Palmar-divergent dislocation of the scaphoid and the lunate

Abstract

We describe a patient with palmar-divergent dislocation of the scaphoid and lunate. After successful closed reduction, the scapholunate and lunotriquetral ligaments were sutured through the dorsal approach, and the anterior capsule was sutured through the palmar approach. The scapholunate and lunotriquetral joints were fixed with Kirschner wires for 7 weeks. At the 1-year follow-up, magnetic resonance imaging showed no evidence of avascular necrosis of the scaphoid or lunate, and radiographs showed no evidence of the dorsal and volar intercalated segment instability patterns associated with carpal instability. However, flexion of the scaphoid and a break in Gilula's line remained. To our knowledge, this is the first report showing treatment of palmar-divergent dislocation of the scaphoid and lunate by suturing the carpal interosseous ligaments.

Fig. 1

Radiographs at initial diagnosis showing palmar-divergent dislocation of the scaphoid and lunate

Fig. 2

Postoperative radiographs showing good alignment of the carpal bones. The scapholunate angle was 54° and the radiolunate angle 6°. Gilula’s line was well-regulated

Fig. 3

Radiographs at the 1-year follow-up. The scapholunate angle was 67° and the radiolunate angle 0°. Dorsal intercalated segment instability (DISI) deformity was not observed, although there was flexion of the scaphoid and a break in arc II of Gilula’s line at neutral and ulnar deviation

Fig. 4

Magnetic resonance imaging at the 1-year follow-up showing no evidence of avascular necrosis of the scaphoid and lunate