Background Reverse perilunate injuries are rare. Contrary to perilunate injuries, the violent force would start from the lunotriquetral ligament, go reversely toward the radial side, and cause the reverse or ulnar-sided perilunate dislocation.
Case Description We describe a 31-year-old man with a reverse perilunate dislocation, who presented to our institution 3 weeks after a motorcycle accident. The patient was successfully treated with the reduction and association of the lunate and triquetrum (RALT) procedure by using closed maneuver and percutaneous headless compression screw fixation. The patient can obtain a good radiographic result and satisfactory function at the 30-month follow-up.
Literature Review Many case series were reported concerning the perilunate injuries. However, few cases of reverse perilunate dislocation have been reported in the literature. No cases of reverse perilunate dislocation treated 3 weeks after the injury with the RALT procedure have been reported.
Clinical Relevance In this case, we found that the dislocation could still be reduced with the closed maneuver. With the RALT procedure, the carpal alignment can be maintained and the stability can be regained. Also, the functional outcomes are good.
Case:
We describe a 33-year-old man who had a giant cell tumor in the ulnar head treated with wide resection and reconstructed using the modified Sauve-Kapandji procedure with an iliac crest bone graft as ulnar support.
Conclusions:
Due to the destructive nature of the tumor and the important role played by the ulnar head in the distal radioulnar joint (DRUJ), treatment of the giant cell tumor in the distal ulna is a challenge. The modified Sauve-Kapandji procedure is an effective technique to restore DRUJ function, which is performed as an ulnar support arthroplasty. Using an iliac crest bone graft as ulnar support in reconstruction surgery could be a practical method after the ulnar head has been resected.
Surgical correction of the distal radius fracture malunion is challenging because of the 3-dimensional deformity. We propose a method by using the Kapandji intrafocal pinning in corrective osteotomy for treatment of the distal radius fracture malunion to facilitate the alignment correction while using the bone graft to restore the radial length. The surgery was started with the osteotomy from a volar approach, and the osteotomy gap was expanded gradually. Then, allobone grafting was performed to maintain the corrected radial length. We used the Kapandji intrafocal pinning dorsally to provide dorsal supporting force and radially to correct the radial inclination. Finally, a volar plate was used to buttress and push the distal fragment to fit as to regain the correct volar tilt. We enrolled 10 patients of distal radius fracture malunion with a mean age of 59.3 years. All patients had bone healing within 3 months after surgery. The mean lengthened distance was 5 mm. The radial inclination and volar tilt could be corrected with improved functional results.
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