Reconstruction of isolated scaphoid dislocation with carpal dissociation, associated with a carpal anomaly

Abstract

A case is presented of isolated scaphoid dislocation with carpal dissociation in the presence of a lunato-triquetral coalition. We present the treatment and follow-up of this case. In addition, the literature on scaphoid dislocation and its treatment is reviewed. We emphasize the need to reconstruct the carpal alignment and scapho-lunate linkage.

Keywords: Axial carpal dissociation; Carpal trauma; Lunato-triquetral coalition; Scaphoid dislocation.

Fig. 1

An isolated scaphoid dislocation with carpal dissociation with a carpal anomaly. The sequella of a conservatively treated ulnar fracture 34 years earlier is still visible

Fig. 2

Reconstruction of the traumatic situation on a sawbone, showing clearly the amount of displacement and involved carpal bones

Fig. 3

Comparison X-ray of the right wrist showing a fibro-cartilaginous coalition of the lunate and triquetrum

Fig. 4

Operative steps (a–d) as described in the text. a Initial situation. b After stabilization with an external fixator. c Scapho-lunate dissociation corrected with Mitek^® bone anchors. d Final situation after placement of the FFS^® wires, realigning the bases of the metacarpals and establishing carpal alignment

Fig. 5

The situation immediately after operative repair

Fig. 6

Clenched fist radiograph compared with the relaxed condition

Fig. 7

Thearcs of Gilula drawn on another patient’s X-ray with an os lunato-triquetrum. Thefirst arc is along the proximal border of the proximal carpal row, thesecond along the distal border of the proximal carpal row, and thethird along the border of the distal carpal row