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

Hand ◽  
2016 ◽  
Vol 12 (2) ◽  
pp. NP27-NP31 ◽  
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.

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

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Grigorios Kastanis ◽  
George Velivasakis ◽  
Anna Pantouvaki ◽  
Manolis Spyrantis
Keyword(s):  
Early Recognition ◽  
Scaphoid Fracture ◽  
Styloid Process ◽  
High Energy ◽  
Fracture Dislocation ◽  
Loss Of Function ◽  
Perilunate Dislocation ◽  
Fracture Dislocations ◽  
Polytrauma Patients ◽  
Car Accident

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.

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

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.

scholarly journals PRIMARY BONE GRAFTING AND K-WIRE FIXATION: A PREFERABLE OPTION TO TREAT ACUTE UNSTABLE SCAPHOID FRACTURE

2021 ◽  
pp. 53-56
Author(s):  
THAKUR SK ◽  
CHOUDHARY SK ◽  
JOSEPH J B MAL ◽  
HIREMATH RN
Keyword(s):  
Functional Outcome ◽  
Bone Grafting ◽  
Scaphoid Fracture ◽  
Kirschner Wire ◽  
Volar Approach ◽  
Mayo Wrist Score ◽  
Anatomic Reduction ◽  
Wire Fixation ◽  
Primary Bone

Objective: The Objective of this study is to analyze the radiological, clinical and functional outcome of patients with acute unstable scaphoid fracture treated with primary bone grafting and K (Kirschner)-wire fixation Methods:Based on inclusion and exclusion criteria , a prospective observational study was carried out on 21 patients with acute unstable  scaphoid fracture who had been treated with primary bone grafting and K-wire fixation from November 2017 to March 2020 and were followed up for a minimum of 24 weeks. The average patient age was 26.9 years. The time from injury to treatment averaged 11days. Surgery was done under Bier’s Block using volar approach. Bone graft was harvested from distal Radius. The mean operating time was 24 minutes.Clinical parameters like tenderness, grip strength and Range of Movement (ROM) at wrist was assessed. The functional outcome was evaluated using Modified Mayo wrist score. Bone union was assessed using serial plain radiographs. Results:Union was achieved in all (100%) at 12 weeks. There was no evidence of Avascular necrosis (AVN) or arthrosis at latest follow up. As per Modified Mayo wrist score, there were 15 excellent,03 good and 03 fair results at the final follow-up. Individuals resumed their routine work at 12 weeks and all were comfortable with heavy works/ sports activity by 24 weeks. Conclusion: Primary bone grafting has a definite role in the management of acute unstable scaphoid fracture by which aquicker and higher rate of union isachieved with minimal complications. Open reduction allows thorough assessment of fracture for better anatomic reduction. Although the type of fixation device hardly contributes for quicker and higher union, but then the use of K-wire for fixation is the only viable option for smaller bony fragments and is more forgiving in terms of its positioning. It has an added advantage in terms of requirement of minimal inventory and thus is a cost-effective modality. This procedure also confirms that the patients could get back to their work earlier hence decreasing economic burden.

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

Hand ◽  
2016 ◽  
Vol 12 (5) ◽  
pp. NP51-NP54 ◽  
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.

MINIMALLY INVASIVE MANAGEMENT OF TRANS-SCAPHOID PERILUNATE FRACTURE-DISLOCATIONS

Hand Surgery ◽  
2008 ◽  
Vol 13 (03) ◽  
pp. 159-165 ◽  
Author(s):  
Tak-Chuen Wong ◽  
Fu-Keung Ip
Keyword(s):  
Minimally Invasive ◽  
Closed Reduction ◽  
Scaphoid Fracture ◽  
Kirschner Wire ◽  
Minimally Invasive Technique ◽  
Invasive Technique ◽  
Fracture Dislocations ◽  
Mean Time ◽  
Radiographic Alignment ◽  
Invasive Management

