Combined Radial Styloid and Scaphoid Fractures with perilunate Dislocation

Trans-styloid trans-scaphoid perilunate fracture-dislocations (PLFDs) are rare, high-energy wrist injuries involving simultaneous disruption of the radial styloid, scaphoid waist, and perilunate ligamentous structures. Early diagnosis and anatomical reduction are essential to prevent chronic instability and avascular necrosis (AVN).

A 27-year-old male sustained a high-energy motor vehicle accident resulting in a displaced scaphoid waist fracture, radial styloid fracture, and perilunate dislocation. Closed reduction was attempted, followed by definitive open reduction through a dorsal approach. The scaphoid was fixed with a Herbert screw, and the radial styloid with a Kirschner wire. Restoration of the radial column resulted in spontaneous reduction of the lunate. At 12-week follow-up, the patient achieved full, pain-free wrist motion with no radiographic evidence of instability or AVN.

This injury pattern represents a severe variant of greater-arc perilunate trauma. The dorsal approach provides optimal visualization for reduction and fixation. Rigid internal fixation of the scaphoid and radial styloid restores carpal alignment and stability. Early mobilization after K-wire removal supports excellent functional recovery.

Early recognition, anatomical reduction, and stable internal fixation are key to achieving favorable outcomes in trans-styloid trans-scaphoid PLFDs. This case demonstrates excellent short-term functional recovery following dorsal-approach open reduction and internal fixation.