Post Traumatic Avascular Necrosis of the Proximal Carpal Row - A Case Report

Abstract

We report a case of avascular necrosis of the scaphoid, lunate and triquetrum in a young 21-year-old patient, after a purely ligamentous peri-lunate dislocation of the wrist. He presented with a Mayfield III peri-lunate dislocation after a road traffic accident and underwent an open reduction and internal fixation. Post-operatively, the scapho-lunate gap widened after removal of the temporary K-wires, and he gradually developed avascular necrosis of the scaphoid, lunate and triquetrum, and osteoarthritis of his wrist. We present this unusual case of simultaneous avascular necrosis of multiple carpal bones and discuss the possible risk factors and subsequent management plans for this complex injury. Our patient has no identifiable contributing factors to developing avascular necrosis. We suspect that the violence of the injury and surgery may have compromised the circulation, and advise caution when treating and counseling these patients pre-operatively.

Concomitant avascular necrosis of the lunate and proximal pole of the scaphoid in a thalassemia minor patient

“…The patients declined further surgeries and chose nonsurgical treatments. [ 1 ] Didden et al . have reported a case of osteonecrosis of the entire proximal carpal row of the wrist, started briefly after intravenous bisphosphonate administration.…”

“…AVN of multiple carpal bones has been mentioned with a history of trauma, metabolic disorder, corticosteroid consumption, rheumatoid disorders, and systemic lupus erythematosus (SLE). [ 1 2 3 4 ] This case report presents a patient with concomitant AVN of the lunate and proximal pole of the scaphoid.…”

Kienböck Disease following a Single Wrist Traumatic Incident: A Scoping Review

“…Ligamentous injury surrounding the lunate may cause an acute interruption of vascular supply and compromise intraosseous circulation of the lunate. [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] Coll reported a case of palmar dislocation of the scaphoid and lunate, which subsequently resulted in lunate avascular necrosis (AVN). 25 Manohara et al described a case of AVN involving the scaphoid, lunate, and triquetrum following an isolated perilunate dislocation (PLD) of the wrist.…”

“…25 Manohara et al described a case of AVN involving the scaphoid, lunate, and triquetrum following an isolated perilunate dislocation (PLD) of the wrist. 26 Bourne et al reported six individuals with Kienböck disease and a history of scapholunate (SL) dissociation. Five out of the six had a single traumatic event that had occurred between 8 months and 7 years before the onset of Kienböck disease.…”

Coexisting Kienböck's and Preiser's Disease of the Wrist: Experience with Proximal Row Carpectomy with Dorsal Capsular Interposition Technique

“…T here are some reports of avascular necrosis of carpal bones. [1][2][3][4] Risk factors of avascular necrosis of bones have been reported to include corticosteroid use, smoking, gout, alcoholism, infections, storage disorders, marrow-infiltrating diseases, coagulation defects, hemoglobinopathies, fat emboli, liver disease, hyperlipidemia types II and III, hemophilia, rheumatoid arthritis, systemic lupus erythematosus, and pancreatitis. 5 Kienböck's disease and Preiser's disease comprise avascular necrosis of the lunate and scaphoid, respectively.…”