[Bipolar dislocation of the forearm: elbow and perilunate dislocation].

Area of Science:

• Orthopedic Surgery
• Traumatology
• Hand and Wrist Surgery

Background:

• Fenton's syndrome is a rare and complex injury involving simultaneous posterior elbow dislocation and transcaphocapital retrolunate carpal dislocation.
• This condition often presents with associated fractures, significantly complicating management and prognosis.

Observation:

• A patient presented with a severe bifocal dislocation of the forearm, comprising posterior elbow dislocation and transcaphocapital retrolunate carpal dislocation (Fenton's syndrome).
• The injury was associated with fractures of both the radius and ulna, necessitating immediate surgical intervention.

Findings:

• Surgical management involved open reduction and internal fixation of the elbow and forearm fractures, along with reduction and osteosynthesis of the carpal dislocations.
• Techniques included posterior and anterior surgical approaches, radial styloid fixation, and temporary pinning of multiple wrist joints (scapholunate, triquetrolunate, scaphocapitate, radiolunate).
• At ten months post-surgery, the patient exhibited restored elbow range of motion, moderate pain only with exceptional exertion, and good wrist flexion/extension (50°/30°).

Implications:

• This case highlights the successful surgical management of Fenton's syndrome, demonstrating that complex bifocal dislocations can achieve favorable functional recovery.
• The study underscores the importance of a comprehensive surgical approach addressing both the elbow and carpal components for optimal outcomes in such rare injuries.
• Findings suggest that timely and appropriate surgical intervention can lead to union of carpal bones and restoration of normal wrist biomechanics.