾角丧失极小，认为无需进行桡骨截骨术。取而代之的是，通过韧带重建稳定腕中（三角钩骨）关节。仅获得了短暂的矫正效果，随后复发性的腕中关节半脱位再次出现。
