Bilateral dorsal trans-scaphoid perilunate fracture-dislocation: A case report

Area of Science:

• Orthopedic Surgery
• Trauma Care
• Hand Surgery

Background:

• Perilunate dislocations are severe carpal injuries, accounting for approximately 10% of all carpal trauma.
• Early and accurate recognition of perilunate dislocations can be challenging.
• Trans-scaphoid perilunate fracture-dislocation is a particularly devastating subtype.

Purpose of the Study:

• To report an uncommon case of bilateral dorsal trans-scaphoid perilunate fracture-dislocation.
• To evaluate the efficacy of closed reduction and percutaneous fixation for this complex injury.
• To discuss fracture prognosis and treatment options in the context of existing literature.

Main Methods:

• A case of bilateral dorsal trans-scaphoid perilunate fracture-dislocation following trauma is presented.
• The injury was initially missed and treated surgically two weeks post-trauma.
• Anatomic reduction was achieved via closed reduction, followed by percutaneous Kirschner wire fixation of the carpus and headless screw fixation of the scaphoid for both wrists.

Main Results:

• The patient underwent bilateral closed reduction and percutaneous fixation.
• An uneventful postoperative period was observed.
• A satisfactory functional outcome was achieved at the two-year follow-up, despite ipsilateral scaphoid non-union.

Conclusions:

• Closed reduction is considered the initial treatment of choice for trans-scaphoid perilunate fracture-dislocations.
• Percutaneous fixation techniques can effectively manage these complex carpal injuries.
• Attempting closed reduction is favored to mitigate risks associated with open reduction, such as avascular necrosis and non-union.