Transscaphoid perilunate fracture-dislocation. Result of open reduction and pin fixation

Sixteen patients with 17 transscaphoid perilunate fracture-dislocations were treated by open reduction and pin fixation. Open reduction was performed through a volar approach in only one wrist, a dorsal approach in nine wrists, and combined volar and dorsal approaches in seven wrists. Primary bone grafting was performed in four patients. The follow-up period was from five months to eleven years and two months, with an average of 2.69 years. Seven patients had median nerve injury and all recovered. Of the 17 wrists, the scaphoid fracture healed in 15. This injury should be treated by early open reduction through a dorsal incision and pinning of the scaphoid fragments in an anatomic position. Avascular necrosis of the proximal fragment is not an indication for further surgery as long as the fracture is well reduced with evidence of healing. This replacement of necrotic bone by new bone requires several years. Primary bone grafting is unnecessary.