Figure 2 - uploaded by L. Badras
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Lateral radiograph of the right wrist shows the domed articular surface of the proximal capitate fragment (black arrows) and an avulsion flake fracture of the dorsal surface of the triquetrum (white arrow). The capitate fragment is rotated 180° facing distally and is displaced palmarly between the lunate and the distal capitate fragment.
Source publication
Trans-scaphoid transcapitate (TSTC) perilunate fracture-dislocation (PLFD) is a rare type of perilunate injury. Because of the rarity and complexity of this entity, initial diagnosis may be delayed and the extent of osseous and ligamentous lesions underestimated. Early surgical treatment by open reduction and fracture stabilization is recommended t...
Contexts in source publication
Context 1
... showed a fracture of the waist of the scaphoid (Figure 1). In addition, the capitate was fractured with the proximal fragment rotated 180° ( Figure 1, Figure 2). A small avulsion fracture on the dorsal surface of the wrist was obvious as well ( Figure 2). ...
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Citations
... This typically occurs secondary to trauma of an outstretched hand such as in recreational sports, high-energy motor vehicle or motorcycle accidents, high-energy military training accidents, ground-level falls, and crush injuries [16,17,18]. Even with satisfactory treatment, numerous complications have been noted with these injuries, such as chondrolysis, carpal instability, traumatic arthritis, avascular necrosis, non-union, and functional impairment [19,20]. Early surgical intervention is often the best course of action for acute PLD-PLFD injuries to prevent complications and poor outcomes [20,21]. ...
... Even with satisfactory treatment, numerous complications have been noted with these injuries, such as chondrolysis, carpal instability, traumatic arthritis, avascular necrosis, non-union, and functional impairment [19,20]. Early surgical intervention is often the best course of action for acute PLD-PLFD injuries to prevent complications and poor outcomes [20,21]. Associated acute compression neuropathy refractory to closed reduction is an indication for urgent decompression to prevent irreversible ner ve damage. ...
... The fracture pattern is also rare, involving an atypical greater arc injury pattern in combination with an inferior arc injury. While there are other reported cases of trans-scaphoid, transcapitate, and perilunate fracture dislocations in the literature, these patients did not concomitantly suffer from inferior arc injuries [20,22,23]. The relative rarity of our patient's case is underscored by Apostolides et al. in a 2011 review, where they described mixed fracture dislocation patterns as rare given their lack of conformation to either lesser arc or greater arc force transmission patterns [17]. ...
Introduction:
Perilunate dislocations and perilunate fracture-dislocations (PLFD) are relatively uncommon injuries, comprising <10% of wrist injuries. Perilunate injuries are often complicated by median neuropathy reported in 23-45% of cases, whereas there are very few reported cases of associated ulnar neuropathy. Combined greater arc and inferior arc injuries are also rare. We report an unusual PLFD pattern with associated inferior arc injury and acute ulnar nerve compression.
Case report:
A 34-year-old male sustained a wrist injury after a motorcycle collision. Computed tomography scan revealed a trans-scaphoid, transcapitate, perilunate fracture-dislocation, and a distal radius lunate facet volar rim fracture with radiocarpal subluxation. Examination revealed acute ulnar neuropathy without median neuropathy. He underwent urgent nerve decompression and closed reduction, followed by open reduction internal fixation the next day. He recovered without complication.
Conclusion:
This case emphasizes the importance of a thorough neurovascular examination to rule out less commonly seen neuropathies. With up to 25% of perilunate injuries misdiagnosed, surgeons should have a low threshold for advanced imaging in high-energy injuries.
... Wrist salvage procedures are indicated when the arthritis has advanced to a degree of which the patient cannot tolerate the pain. 4,5 We present a case of a patient who suffered a transscaphoid transcapitate perilunate fracture-dislocation in the setting of a prior scaphoid nonunion and SNAC wrist. Radiographs revealed a greater arc injury with transmission of force through the previous scaphoid nonunion site, resulting in displacement of the cannulated screw from the proximal pole of the scaphoid (Figs 1 and 2). ...