This retrospective study evaluates the functional and radiological results of a series of acute trans-scaphoid dorsal perilunate fracture-dislocations treated operatively by minimally invasive technique. Twenty-one patients had surgery performed by one of three surgeons between 1994 and 2006, and all cases involved: (1) closed reduction of the carpus; (2) closed reduction and percutaneous screw fixation of the scaphoid fracture; and (3) closed reduction and multiple Kirschner wire stabilisation of the carpal dissociation. Seventeen males and four females with an average age of 29 years were evaluated. Ninety five per cent of internally fixed scaphoid healed at a mean time of 16 weeks. Radiographic alignment of the carpus was satisfactory in 17 cases. The average Mayo wrist score was 80 with three excellent and two poor results. There was one patient with asymptomatic DISI deformity. Two patients had radiographic evidence of mid-carpal arthritis. One patient with a scaphoid nonunion required surgical repair with bone grafting. The results of this study suggest that a minimally invasive technique for treating acute trans-scaphoid perilunate fracture-dislocations can be considered as an alternative to open approaches.

Translunate, Transmetacarpal, Scapho-Radial Fracture with Perilunate Dislocation A Case Report

1985 ◽  
Vol 10 (3) ◽  
pp. 382-384
Author(s):  
P. TOFT ◽  
K. BERTHEUSSEN ◽  
S. OTKJAER
Keyword(s):  
Case Report ◽  
Avascular Necrosis ◽  
Closed Reduction ◽  
Open Reduction ◽  
X Rays ◽  
Radial Fracture ◽  
Perilunate Dislocation ◽  
Carpal Fracture ◽  
Fracture Dislocations

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.

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

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.

First Metatarsal-Phalangeal Joint Arthrodesis: A Biomechanical Assessment of Stability

2003 ◽  
Vol 24 (4) ◽  
pp. 332-337 ◽  
Author(s):  
Joel Politi ◽  
John Hayes ◽  
Glen Njus ◽  
Gordon L. Bennett ◽  
David B. Kay
Keyword(s):  
Plate Fixation ◽  
Kirschner Wire ◽  
High Rate ◽  
Fixation Method ◽  
Materials Testing ◽  
Dorsal Plate ◽  
Kirschner Wires ◽  
First Metatarsal ◽  
Lag Screw ◽  
Kirschner Wire Fixation

Background: First metatarsal phalangeal joint (MTP) arthrodesis is a commonly performed procedure for the treatment of hallux rigidus, severe and recurrent bunion deformities, rheumatoid arthritis and other less common disorders of the joint. There are different techniques of fixation of the joint to promote arthrodesis including oblique lag screw fixation, lag screw and dorsal plate fixation, crossed Kirschner wires, dorsal plate fixation alone and various types of external fixation. Ideally the fixation method should be reproducible, lead to a high rate of fusion, and have a low incidence of complications. Methods: In the present study, we compared the strength of fixation of five commonly utilized techniques of first MTP joint arthrodesis. These were: Surface excision with machined conical reaming and fixation with a 3.5 mm cortical interfragmentary lag screw. Surface excision with machined conical reaming and fixation with crossed 0.062 Kirschner wires. Surface excision with machined conical reaming and fixation with a 3.5 mm cortical lag screw and a four hole dorsal miniplate secured with 3.5 mm cortical screws. Surface excision with machined conical reaming and fixation with a four hole dorsal miniplate secured with 3.5 mm cortical screws and no lag screw. Planar surface excision and fixation with a single oblique 3.5 mm interfragmentary cortical lag screw. Testing was done on an Instron materials testing device loading the first MTP joint in dorsiflexion. Liquid metal strain gauges were placed over the joint and micromotion was detected with varying loads and cycles. Results: The most stable technique was the combination of machined conical reaming and an oblique interfragmentary lag screw and dorsal plate. This was greater than two times stronger than an oblique lag screw alone. Dorsal plate alone and Kirschner wire fixation were the weakest techniques. Conclusions: First MTP fusion is a commonly performed procedure for the treatment of a variety of disorders of the first MTP joint. The most stable technique for obtaining fusion in this study was the combination of an oblique lag screw and a dorsal plate. This should lead to higher rates of arthrodesis.

