Bilateral trans-radial trans-scaphoid perilunate fracture-dislocation with bilateral dorsal elbow dislocation: a case...

Bilateral trans-radial trans-scaphoid perilunate fracture-dislocation is one of the less common injuries of the wrist, occurring as a consequence of high-energy trauma. Its coincidence with bilateral elbow dislocation is extremely rare.

The authors present a case of a 24-year old male of Czech origin who attained this unique injury by falling from a height of 4 m onto both upper extremities. Bilateral open reduction of the wrists using both palmar and dorsal approaches and closed reduction of both elbow joints was performed. The arms were immobilized in casts for a total of 7 week (4 weeks with total elbow fixation and 3 weeks allowing flexion and extension at the elbow). In the follow-up period of 4 years, no signs of post-traumatic arthrosis were noted on radiological examinations. After finishing rehabilitation, the range of joint motion in the right wrist was 80° for dorsal flexion and 70° for palmar flexion, and in the left wrist was 80° for dorsal flexion and 80° for palmar flexion, as well as the full extent of radial and ulnar ductions (deviations), and in both the left and right elbows the range was 0-130°. Both elbow joints were stable. The patient continues to work as an installer on tall construction projects without disability.

To successfully treat such a patient, the surgeon should favor a wrist open reduction, with the goal of reconstructing the anatomical relationship between the carpal bones and closed reduction of the elbow joints with external fixation, with the initial treatment to relieve pressure on the median nerve in the carpal tunnel.