[Volar transcaphocapitate perilunate disclocation of the carpus: a new variety, a new approach]

On the one hand, surgical treatment of dorsal perilunate fracture-dislocation is now well codified. The posterior approach is preferred by the majority of the authors. On the other hand, surgical schedule for volar perilunate dislocation is not well establish in the literature. The anterior approach is the most frequently recommended. In case of Fenton's syndrome (scaphocapitate fracture), the head of the capitatum is described with a rotation of 180 degrees. The authors reports a case of a volar transcaphocapitate perilunate fracture-dislocation of the carpus in a polytrauma. The head of the capitatum was in place onto the neck. By a posterior approach, a primary repair of all the elements has been performed including open reduction and internal fixation of the carpal scaphoid fracture in addition with a bone graft. The capitatum were fixed by wiring. At two years follow-up, the result were good. The patient did return at the same work. Clinically, there was a range of motion of 70 degrees in flexion-extension. Radiologically, all the fractures healed and there were no intracarpal desaxation. Volar perilunate fracture-dislocation of the carpus and Fenton's fracture (scaphocapitate fracture) are two exceptional entities in the literature. Association of both lesions has been found only twice in the literature. No similar case with a head of the capitatum in place has been already described.