An Unusual Localization of Lunate in a Transcaphoid Volar Lunate Dislocation: Current Concepts

Perilunate dislocation and fracture dislocations are rare injuries corresponding to 10% of all carpal injuries. They usually come with high-energy trauma, with associated injuries representing 61%. Volar lunate dislocation or fracture-dislocation accounts for 3% of perilunate injuries. We present a case of a 42-year-old polytrauma male, transmitted to our department 48 hours after a car accident with a trans-scaphoid volar lunate dislocation. During operation, the lunate was displaced volarly to the ulnar side of the wrist, forward to the styloid process of the distal ulna, while the scaphoid fracture appeared at the waist with comminution, and the proximal pole of the scaphoid protruded under the dorsal capsule. Carpal injuries are often missed out in polytrauma patients, and these injuries are underestimated because of the severity of the other visceral or extremity lesions. Untreated or improperly treated, those injuries lead to serious morbidity and loss of function. Therefore, good functional prognosis with decreased percentage of complications can be achieved following early recognition and early open surgical ligamentous complex repair.

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Scaphocapitate Syndrome With Associated Trans-Scaphoid, Trans-Hamate Perilunate Dislocation

Hand ◽

10.1177/1558944716668837 ◽

2016 ◽

Vol 12 (2) ◽

pp. NP27-NP31 ◽

Cited By ~ 4

Author(s):

Fiesky A. Nunez ◽

T. David Luo ◽

Jesse B. Jupiter ◽

Fiesky A. Nunez

Keyword(s):

Scaphoid Fracture ◽

Kirschner Wire ◽

High Energy ◽

Perilunate Dislocation ◽

Lag Screw ◽

Anatomic Reduction ◽

Stable Osteosynthesis ◽

Fracture Dislocations ◽

Hamate Fracture ◽

Scaphocapitate Fracture Syndrome

Background: Perilunate fracture dislocations are often associated with fractures of the distal pole of the scaphoid or the proximal pole of the capitate. However, the combination of perilunate dislocation with multiple carpal fractures and associated scaphocapitate syndrome is very rare. Methods: We report a unique case of scaphocapitate fracture syndrome with perilunate dislocation and fracture of the hamate resulting from a high-energy injury to the wrist during a dirt-bike competition. Results: Open reduction and internal fixation of the scaphoid fracture with a 3.0-mm headless screw, the head of the capitate with a 1.5-mm lag screw, and the hamate fracture with a 1.3-mm lag screw was performed. The lunotriquetral dissociation was reduced, with the ligament repaired and the joint stabilized using a Kirschner wire. All screw heads are carefully buried under the articulate cartilage. Conclusions: Prompt anatomic reduction and stable osteosynthesis of all fractures in this patient resulted in successful healing and return to activity.

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Case Study: Trans-styloid, Trans-scaphoid, Trans-triquetral, and Perilunate Dislocation

Journal of Orthopaedic Case Reports ◽

10.13107/jocr.2021.v11.i06.2260 ◽

2021 ◽

Vol 11 (6) ◽

Author(s):

Nicholas Frane ◽

Peter Regala ◽

Brandon Klein ◽

Joshua Mitgang ◽

Gus Katsigiorgis

Keyword(s):

Carpal Tunnel ◽

Closed Reduction ◽

Early Recognition ◽

Case Reports ◽

High Energy ◽

Fracture Dislocation ◽

Dominant Male ◽

Chronic Instability ◽

Perilunate Dislocation ◽

Ligamentous Repair

Introduction: Perilunate dislocations are rare high-energy injuries, and the diagnosis is not infrequently missed at initial presentation. The combination of fractures resulting in a trans-styloid, trans-scaphoid, and trans-triquetral perilunate fracture dislocation is extremely rare. Early recognition and diagnosis of these injuries is prudent to restore patient function and prevent morbidity. This injury pattern may progress through several distinct phases often involving the greater or lesser arc. The injury begins with traumatic disruption of the scapholunate joint, followed by an ordered progression of injury to the capitolunate, lunotriquetral, and radiolunate joints. When the radiolunate joint is disrupted, the lunate often dislocates volar transposing into the carpal tunnel, associated with median nerve compression. These injuries have the potential to cause lifelong disability of the wrist. Early treatment may prevent or lessen the chance of median neuropathy, post-traumatic wrist arthrosis, chronic instability, and fracture nonunion. Non-operative treatment is not indicated and is associated with poor functional outcomes and recurrent dislocation. Open reduction and internal fixation (ORIF) with ligamentous repair after emergent closed reduction and splinting is indicated for acute injuries (<8 weeks after injury). Case Report: We report a case of a 48-year-old right hand dominant male with a trans-styloid, trans-scaphoid, trans-triquetral, and perilunate dislocation after mechanical fall from height. He was evaluated in the ER and provisionally treated with closed reduction and splinting. ORIF of scaphoid, radial styloid, and triquetrum was performed, with ligamentous repair of the scapholunate joint and carpal tunnel decompression. Conclusion: The combination of fractures/injuries in this case has been very rarely been published in case reports to date. It is necessary to recognize these wrist injuries. Great detail should be given to physical and radiog

