Acute scaphoidectomy and four-corner fusion for the surgical treatment of trans-scaphoid perilunate fracture dislocation with pre-existing scaphoid non-union

Abstract

This paper presents a rare case of trans-scaphoid perilunate fracture dislocation with concurrent scaphoid non-union of the left wrist following a motorcycle accident. Emergent CT identified scaphoid non-union advanced collapse and an acute scaphoidectomy, four-corner fusion, denervation and radiocarpal ligament repair was performed.

Isolated Osseous Excision in the Adult Carpus: A Narrative Review

“…10 In acute trauma such as scaphoid fracture, perilunate fracture dislocation, scapholunate ligament rupture, or where open reduction and internal fixation (ORIF) would likely not have a satisfactory outcome, 4CA or 3CA yields positive results. [11][12][13] Perilunate fracture dislocations can prove difficult to treat when associated with asymptomatic scaphoid nonunion advanced collapse (SNAC). Scaphoidectomy with 4CA, denervation, and ligament reconstruction is a viable option-patient follow-up at 6 months reported complete reduction in pain and reasonable wrist mobility.…”

“…Scaphoidectomy with 4CA, denervation, and ligament reconstruction is a viable option-patient follow-up at 6 months reported complete reduction in pain and reasonable wrist mobility. 12 Scapholunate advanced collapse (SLAC) and SNAC are the two most common causes of degenerative osteoarthritis of the wrist involving the scaphoid, whose late-stage treatments center largely around scaphoid excision and carpal arthrodesis. [14][15][16] Treatment options for stage II and III SLAC wrist have traditionally included PRC, scaphoidectomy with 4CA, and total wrist arthrodesis (TWA).…”

Outcomes Following Isolated Posterior Interosseous Nerve Neurectomy: A Systematic Review

“…17 These findings were reinforced by a second German report 11 years later in which a combination of wrist denervations were performed, yielding good pain relief in 80% of patients after a follow-up of more than 2 years. 3 Subsequently, PINN has been used as both an isolated 5,6,8,9,11,12 and adjunct procedure 1,4,13,18 treating patients with chronic dorsal wrist pain that is unresponsive to nonoperative treatments. Although several techniques for wrist denervation exist, 7,10 the PINN is the simplest technically to achieve, requires the least soft tissue handling, and the PIN innervates the central two-thirds of the wrist including to the wrist capsule, scaphoid, lunate, and dorsal distal radius.…”

“…15 However, the PINN literature is comprised of short case series without controls. In addition, because the procedure is typically in addition to other treatments to include carpal excision, 13 wrist fracture, 1 nonunion, 18 or Kienbock disease, 4 the quality of and length of effect of wrist denervation alone are not well known. The goal of this study is to produce a large conglomeration of patients who have undergone an isolated PINN to give a better understanding of the advantages and disadvantages of the technique.…”