Single-Person Reduction of Ipsilateral Elbow, Lunate, and Scaphoid Dislocation: A Review of the Literature

Abstract

Here, we present a novel emergency department reduction for a rare case of dissociative scaphoid and lunate dislocation with an ipsilateral elbow dislocation. Dissociative scaphoid and lunate dislocations have rarely been described in the literature. Most often, the reduction is performed on an urgent basis in the operating room because of the difficulty of closed reduction and associated complications, such as acute carpal tunnel syndrome. We illustrate and describe the setup and stepwise reduction techniques of ipsilateral elbow, scaphoid, and lunate dislocations, without the use of an assistant. A review of the current literature, a description of the patient's operative management, and 2-year follow-up data are provided.

Keywords: Dislocation; Elbow; Lunate; Reduction; Scaphoid.

Figure 1

Injury films of A AP and B lateral radiographs demonstrating a simple posterior elbow dislocation. C AP and D lateral radiographs demonstrating volar dislocation of the lunate and the scaphoid. AP, anterior-posterior.

Figure 2

Postreduction elbow films, including A AP and B lateral radiographs demonstrating congruent closed reduction of the posterior elbow dislocation. AP, anterior-posterior.

Figure 3

A Clinical photographs showing the emergency department setup using an IV pole and Kerlix to hang the upper extremity from the index and middle fingers. B–E Photographs demonstrating the reduction technique with traction, B, C milking the distal forearm from proximal to distal, D followed by traction, flexion, and a volar-to-dorsal force on the scaphoid-lunate complex, E then wrist extension. IV, intravenous.

Figure 4

A Lateral view showing volar dislocation of the lunate and the scaphoid. Sequential films demonstrating closed reduction of B the scaphoid first, then C the lunate.

Figure 5

Postoperative A AP and B lateral radiographs demonstrating pin fixation of the scaphoid and the lunate with additional scapholunate ligament repair using suture anchors. AP, anterior-posterior.

Figure 6

A, B 10-month and C, D 2-year postoperative AP and lateral films demonstrating minimal degenerative changes to the radiocarpal and intercarpal joints. No obvious avascular necrosis of the lunate or the scaphoid. AP, anterior-posterior.