Complex and Rare Fracture Patterns in Perilunate Dislocations

Abstract

Introduction The wrist represents a complex anatomic region in the upper extremity and a highly functional and intricate structural joint. Perilunate injuries have classically been described as involving a greater or lesser arc as described by Mayfield and imply a specific pattern of force transmission. The greater and lesser arc classifications do not include descriptions of when non-scaphoid carpal fractures occur as part of a perilunate injury. Methods/Results We present three cases of complex and rare perilunate fracture dislocation patterns and discuss the surgical management as a treatment model for these complex wrist injuries: the trans-scaphoid, trans-capitate perilunate dislocation, the trans-scapholunate ligament, trans-capitate dislocation, and the trans-scaphoid, transtriquetral perilunate dislocation. Discussion Although there is a low incidence of injury to non-scaphoid carpal bones, it is beneficial to understand the approach to the perilunate reduction and scaphoid fixation through a combined volar and dorsal approach, which will also allow for the reduction and fixation of more rare and complex carpal fractures.

Initially unrecognised lunate dislocation as a cause of carpal tunnel syndrome

“…Dislocation of the lunate bone is a result of a high-energy trauma 13. Combined injuries involving other carpal bones in the forearm are frequently seen by trauma surgeons 14 15…”

Skafoid harici karpal kemik kırıkları

“…Ancak, literatürde bu tip yaralanmalarda volar mi, dorsal mi yoksa her iki yaklaşımın da mı kullanılması gerektiğine dair görüş birliği yoktur. [28] Ayrıca kırıklarla birlikte olan perilunat çıkıkların bağ yırtıkları ile birlikte olan çıkıklara göre daha kolay iyileştiği ve sonuçlarının daha iyi olduğu gözlemlenmiştir. [28] Bunun nedeni olarak, bağ yırtıklarının sağlam tamirinin ve sonrasında korunmasının zor, buna bağlı olarak da iyileşmenin zayıf olması düşünülmüştür.…”

Pancarpal dissociation, a very rare type of injury

“…[1] Perilunate injury according to a classification described by Mayfield is well-known injury pattern, but there are many variations that are not clearly categorized. [2][3][4] Among these, pancarpal dissociation is even rarer and has not been clearly defined. Only one case report has been published, but this case was more consistent with capitate fracture-dislocation than pancarpal dissociation.…”

“…Carpal dislocation and fracture-dislocation are usually caused by high-energy trauma [1] . Perilunate injury according to a classification described by Mayfield is well-known injury pattern, but there are many variations that are not clearly categorized [2–4] . Among these, pancarpal dissociation is even rarer and has not been clearly defined.…”