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Palmar lunate transtriquetral fracture dislocation
W J Skelly1, S H Nahigian, E B Hidvegi
1Saint Luke's Hospital, Cleveland, Ohio.
The Journal of Hand Surgery
|May 1, 1991
Summary
A rare wrist injury, palmar lunate transtriquetral fracture dislocation with radial styloid avulsion, was treated. Successful reduction required addressing triquetral malrotation, highlighting its importance in perilunar instability.
Area of Science:
- Orthopedics
- Hand Surgery
- Traumatology
Background:
- Perilunar instability encompasses a spectrum of wrist injuries.
- Stage IV perilunar instability involves disruption of the proximal carpal row.
- This case presents a previously undescribed variant of this injury pattern.
Observation:
- A palmar lunate transtriquetral fracture dislocation with a concomitant radial styloid avulsion fracture was observed.
- Initial closed reduction and percutaneous pinning failed to resolve scapholunate dissociation.
- Intraoperative findings revealed triquetral malrotation despite apparent anatomical reduction.
Findings:
- The triquetrum, dislocated palmarward with the lunate, was found to be rotated 180 degrees on its transverse axis.
- Persistent scapholunate dissociation was directly linked to the uncorrected triquetral malrotation.
- Open reduction and direct reduction of the triquetral fracture were necessary to restore the normal scapholunate interval.
Implications:
- This case expands the understanding of perilunar instability variations.
- Accurate assessment and reduction of all fracture components, including rotational deformities, are critical for successful treatment.
- Highlights the complex biomechanics of the wrist and the interconnectedness of carpal bones.