Isolated Scaphoid Dislocation: A Case Report and Review of the Literature

Abstract

Background Isolated scaphoid dislocation is an exceedingly rare event with only 55 cases described. Closed reduction followed by operative intervention with Kirschner's wires (K-wire) fixation and ligamentous reconstruction are the mainstays of treatment. Case Description We describe a patient with a solitary scaphoid dislocation treated with initial closed reduction and urgent open reduction with K-wire stabilization and ligamentous repair. The patient was immobilized for 6 weeks and on 24-month follow-up, the patient was doing well with no limitations in his daily living, no pain, and acceptable range of motion. Literature Review A literature review was performed on the 55 cases described in the English language. The majority of the patients were males, aged between 18 and 79 years, and presented with motor vehicle accidents as the most common mechanism. Historically, isolated scaphoid dislocations were treated with closed reduction. However, K-wire fixation and, now, K-wire fixation coupled with ligamentous injury repair remain the current treatments of choice. Avascular necrosis of the scaphoid remains a rare event with only one documented case. Overall, patients do well with only minor pain and limited wrist movements. Notably, only eight cases were associated with type-II lunates. Type-II lunates appear to be protective for carpal injury. Clinical Relevance Although isolated scaphoid dislocations remain a rare event, understanding the anatomy and the current ability to restore carpal anatomy is important. Type-II lunates appear to confer protection from carpal injuries.

Keywords: carpus; lunate morphology; perilunate dislocation; scaphoid dislocation; scaphoid vascularity.

Fig. 1

Anteroposterior radiograph showing acute radial dislocated right scaphoid.

Fig. 2

Fluoroscopic image taken after successful closed reduction.

Fig. 3

( A ) Operative reduction through dorsal incision. ( B ) Volar tear through space of Poirier at the radioscaphocapitate ligament. Arrow points to torn radioscaphocapitate ligament ( C ) Volar tear repaired with sutures. Arrow points to repaired tear through the space of Poirer. R, radius; S, scaphoid; L, lunate; C, capitates.

Fig. 4

Suture anchors are placed at dorsal tubercle of the scaphoid to reconstruct the dorsal capsule and the tubercle of the triquetrum.

Fig. 5

Intra-operative fluoroscopy showing Kirschner's-wire fixation.

Fig. 6

Final postoperative radiographs showing maintenance of scaphoid reduction and healed pisiform fracture.