Case Study: Trans-styloid, Trans-scaphoid, Trans-triquetral, and Perilunate Dislocation

Area of Science:

• Orthopedic Surgery
• Trauma Surgery
• Hand Surgery

Background:

• Perilunate dislocations are rare, high-energy wrist injuries often missed on initial presentation.
• These injuries can involve complex fracture patterns, including trans-styloid, trans-scaphoid, and trans-triquetral dislocations.
• Delayed diagnosis and treatment can lead to significant morbidity, including median nerve compression and chronic wrist dysfunction.

Observation:

• A 48-year-old male sustained a trans-styloid, trans-scaphoid, trans-triquetral perilunate dislocation after a fall.
• Initial ER management included closed reduction and splinting.
• Surgical intervention involved open reduction and internal fixation (ORIF) with ligamentous repair and carpal tunnel decompression.

Findings:

• The reported injury pattern is exceptionally rare, with limited published case reports.
• Early diagnosis and radiographic evaluation are critical for successful management.
• Open reduction and internal fixation (ORIF) with ligamentous repair is the indicated treatment for acute injuries.

Implications:

• Prompt surgical management of these complex wrist dislocations is essential to restore function and prevent complications.
• Adequate reduction and fixation can mitigate risks of median neuropathy, arthrosis, instability, and nonunion.
• While operative intervention aims to maximize functional recovery, outcomes can still be challenging following such severe injuries.