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Evaluation of results of three and four-part fracture dislocations of proximal humerus in young adults using philos (proximal humerus internal locking system)

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20180303 ◽

2018 ◽

Vol 6 (2) ◽

pp. 585

Author(s):

Amit Thakur ◽

Khalid Muzzafar ◽

Sumeet Singh Charak ◽

Bias Dev ◽

Abdul Ghani

Keyword(s):

Proximal Humerus ◽

Young Patients ◽

Soft Tissue Injuries ◽

Functional Results ◽

High Energy ◽

High Rate ◽

Fracture Dislocation ◽

Rotator Cuff Insufficiency ◽

Fracture Dislocations ◽

Adequate Management

Background: The fractures of proximal humerus constitute about 5% of fractures in adults third in number to fracture colles and hip usually in elderly patients due to a low energy trauma. In young patients the fractures are mostly due to high energy trauma and as such are associate with other soft tissue injuries. A sub group of young patients have a three or four fracture dislocation of shoulder joint. The aim of this study was to find the results of fixation by PHILOS in these young patients.Methods: This study was done in a teritiary referral centre over a period of about 1 year. All patients were operated within three weeks. Open fractures, patients with age more than 50 years were excluded from the study. All patients underwent open reduction and fixation using commercially available PHILOS. A minimum of 6 months follows up was essential for inclusion into the study. Final functional results were evaluated by Constant Murley scoring.Results: 14 patients were included in the study. The average age of patients was 38.42years. All fractures united. We had 71.4% excellent or good results. The complications noted were shoulder stiffness in 3, inadequate post op reduction, rotator cuff insufficiency, head necrosis, secondary osteo arthritis 1 each.Conclusions: Despite the relatively high rate of complications encountered in the management of these complicated high-energy fractures, the PHILOS plating system could be considered an adequate management of these patients.

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Dorsal Fracture-Dislocation of the Tarsal Navicular

Journal of the American Podiatric Medical Association ◽

10.7547/15-103 ◽

2017 ◽

Vol 107 (3) ◽

pp. 226-230 ◽

Cited By ~ 1

Author(s):

Isidro Jimenez ◽

Juan Pedro Rodriguez-Alvarez ◽

Ricardo Navarro-Navarro

Keyword(s):

Clinical Case ◽

Case Reports ◽

High Energy ◽

Fracture Dislocation ◽

Published Data ◽

Excellent Outcome ◽

Appropriate Treatment ◽

Chopart Joint ◽

Fracture Dislocations ◽

Tarsal Navicular Bone

Fracture-dislocations of the tarsal navicular are rare and highly complex injuries to the midfoot. The only published data on this type of fracture are clinical case reports. These injuries are normally caused by high-energy trauma, and their pathophysiology and most appropriate treatment remain unclear. We report a clinical case of a dorsal fracture-dislocation of the tarsal navicular bone associated with a medial swivel dislocation of the Chopart joint caused by a bicycle fall in a 20-year-old healthy man. Open reduction and percutaneous pinning in a novel arrangement was performed, with an excellent outcome 18 months after the injury.

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Simultaneous Scaphoid and Distal Radial Fractures

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681(94)90095-7 ◽

1994 ◽

Vol 19 (3) ◽

pp. 384-388 ◽

Cited By ~ 24

Author(s):

L. M. HOVE

Keyword(s):

Scaphoid Fracture ◽

High Energy ◽

Fracture Dislocation ◽

Distal Radial Fracture ◽

Radial Fracture ◽

Distal Radial Fractures ◽

Scaphoid Fractures ◽

Salter Harris ◽

Greenstick Fracture

Simultaneous fractures of the distal radius and scaphoid are uncommon. In a prospective 3-year study we registered 2,330 distal radial fractures and 390 scaphoid fractures, and 12 were combined. Ten of these had high energy trauma; six were styloid fractures, four Colles’ fractures, one was a greenstick fracture and one Salter–Harris Type 2 epiphyseal fracture. All but one of the 12 scaphoid fractures were stable and healed without problems, and one was a trans-scaphoid, trans-styloid peri-lunate fracture-dislocation. The study supports the opinion that the distal radial fracture constitutes the principal injury that determines the outcome and hence the treatment. If the scaphoid fracture is unstable or dislocated, we recommend internal fixation of the scaphoid. Only a small proportion of these injuries represent a more serious disruption with carpal instability.

