The diagnosis and treatment of Criss-Cross injury of the forearm: A retrospective analysis

Background: Due to the paucity of 'Criss-Cross' injury, the pathological changes and injury patterns have not been clearly described; as well as the treatment and prognosis. This retrospective study aimed to investigate the treatment and clinical outcomes of 'Criss-Cross' injury of the forearm.Methods: All patients diagnosed with Criss-Cross injury meeting the inclusion and exclusion criteria in our Level 3 hospital (most advanced level) from 2010 to 2022, were enrolled in the study. A total of 12 patients were enrolled in our retrospective analysis. Closed reduction was successful in 3 patients, open reduction performed in the remaining patients. 6 patients associated with a fracture, while 2 cases had a concomitant convergent elbow dislocation. The follow-up time in conservative patients was 23.0 months on average (3-51 months), while 38.4 months in surgery group on average (3-108 months). The forearm function was evaluated with the Anderson's forearm function score. The range of motion (ROM) of the elbow and wrist and forearm rotation including any complications was also documented during the follow-up.Results: On final follow-up, ROM of the elbow, wrist, and forearm rotation significantly improved after conservative treatment (50.0 +/- 24.5(degrees) to 128.3 +/- 2.9(degrees), 55.0 +/- 7.1(degrees) to 166.7 +/- 5.8(degrees), 83.3 +/- 20.8(degrees) to 165.0 +/- 15.0(degrees), respectively, p < 0.001) and surgical treatment (41.7 +/- 22.4(degrees) to 102.8 +/- 21.1(degrees), 42.2 +/- 16.4(degrees) to 125.6 +/- 25.1(degrees), 34.4 +/- 26.5(degrees) to 138.3 +/- 22.6(degrees), respectively, p < 0.001). However, compared with the contralateral side, there were still significant difference regarding the ROM of the elbow (102.8 +/- 21.1(degrees) to 143.9 +/- 4.9(degrees)), wrist (125.6 +/- 25.1(degrees) to 167.8 +/- 5.1(degrees)), and forearm rotation (138.3 +/- 22.6(degrees) to 163.3 +/- 3.5(degrees)) after surgical treatment (P < 0.01). Anderson's Forearm Function Score was excellent in all conservative cases and 2 of 9 patients treated with operation. 2 patients complained about occasional elbow locking, wrist pain and reduced power after conservative treatment. 2 patients reported ulnar neuritis after the operation, one of which was treated with anterior transposition of the ulnar nerve.Conclusion: The Criss-Cross injury could be associated with different fractures and/or simultaneous convergent elbow dislocation. The basic principle of treatment is to reduce both PRUJ and DRUJ by closed reduction or surgery, with early rehabilitation. Most of the patients regained good forearm function after receiving either conservative or surgical treatment.