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Two stage procedure for neglected transscaphoid perilunate dislocation.

Hitesh Lal1, Vivek Jangira, Rahul Kakran

  • 1Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, Chandigarh, India.

Indian Journal of Orthopaedics
|June 22, 2012
PubMed
Summary
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This study details a two-stage surgical repair for a complex wrist fracture dislocation in an 18-year-old male. The procedure achieved pain-free function with good range of motion after three years.

Area of Science:

  • Orthopedic Surgery
  • Traumatology
  • Hand and Wrist Surgery

Background:

  • Neglected perilunate fracture dislocations are rare and complex injuries.
  • Volar transscaphoid, transcapitate perilunate fracture dislocation presents significant surgical challenges.

Purpose of the Study:

  • To describe a novel two-staged surgical approach for a neglected perilunate fracture dislocation.
  • To evaluate the functional outcomes of this surgical technique.

Main Methods:

  • A two-staged surgical procedure was employed, starting with soft tissue stretching using a bilateral uniplanar wrist distractor.
  • The second stage involved open reduction and internal fixation via a combined volar and dorsal approach, augmented with a pronator quadratus flap.

Main Results:

Keywords:
Volar perilunate dislocationdistractorpronator quadratus flap

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  • The patient, an 18-year-old male, experienced a pain-free outcome at 3-year follow-up.
  • Full range of forearm supination and pronation was achieved.
  • Wrist demonstrated good radial and ulnar deviation with a minor 10° dorsiflexion deficit.

Conclusions:

  • A two-staged surgical intervention can effectively manage neglected volar transscaphoid, transcapitate perilunate fracture dislocations.
  • This approach yields favorable long-term functional recovery in young patients.