Bilateral greater arc Perilunate injury: A case report

Perilunate injuries are rare and are frequently missed during initial examinations. These injuries are missed upon primary evaluation in approximately 25 % of cases, which can result in catastrophic outcomes. Early diagnosis is essential to avoid chronic wrist pain and limited range of motion.

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We report the case of a 25-year-old man who presented with a bilateral Perilunate fracture-dislocation injury. He underwent bilateral definitive open reduction using a dorsal approach. Headless screws were used for the internal fixation of the bilateral scaphoids, and Kirschner wires were used to secure the left distal radius and for bilateral intercarpal fixation. Aggressive physiotherapy was initiated 8 weeks after the open reduction. After 1 year, the patient showed a satisfactory outcome with an excellent bilateral Mayo wrist score.

Perilunate dislocations and fracture-dislocations are considered orthopedic emergencies with close reduction being the initial treatment of choice. Early diagnosis and treatment of such injuries are essential to achieve optimal outcomes, which may be achieved with open reduction and internal fixation through a combined volar and dorsal approach.

Perilunate injuries should be considered as one of the differential diagnoses in wrist injuries. All Perilunate injuries should undergo emergency close reduction, typically followed by open reduction and reconstruction.