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Irreducible Galeazzi Fracture-Dislocations

Hand ◽

10.1177/1558944717744334 ◽

2017 ◽

Vol 14 (2) ◽

pp. 249-252 ◽

Cited By ~ 2

Author(s):

Nicholas J. Yohe ◽

Jadie De Tolla ◽

Marc B. Kaye ◽

David M. Edelstein ◽

Jack Choueka

Keyword(s):

High Energy ◽

Fracture Dislocation ◽

Rare Injury ◽

Root Cause ◽

Energy Mechanism ◽

Galeazzi Fracture ◽

Pubmed Database ◽

Fracture Dislocations ◽

Tendon Entrapment ◽

Age Range

Background: Fractures of the radial shaft with disruption of the distal radial ulnar joint (DRUJ) or Galeazzi fractures are treated with reduction of the radius followed by stability assessment of the DRUJ. In rare instances, the reduction of the DRUJ is blocked by interposed structures requiring open reduction of this joint. The purpose of this study is to review all cases of irreducible Galeazzi fracture-dislocations reported in the literature to offer guidelines in the diagnosis and management of this rare injury. Methods: A search of the MEDLINE database, OVID database, and PubMed database was employed using the terms “Galeazzi” and “fracture.” Of the 124 articles the search produced, a total of 12 articles and 17 cases of irreducible Galeazzi fracture-dislocations were found. Results: The age range was 16 to 64 years (mean = 25 years). A high-energy mechanism of injury was the root cause in all cases. More than half of the irreducible DRUJ dislocations were not identified intraoperatively. In a dorsally dislocated DRUJ, a block to reduction in most cases (92.3%) was secondary to entrapment of one or more extensor tendons including the extensor carpi ulnaris, extensor digiti minimi, and extensor digitorum communis, with the remaining cases blocked by fracture fragments. Irreducible volar dislocations due to entrapment of the ulnar head occurred in 17.6% of cases with no tendon entrapment noted. Conclusions: In the presence of a Galeazzi fracture, a reduced/stable DRUJ needs to be critically assessed as more than half of irreducible DRUJs in a Galeazzi fracture-dislocation were missed either pre- or intraoperatively.

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Perilunate Dislocation Above the Age of 65 Years: Case Series and Review of Literature

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/21514593211036230 ◽

2021 ◽

Vol 12 ◽

pp. 215145932110362

Author(s):

Guy Rubin ◽

Amir Eliyahu ◽

Erez Grinbaum ◽

Nimrod Rozen

Keyword(s):

Literature Review ◽

Elderly Population ◽

Case Series ◽

The Elderly ◽

High Energy ◽

Perilunate Dislocation ◽

Energy Mechanism ◽

Fracture Dislocations ◽

Missed Diagnosis

Introduction Perilunate and fracture dislocations predominantly follow a high-energy mechanism. Perilunate dislocations have an incidence of 0.5/105 individuals/year, occurring at a mean age of 26 years and are frequently seen in men. This study aimed to describe the characteristics of this injury in elderly population of patients using literature review and our experience with four cases aged >65 years. Materials and Methods We treated four patients with perilunate dislocation aged >65 years. All the patients’ medical records were reviewed retrospectively. A literature review for case studies of perilunate dislocation was conducted with the purpose of finding cases including patients aged >65 years. Results Three of our patients had injuries that were missed in the first visit in the emergency department. The mechanism of injury was high energy in only two patients. Two patients had posterior perilunate dislocation, while the other two had transradial perilunate dislocation. Three patients were available for follow-up. The overall outcome was satisfaction according the Mayo wrist score and minimal disability according to the Disabilities of the Arm, Shoulder and Hand score. All patients reported that pain was absent and they were able to return to their regular activities. The literature review found only seven papers documenting treatment of patients aged >65 years. Discussion Perilunate dislocation is extremely rare in the population aged >65 years. Although the rate of missed diagnosis in our cohort was extremely high, the overall satisfaction and return to function was high. Conclusions This case series and literature review highlight the unique characteristics of this injury in the age group of patients aged >65 years. Although perilunate dislocation in patients aged >65 years is rare, clinicians should be aware of the presentation of this condition in the elderly.

