Scaphoid and lunate palmar divergent dislocation. Apropos of a case

Abstract:

Discussion Simultaneous dislocation of scaphoid and lunate as a unit or with a large gap between the two bones are extremely rare injuries. In all cases already reported, results were briefly presented without any available clinical and radiological data because patients were lost for follow-up. In our case report, the anatomy and kinematics of the wrist showed the lack of our initial treatment with a single volar approach, anterior capsular reparation and a long arm cast alone. In fact, at 3.5 years follow up, ligamentous healing was inadequate to control compressive forces across the wrist and the scaphoid volarflexed despite a good alignement in the cast. Although the functional results is good, radiological outcome is far from being good. This case demonstrated that even in early treatment with a good position of carpal bones in the sole cast, healing of the ligamentous system without loosing reduction is difficult. Conclusion In such a case, and with a low rate of avascular necrosis in perilunate dislocations treated early we suggest an open reduction and internal fixation (ORIF) to prevent carpal instability. We recommend combined volar and dorsal approaches for repairing anterior and posterior ligaments (especially interosseous ligaments on both sides of the lunate), associated with a stabilization of the entire carpum by scapho-lunate, triquetro-lunate, and capito-lunate Kirschner wire fixation.

Año de publicación:

1997

Keywords:

Fuente:

google