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

Area of Science:

• Orthopedic Surgery
• Trauma Management
• Radiology

Background:

• Bilateral trans-scaphoid perilunate fracture-dislocation is a rare wrist injury.
• Often results from high-energy trauma or falls on an outstretched hand.
• Can be easily missed in polytrauma patients, leading to poor outcomes like pain and arthritis.

Observation:

• A 26-year-old male sustained bilateral trans-scaphoid perilunate fracture-dislocation with other severe injuries after a fall.
• Initial closed reduction was successful on the right but failed on the left, requiring intraoperative reduction.
• Simultaneous surgical management of wrist, bilateral calcaneal, and lumbar spine fractures was performed.

Findings:

• Open reduction and Herbert screw fixation for bilateral scaphoid fractures via a volar approach.
• Successful management of associated calcaneal and L3 burst fractures.
• Postoperative recovery showed stable neurological function and no residual wrist pain after 18 months.

Implications:

• High index of suspicion is crucial for diagnosing rare injuries like perilunate fracture-dislocations, especially in polytrauma.
• Multidisciplinary preoperative planning and timely surgical intervention (closed or open reduction) are key for optimal functional outcomes.
• Early surgical management can prevent long-term complications and restore wrist function.