Complex Axial Carpal Dislocation with Scapholunate Ligament Injury

Area of Science:

• Orthopedic surgery
• Traumatology
• Radiology

Background:

• Axial carpal dislocations (ACDs) represent severe wrist trauma affecting both carpal rows.
• These injuries pose significant diagnostic and therapeutic challenges due to their complexity.
• Understanding ACDs is vital for effective clinical management and patient outcomes.

Observation:

• A 27-year-old male sustained an irreducible second carpometacarpal joint (CMCJ) dislocation with associated scapholunate (SL) ligament injury after a motorcycle accident.
• Initial closed reduction attempts were unsuccessful, necessitating surgical intervention.
• Surgical repair involved fixation of the second CMCJ and SL interval, with ligamentous repair.

Findings:

• The case presents a unique variant of ACD originating from the second CMCJ, leading to SL interval instability.
• This pattern differs from previously described ACDs that typically initiate in the third webspace.
• Postoperative imaging confirmed proper alignment, though a minor SL gap persisted.

Implications:

• This case underscores the importance of considering ACD in all CMCJ dislocations, even if not immediately apparent on radiographs.
• Computed tomography (CT) scans are crucial for detecting subtle injuries like the SL instability missed on initial X-rays.
• Accurate diagnosis and comprehensive management of this rare ACD variant are essential for optimizing wrist function and patient recovery.