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Scaphoid and Lunate Dislocation with Complete Soft-Tissue Avulsion: A Case Report.
Kevin H Phan1, Hassan J Azimi, Orrin I Franko
1School of Medicine, University of California, San Diego, San Diego, California.
JBJS Case Connector
|December 19, 2017
Summary
Open reduction and internal fixation (ORIF) for severe wrist dislocations, including the lunate and scaphoid bones, led to good functional recovery. This surgical approach may offer better outcomes than other wrist salvage procedures.
Area of Science:
- Orthopedic Surgery
- Hand and Wrist Surgery
- Trauma Surgery
Background:
- Simultaneous divergent dislocations of the lunate and scaphoid bones are rare and complex wrist injuries.
- These injuries often involve significant soft-tissue damage and compromise of vascular supply, complicating treatment and prognosis.
Observation:
- A case of intercarpal dislocation involving proximal and rotatory displacement of the lunate and volar and radial dislocation of the scaphoid is presented.
- Both the lunate and scaphoid bones were severely stripped of soft tissue attachments.
Findings:
- Open reduction and internal fixation (ORIF) was performed for the complex dislocation.
- At three years postoperatively, the patient demonstrated a low Disabilities of the Arm, Shoulder and Hand (DASH) score of 10.
- Functional outcomes included equivalent grip strength, 50% wrist palmar flexion, and 98% wrist dorsiflexion compared to the uninjured side.
- Radiographic evaluation revealed evidence of posttraumatic arthritis.
Implications:
- ORIF combined with soft-tissue repair can yield favorable intermediate-term functional outcomes for severe lunate and scaphoid dislocations.
- This surgical strategy may be a superior alternative to other salvage procedures like proximal row carpectomy for such complex injuries.
