Two stage procedure for neglected transscaphoid perilunate dislocation

We report a two-staged surgical procedure for neglected 3 month old volar transscaphoid, transcapitate perilunate fracture dislocation wrist in an 18 year old right handed male student. The lunate with proximal scaphoid and proximal capitate maintained its articulation with distal end radius while the rest of carpal bones had dislocated volarly. In the first stage, bilateral uniplanar wrist distractor was applied with the aim of stretching soft tissue. In the next stage open reduction and internal fixation was done by a combined volar and dorsal approach augmented by pronator quadratus flap. At 3 years followup the patient was pain free and had a full range of supination pronation of the forearms and radial and ulnar deviation of wrist with 10° dorsiflexion deficit.     

Chronic transscaphoid,transcapitate perilunate fracture dislocation of the wrist: Fenton's syndrome

The authors report about chronic Fenton's syndrome. This rare injury of the wrist is characterized by scapho-capitate fracture accompanied by 180° rotation of the head of capitate and associated perilunate dislocation. Two patients suffering from chronic Fenton's syndrome were treated with pyrocarbon capitate resurfacing prosthesis. Patients were evaluated according to the wrist range of motion, Mayo modified wrist and DASH scores. In conclusion, prosthetic surgery may achieve satisfactory results for this rare and diagnostically challenging syndrome.     

Triple jeopardy: transscaphoid, transcapitate, transtriquetral, perilunate fracture dislocation

Carpal injuries are frequently underdiagnosed and underreported injuries of the hand. Scapholunate perilunate dissociation is the most common perilunate instability pattern seen in clinical practice. Transscaphoid, transtriquetral, transcapitate dislocation with a volar intercalated segment instability pattern is a very rare pattern of carpal injury. We describe a case with this unique pattern of injury, explaining its mechanism and treatment. Good outcome can be achieved in these injuries following open reduction and internal fixation with ligamentous repair.     

早期手术治疗经舟骨月骨周围骨折脱位的临床分析

目的 评价早期手术治疗经舟骨月骨周围骨折脱位的临床疗效.方法 15例经舟骨月骨周围骨折脱位的患者,采用切开复位加压螺钉和克氏针内固定.术后评估腕部疼痛、腕关节活动度、手部握力及骨折愈合,并用腕关节Krimmer评分法评估疗效.结果 13例获得6～12个月随访,平均9个月.2例出现静息痛,3例活动时疼痛.腕关节屈伸活动度（65±11）°,尺桡偏角度为（10±8）°,平均握力较健侧减少10%.X片检查3例腕关节炎,2例舟骨骨折近端骨质吸收致舟骨不愈合.11例腕舟骨愈合,平均愈合时间为4.8个月.Krimmer评分法评估总体疗效：优7例,良1例,可3例,差2例.结论 早期切开复位应用克氏针和加压螺钉同时内固定治疗经舟骨月骨周围骨折脱住手术方式可行、疗效可靠.     

Transstyloid, transscaphoid, transtriquetral perilunate dislocation - A late presentation

Transstyloid, transscaphoid, transtriquetral perilunate dislocations are extremely rare carpal dislocations. We report a 24-year-old male who presented with this rare injury pattern four weeks after sustaining trauma. The patient underwent open reduction and internal fixation via dorsal approach. Reduction was assisted by the use of Joshi’s Distraction System. Scaphoid fracture healed by 16 weeks. At 2 years follow-up patient has good range of motion around wrist without any discomfort.     

Radial perilunate trans-styloid trans-triquetrum fracture dislocation: a case report

We present a rare case of radial perilunate trans-styloid fracture dislocation, in which the scaphoid invaginated radially into the fractured radial styloid.     

Trans-triquetral dorsal perilunate fracture dislocation

A rare case of trans-triquetral dorsal perilunate dislocation is described. It differs from the Mayfield and Johnson theory of progressive perilunar instability in greater arc injuries which states that the injury passes from the radial to the ulnar carpal bones and soft tissues in stages. This injury supports the concept of a reverse greater arc injury from ulnar to radial being possible with the radial carpal bones being spared in some cases.     