Extension-Block Pinning for Unstable Dorsal Proximal Interphalangeal Joint Fracture-Dislocations: A Simple, Percutaneous Technique With Reproducible Outcomes

Hand ◽  
2022 ◽  
pp. 155894472110663
Author(s):  
Christopher A. Worgul ◽  
Andrew B. Stein
Keyword(s):  
Range Of Motion ◽  
Articular Surface ◽  
Kirschner Wire ◽  
Proximal Phalanx ◽  
Treatment Delay ◽  
Joint Fracture ◽  
Fracture Dislocations ◽  
Pip Joint

Background: Proximal interphalangeal (PIP) joint fracture-dislocations can be technically challenging injuries to treat, and no technique has proven to be superior nor lead to predictably good outcomes. We describe our experience of treating unstable dorsal fracture-dislocations of the PIP joint with extension-block pinning (EBP) at our institution over a 22-year period. Methods: In all, 23 patients with 24 unstable dorsal fracture-dislocations of the PIP joint treated with EBP between January 1998 and October 2020 were identified. All patients underwent closed reduction of the PIP joint and insertion of a Kirschner wire into the proximal phalanx, creating a mechanical block. Range of motion and joint congruity were assessed at final clinic follow-up. Long-term function was assessed via completion of a Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire. Spearman’s correlation coefficient was utilized to assess if any association existed between treatment delay, pin-in-body days, or amount of articular surface involved and QuickDASH score. Results: Mean range of motion at final follow-up was 83.3° and 22 of 24 PIP joints demonstrated a congruent reduction. In all, 15 of the 23 patients completed the QuickDASH questionnaire at a median long-term follow-up of 57.5 months (range: 3-157 months). Average QuickDASH score was 18.8, indicating minimal long-term disability. No statistically significant associations were found between treatment delay, pin-in-body days, or amount of articular surface involved and QuickDASH score. Conclusions: EBP offers a simple and innovative method to treat a complex injury of the PIP joint. It is technically straightforward and cheap, and produces excellent functional outcomes with minimal long-term disability.

Dorsal Dislocation of the Trapezoid with Metacarpal Instability: A Boxing Injury

2020 ◽  
Author(s):  
Oren I. Feder ◽  
Joseph P. Letzelter ◽  
Jacques H. Hacquebord
Keyword(s):  
Motor Vehicle ◽  
Treatment Strategies ◽  
High Energy ◽  
Acute Injury ◽  
Long Term Results ◽  
Steering Wheel ◽  
Return To Sports ◽  
Joint Dislocations ◽  
Anatomic Reduction ◽  
Wide Range

Abstract Background The second and third metacarpals are firmly attached, immobile structures which for the stable pillar of the hand. The trapezoid has been described as the keystone of the wrist, allowing a wide range of functional motion as well as inherent anatomic and biomechanical stability to the carpus. Case Description We describe a novel boxing injury with a 180-degree in situ dislocation of the right trapezoid with concomitant second and third carpometacarpal (CMC) joint dislocations. Open anatomic reduction of the trapezoid was obtained, and subsequent percutaneous pinning of the metacarpals allowed for a full functional recovery and return to sports at 6 months. Literature Review Combined trapezoid and CMC dislocations are extremely rare and have only been previously described in high-energy mechanism injuries, involving a direct dorsal force such as from the steering wheel in a motor vehicle collision. There are no previous reports of this injury occurring in the setting of direct axial load along the metacarpals in a clenched fist such as in a punch or fighting injury. Clinical Relevance The rare nature of this combined injury, its novel mechanism, and the difficulty in interpreting acute injury and postreduction radiographs require that the treating physician have a high degree of clinical suspicion for associated injuries when CMC dislocations are identified. Treatment strategies incorporating intraoperative fluoroscopy, open anatomic reduction of the trapezoid under direct visualization along with closed reduction, and pinning of the metacarpals reestablish carpal stability and provide excellent long-term results.

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