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Andreas Panagopoulos, Dimitrios Bougiouklis, George Prelorentzos, Panagiotis Grigoropoulos, Zinon T. Kokkalis, Efstathios Chronopoulos
(Department of Upper Limb Surgery and Microsurgery, Patras University Hospital, Rio-Patras, Greece)
Med Sci Case Rep 2017; 4:14-18
Palmar perilunate fracture-dislocations in which the lunate remains in its normal position when the other carpal bones dislocate towards the volar aspect of the wrist accounts for less than 3% of perilunate dislocations.
CASE REPORT: A 24-year-old motorcyclist was admitted to our Department after having been involved in a traffic accident in which he had landed with his outstretched right hand on the road surface. X-rays revealed a volar trans-scaphoid perilunate dislocation of the carpus. Because closed reduction initially failed, the patient was transferred immediately to the operating theater for open reduction and fixation. Through a volar approach the median nerve was decompressed, the scaphoid was fixed with a cannulated screw, and the volar capsular-ligamentous complex was repaired with interrupted sutures. The carpus was relocated and stabilized with 2 K-wires through a dorsal approach. At 2-year follow-up, he had good range of motion and grip strength and demonstrated a Mayo wrist score of 86 points.
CONCLUSIONS: Volar trans-scaphoid perilunate carpal dislocations are rare injuries and can be initially missed if not properly assessed. Early management with anatomical fixation using both volar and dorsal approaches can provide an excellent clinical outcome.