复位内固定联合腕骨间韧带修补治疗急性经舟月骨或月骨周围脱位

Objective To evaluate the results of Open reducdon and internal fixation combined with repairing of the intercarpal ligaments using suture anchors for the treatment of perilunate fracture dislocations or perilunate dislocations. Methods From February 2004 to August 2006,12 cases of perilunate fracture dislocations or perilunate dislocations were treated operatively,in which 8 cases were transscaphoid fracture dislocations and 4 cases were perilunate dislocations.All the fractures were fixed with AO 3.0 mm cannulated screws or 3.0 mm Bold screws,with the scapholunate or lunotriquertral ligaments sutured by Mitek mini suture anchors. Results All cases were followed up for a mean period of 37 months(from 33 to 48 months).All the scaphoid healed primarily,the height of the carpal was maintained well with a mean scapho-lunate angle of 50°(35°to 65°),mean radio-lunate angle of 5°(-10°to 15°),the mean index of carpal height was 0.51(0.50 to 0.53),the ROM of the wrist iS about 92.5°,The grip strength was 76.7% of the contralateral side.The modified Nayo wrist score revealed 1 excellent,4 good,4 fair and 3 poor results.The average score was 72(50to 95). Collclusion The wrist function can be obtained satisfactorily by early open reduction and internal fixation for perilunate fracture disloeations or perilunate dislocations.Carpal instability or carpal collapse can be avoided by Intercarpal fixation and ligaments rear in short term.     

复位内固定联合腕骨间韧带修补治疗急性经舟月骨或月骨周围脱位

Objective To evaluate the results of Open reducdon and internal fixation combined with repairing of the intercarpal ligaments using suture anchors for the treatment of perilunate fracture dislocations or perilunate dislocations. Methods From February 2004 to August 2006,12 cases of perilunate fracture dislocations or perilunate dislocations were treated operatively,in which 8 cases were transscaphoid fracture dislocations and 4 cases were perilunate dislocations.All the fractures were fixed with AO 3.0 mm cannulated screws or 3.0 mm Bold screws,with the scapholunate or lunotriquertral ligaments sutured by Mitek mini suture anchors. Results All cases were followed up for a mean period of 37 months(from 33 to 48 months).All the scaphoid healed primarily,the height of the carpal was maintained well with a mean scapho-lunate angle of 50°(35°to 65°),mean radio-lunate angle of 5°(-10°to 15°),the mean index of carpal height was 0.51(0.50 to 0.53),the ROM of the wrist iS about 92.5°,The grip strength was 76.7% of the contralateral side.The modified Nayo wrist score revealed 1 excellent,4 good,4 fair and 3 poor results.The average score was 72(50to 95). Collclusion The wrist function can be obtained satisfactorily by early open reduction and internal fixation for perilunate fracture disloeations or perilunate dislocations.Carpal instability or carpal collapse can be avoided by Intercarpal fixation and ligaments rear in short term.     

复位内固定联合腕骨间韧带修补治疗急性经舟月骨或月骨周围脱位

目的 总结切开复位内固定联合腕骨间韧带修补治疗急性经舟骨骨折月骨周围脱位或经月骨周围脱位的疗效.方法 2004年2月至2006年8月共收治12例月骨周围损伤的患者,其中8例经舟骨骨折月骨周围脱位,4例月骨周围脱位.全部采用切开复位,3.0mm AO空心螺纹钉或通用公司Bold钉固定舟骨骨折,克氏针固定腕骨间关节,并使用Nitek锚钉修补腕骨间韧带.结果 术后平均随访时间为37个月(33～48个月),X线片显示所有舟骨骨折均愈合,舟月角平均50°(35°～65°),桡月角平均5.(-10°～15°),腕骨高度指数平均0.51(0.50～0.53).临床检查腕关节活动度平均为92.5°,握力达健侧的76.7%,腕关节无痛者8例、轻痛者2例、中度疼痛者2例.按照改良Mayo腕关节评分法平均为72分(50～95分),其中极好1例、好4例、可4例、差3例.结论 早期切开复位治疗月骨周围损伤可获得较满意的腕关节功能,结合韧带修补可防止腕骨间不稳以及继发的腕关节塌陷.     

Treatment of an unusual trans-scaphoid perilunate avulsion fracture dislocation: a case report

We describe an unusual case of trans-scaphoid perilunate injury where the proximal half of the scaphoid avulsed from all attaching ligaments and extruded into the forearm. Treatment involved anatomic reduction and internal fixation of the fracture, scapholunate (SL) ligament repair, temporary K-wire fixation, and prolonged immobilization. At 19-month follow-up, the fracture healed, SL ligament remained intact, and the patient recovered much of his hand function.     

Transscaphoid-transtriquetral perilunate fracture dislocation: report of a case and review of the literature

INTRODUCTION: 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. RESULTS: At the final follow-up examination 68 months after the initial operation, the arc of motion of the right wrist, 150 degrees (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 degrees and a scapholunate gap of 2 mm. CONCLUSION: 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.     

Translunate, transmetacarpal, scapho-radial fracture with perilunate dislocation a case report

A case translunate, transmetacarpal, scapho-radial fracture with perilunate dislocation occurred as a young man drove his motorcycle into the side of a car. Closed reduction was performed initially. Open reduction was performed with a screw in the lunate. Eighteen months later the screw was removed and after two and a half years x-rays revealed no signs of avascular necrosis or arthrosis. The patient fully recovered. This case stresses the necessity of open reduction in cases of complicated carpal fracture dislocations.