Bilateral trans-scaphoid perilunate fracture-dislocation: A case report

Bilateral trans-scaphoid perilunate fracture dislocation is an infrequent injury that usually occurs following either high-energy trauma or a fall on an outstretched hand. It can be easily overlooked in patients with polytrauma and may lead to an unfavorable prognosis with pain and arthritis.

We present the case of a 26-year-old man with a history of a fall from a two-story building, diagnosed with bilateral trans-scaphoid perilunate fracture-dislocation, bilateral calcaneal fractures, and a burst fracture of the third lumbar vertebra (L3). In the emergency department, the patient underwent closed reduction for a right perilunate dislocation using the Tavernier technique. However, closed reduction could not be achieved on the left side, and was reduced intraoperatively. Bilateral scaphoid fractures were managed through open reduction and fixation using Herbert screws via the volar approach. Bilateral calcaneal and L3 burst fractures were managed in the same setting. Postoperatively, the patient was stable with intact neurological function. Eighteen months after surgery, the patient had no residual pain in his wrist and returned to work.

Diagnosing rare injuries, such as perilunate fracture-dislocations, necessitates a high index of suspicion and scrutiny of the findings, especially in patients with polytrauma. Careful preoperative planning involving a multidisciplinary team, followed by operative management with open reduction and ligamentous repair, can yield optimal functional outcomes. Moreover, immediate closed reduction of perilunate fracture dislocation should be attempted in the emergency department, and if closed reduction fails, an emergency open surgical procedure should be planned.