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Perilunate instability: A rare variant

SAGE Open Medical Case Reports ◽

10.1177/2050313x211016980 ◽

2021 ◽

Vol 9 ◽

pp. 2050313X2110169

Author(s):

Amanda Partap ◽

Ian James Persad

Keyword(s):

High Energy ◽

Fracture Dislocation ◽

Proximal Pole ◽

Lunotriquetral Ligament ◽

Fracture Dislocations ◽

Ligament Disruption ◽

Serious Injuries ◽

High Degree ◽

Lunate Fossa

Perilunate dislocations and perilunate fracture dislocations are rare injuries that occur as a result of high energy trauma. We describe a case of a volar fracture dislocation of the proximal pole of the scaphoid with an associated scapholunate and lunotriquetral ligament disruption as well as a lunate fossa fracture of the distal radius. These injuries are serious injuries that require a high degree of clinical acumen and radiographic scrutiny to allow for prompt treatment in order to avoid the sequelae of long-term complications that can arise. This case serves as a reminder of the complexity of these injuries and their associated mechanics.

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Coronal Hamate Fracture Associated With Carpometacarpal Dislocations of All of the Fingers: Review of the Literature and Case Report

Hand ◽

10.1177/1558944716668860 ◽

2016 ◽

Vol 12 (5) ◽

pp. NP51-NP54 ◽

Cited By ~ 2

Author(s):

Joseph A. Gil ◽

Avi D. Goodman ◽

Adam Starr

Keyword(s):

Case Report ◽

Clinical Presentation ◽

Relevant Literature ◽

High Energy ◽

Fracture Dislocation ◽

Review Of The Literature ◽

Rare Injury ◽

Fracture Dislocations ◽

Hamate Fracture

Background: Dislocation of all 5 carpometacarpal (CMC) joints of a single hand is a rare injury. Methods: The literature regarding CMC fracture-dislocations was reviewed and a case was presented. Results: The relevant literature was consolidated to clinically relevant categories including ‘Clinical Presentation and Diagnosis,’ ‘Management of CMC Fracture Dislocation and Hamate Fractures,’ and ‘Outcomes.’ Conclusions: The mechanism associated with this injury is often high energy that causes multiple simultaneous life- or limb-threatening injuries that could distract the examiner from identifying this injury. The case we present involves an axial dislocation of the carpus that resulted in dorsal dislocations of all CMC joints, dislocation of the hamate-capitate articulation, as well as fractures of the first metacarpal and the hamate.

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Perilunate Injury with Concomitant Short Radiolunate Ligament Disruption: Prevalence and Surgical Outcomes—"An Unusual Perilunate Injury Variant”

Journal of Wrist Surgery ◽

10.1055/s-0040-1710396 ◽

2020 ◽

Vol 09 (04) ◽

pp. 312-320

Author(s):

Nicole M. Sgromolo ◽

Ian A. Mullikin ◽

Peter C. Rhee

Keyword(s):

Return To Work ◽

Visual Analogue Score ◽

High Energy ◽

Injury Pattern ◽

Fracture Dislocation ◽

Level Of Evidence ◽

Perilunate Dislocation ◽

Combined Injury ◽

Radiographic Outcomes ◽

Ligament Disruption

Abstract Background In the classic description of perilunate injuries, the short radiolunate ligament (SRL) remains intact. Objective This study was aimed to determine the occurrence of SRL disruptions with perilunate injuries and review the clinical and radiographic outcomes after surgical management. Patients and Methods A retrospective review was conducted for patients who sustained a perilunate injury and a concomitant disruption of the SRL at a single–level-1 trauma center between January 2013 and January 2017. Patients with the combined injury pattern were compared with those with perilunate injury alone without SRL injury during the study period. Outcome measures included pain scores (visual analogue score), wrist and forearm range of motion, patient's return to their former occupation, and multiple radiographic parameters. Results Twenty-seven patients were treated operatively for a perilunate injury. Eight of these patients (30%) were found to have associated disruption of the SRL. When compared with patients with perilunate injury alone, these patients had a lower rate of return to work (57% [4 of 7] vs. 92% [12 of 13]), a significantly longer mean length of time to return to work (5.9 vs. 3.8 months), and a higher rate of associated upper extremity injury (75% [3 of 8] vs. 16% [3 of 19]. Conclusion Combined SRL disruption and perilunate dislocation or fracture dislocation represent a high-energy variant from the classic description of a perilunate injury. A heightened awareness for this combined injury pattern should be maintained when treating patients with perilunate injuries. Level of Evidence This is a Level III, prognostic study.

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