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Scaphoid proximal pole ejection in perilunate injury: a case report and pathophysiological hypothesis
Jean-Baptiste de Villeneuve Bargemon1, Rémy Dubian2, Marie Witters2
1Hand, Wrist and Elbow Surgery, Saint Roch Private Hospital, Toulon, 99 Avenue Saint Roch, 83100 Toulon, France; Department of Hand Surgery, Plastic and Reconstructive Surgery of the Limbs - La Timone University Hospital, Assistance Publique Hôpitaux de Marseille, Marseille, France.
Hand Surgery & Rehabilitation
|January 7, 2024
Summary
Isolated proximal pole scaphoid fractures are rare perilunate injuries. This case study explores the biomechanics and risks, like avascular necrosis, associated with this specific scaphoid bone injury.
Area of Science:
- Orthopedic Surgery
- Traumatology
- Hand Surgery
Background:
- Perilunate injuries are complex wrist traumas.
- Scaphoid fractures are common, but proximal pole ejection is exceptionally rare.
- Existing biomechanical classifications may not fully explain proximal pole scaphoid fractures.
Observation:
- This report details a rare case of isolated proximal pole scaphoid ejection in a perilunate injury.
- The injury pattern does not align with established biomechanical models (Herzberg, Mayfield).
- Avascular necrosis is a significant risk due to compromised blood supply, even with successful bone fixation.
Findings:
- The study presents a unique case of scaphoid proximal pole ejection.
- A theoretical biomechanical hypothesis for this specific injury mechanism is proposed.
- The precarious vascularization of the proximal scaphoid pole increases avascular necrosis risk.
Implications:
- Highlights the need for specialized assessment of rare scaphoid fracture patterns.
- May inform revised biomechanical models for wrist injuries.
- Emphasizes careful management to mitigate avascular necrosis risk in proximal pole scaphoid fractures.
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