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Case Reports
. 2022 Sep 1:9:917555.
doi: 10.3389/fsurg.2022.917555. eCollection 2022.

Non-traumatic scapholunate dissociation in a 10-year-old female: A case report

Diletta Bandinelli  1 , Alessia Pagnotta  2 , Edoardo Maria Pieracci  3 , Luca Basiglini  1 , Angelo Gabriele Aulisa  1   4
Affiliations
Case Reports

Non-traumatic scapholunate dissociation in a 10-year-old female: A case report

Diletta Bandinelli et al. Front Surg. .

Abstract

Introduction: Severe or minor repetitive trauma, inflammation, infection, tumors, and congenital ligamentous laxity have been etiologically implicated in scapholunate dissociation (SLD). While a few cases of patients with asymptomatic SLD have been reported in the literature, despite radiographically demonstrated widened scapholunate angles and rotatory subluxation of the scaphoid bone, these patients experienced only mild or no pain and no dorsal intercalated segment instability deformity. Here, we report the case of a monolateral non-traumatic SLD in a young 10-year-old girl that led to an important range of motion impairment with no wrist pain. The case represents a rarity for no previous history of trauma, young age, and no pain.

Main symptoms and important clinical findings: In our patient, an examination revealed a reduced range of motion in the left wrist and no pain during passive or active mobilization. The X-ray showed a 16 mm scapholunate gap in the anteroposterior roentgenogram. In this case, we suggested that congenital or developmental ligamentous laxity may be the cause of SLD. The diagnostic assessment was completed with a wrist MRI and CT.

Therapeutic interventions and outcomes: The patient underwent an open dorsal surgery: we directly reduced the dislocated bones and fixed them with five percutaneous 1 mm k-wires. Finally, the scapholunate ligaments were repaired using bone-absorbable anchor sutures. The wrist was immobilized in a volar cast for 8 weeks. The patient was able to resume her daily life activities (included sport) within 12 months.

Conclusion: Carpus injuries are rare in children, and treatment, especially for young-age patients, is fraught with risks and remains controversial. Our case demonstrates that the patient has had a good clinical outcome. The physio-rehabilitation program for this patient has been of long duration. Most previous studies have shown excellent clinical results after an average of 2.4 years.

Keywords: carpal injuries; child; non-traumatic; scapholunate dissociation; young age.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Presurgery X-ray: a comparison between an injured wrist (left) and a healthy wrist (right) in PA and lateral views; measuring the scapho-lunate distance and angle.
Figure 2
Figure 2
Postsurgery X-ray: carpal bones reduced and fixed with k-wires.
Figure 3
Figure 3
Wrist mobility 10 months after the performance of the surgery.
Figure 4
Figure 4
An injured wrist X-ray 10 months after the surgery.
See this image and copyright information in PMC

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