Bilateral dorsal trans-scaphoid perilunate fracture-dislocation: A case report

Abstract

Introduction: Perilunate dislocations represent one of the most devastating injuries to the carpus. Fortunately, these injuries are relatively rare, constituting approximately 10% of all carpal injuries. One of the problems associated with this injury is the difficulty of its accurate and early recognition.

Presentation of case: In this study, an uncommon case of bilateral dorsal trans-scaphoid perilunate fracture-dislocation following trauma has been reported. The injury was missed initially and the patient was subsequently operated after two weeks. Anatomic reduction was achieved by closed reduction. After closed reduction, percutaneous pin fixation of the carpus was performed using Kirschner wires. Finally, the scaphoid was stabilized with a headless screw percutaneously. The same procedure was repeated for the other wrist. This was followed by an uneventful post-operative period, with a satisfactory functional outcome at the two-year follow-up, despite non-union of the scaphoid in one side.

Discussion: The case was examined in detail, and compared to the findings in the literature; observations regarding fracture prognosis were also made. Most authors agree that closed reduction is the initial treatment of choice for trans-scaphoid perilunate fracture-dislocations. In addition, treatment often requires intercarpal fixation within the proximal carpal row.

Conclusion: We believe that closed reduction in these cases should be attempted regarding the potential risks of avascular necrosis and non-union of the affected carpal bones due to open reduction.

Keywords: Minimally invasive surgery; Non-union; Perilunate fracture–dislocation; Scaphoid fracture; Trans-scaphoid.

Fig. 1

Right wrist. (a) Anteroposterior and (b) lateral radiographs showing dorsal trans-scaphoid perilunate fracture–dislocation. The fracture through the waist of the scaphoid is clearly seen. Left wrist. (c) Anteroposterior and (d) lateral radiographs showing the same appearance as (a) and (b). Old avulsion fracture of the ulnar styloid was prior to this injury.

Fig. 2

Intra-operative photograph showing percutaneous fixation of the scaphoid fracture and percutaneous stabilization of the carpus with K-wires.

Fig. 3

Right wrist. (a) Anteroposterior and (b) lateral view immediately after anatomic reduction, stabilization of the carpus with K-wires and fixation of the scaphoid fracture. Left wrist. (c) Anteroposterior and (d) lateral radiographs showing the same appearance as (a) and (b).

Fig. 4

Right wrist. (a) Anteroposterior and (b) lateral view. The normal carpal bone relationships are still maintained with non-union of the scaphoid fracture on the X-ray findings at two-year after the operation. Left wrist. (c) Anteroposterior and (d) lateral radiographs. The normal carpal bone relationships are still maintained with the scaphoid fracture healed completely on the X-ray findings at two-year after the operation.