Trans-scaphoid Perilunate Fracture-dislocation with Concomitant Lunotriquetral Ligament Disruption: A Case Report

We report a case of trans-scaphoid perilunate fracture-dislocation with concomitant lunotriquetral ligament disruption of the right wrist in a 44-year-old man, sustained from a 10-m fall landing on his outstretched right hand. Open reduction was performed 1 day after injury; at first the palmar dislocation of the lunate was reduced with the palmar approach. Under direct view with the dorsal approach, the scaphoid was comminuted and then treated with open reduction and internal fixation with a double threshold screw using a dorsal approach and a bone graft from the distal radius. Although the scapholunate ligament was intact, the lunotriquetral ligament was disrupted and required repair with metal suture anchors. At the 28-month follow-up evaluation, the patient had no residual pain in his wrist and returned to work. Trans-scaphoid perilunate fracture-dislocations often accompany a comminuted fracture of the scaphoid and disruptions of the intercarpal ligaments, and bone union and ligament healing time is delayed. Prolonged immobilization of the wrist may restrict its range of motion and limit daily activities. Therefore, open reduction and internal fixation with a bone graft for the scaphoid and simultaneous repair of interosseous intercarpal ligaments are essential for satisfactory recovery from perilunate fracture-dislocations.