Transscaphoid-transtriquetral perilunate fracture dislocation: report of a case and review of the literature
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A transscaphoid and transtriquetral perilunate fracture dislocation is fairly rare among the known cases of perilunate fracture dislocations, and the details of the initial treatment and outcome of this injury have never been reported.
Materials and methods
A 21-year-old, right-handed man presented with fractures at the proximal third of the scaphoid and at the mid-body of the triquetrum with an associated dorsal perilunate dislocation after a fall onto his outstretched hand. Under general anesthesia, closed reduction was attempted with 3 kg of traction applied by means of finger traps. After anatomical reduction was achieved, percutaneous fixation was applied to both the triquetrum and scaphoid using cannulated screws. A short arm thumb spica splint was applied for 2 weeks, and part-time splinting was continued for an additional 3 weeks. The patient subsequently underwent 3 months of intensive range-of-motion and muscle-strengthening exercises.
At the final follow-up examination 68 months after the initial operation, the arc of motion of the right wrist, 150°(extension plus flexion arc), and grip strength, 41 kg, were 94% and 103% of the values for the unaffected wrist, respectively. Radiographs showed a bony union of the scaphoid and triquetrum, and no sign of avascular necrosis in the proximal scaphoid fragment, as well as other carpi. No midcarpal or radiocarpal degenerative arthritis was observed, and the normal carpal bone relationships were still maintained, with a scapholunate angle of 48°and a scapholunate gap of 2 mm.
We recommend closed reduction and percutaneous screw fixation of the scaphoid, as well as the triquetrum in this case, to minimize the interruption of the blood supply to the carpus and also to obtain rigid fixation during the procedure
KeywordsPerilunate fracture dislocation Scaphoid fracture Triquetral fracture Carpal instability Minimally invasive surgery
We thank Edward Diao, MD, San Francisco, CA, USA, for his constant interest and guidance in this report. Read in part at the 8th Congress of the International Federation of Societies for Surgery of the Hand, June 10–14, 2001, held in Istanbul, Turkey.
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