Concomitant Distal Radius Fracture with Scaphoid Fracture-Dislocation and Carpal Instability: A Case Report

Concomitant ipsilateral fractures of the distal radius and scaphoid are uncommon and are typically associated with high-energy trauma. The combination of a comminuted intra-articular distal radius fracture with scaphoid fracture-dislocation and carpal instability represents a particularly rare and complex injury pattern. Early recognition of associated carpal injuries is important to restore and maintain anatomical alignment.

A 32-year-old right-hand-dominant man presented with severe pain, swelling, and deformity of the left wrist following a high-energy motorcycle road traffic accident. Radiographs demonstrated a comminuted intra-articular distal radius fracture associated with a displaced scaphoid fracture-dislocation and disruption of carpal alignment. Neurovascular status was intact. Following initial immobilization and resolution of soft-tissue swelling, definitive surgery was performed on day 3. The distal radius was reduced and stabilized through a modified Henry approach using volar locking plate fixation supplemented by dorsal plating. The scaphoid fracture was reduced and stabilized with a Herbert screw, while the associated carpal instability was addressed with Kirschner-wire fixation. Wrist range-of-motion exercises were initiated at 4 weeks, and the carpal Kirschner wires were removed at 6 weeks. At 8 months, radiographs demonstrated complete union of the distal radius and scaphoid with maintained carpal alignment. The patient achieved 40° of wrist flexion and 60° of extension, with a pain score of 3/10 and no limitation in activities of daily living.

This case highlights the importance of carefully evaluating carpal alignment in high-energy distal radius fractures to identify associated scaphoid and intercarpal injuries. Comprehensive operative stabilization of the distal radius, scaphoid, and unstable carpal relationships can restore anatomical alignment and provide a stable construct for rehabilitation.