Reduction and Association of the Lunotriquetral Ligament for Reverse Perilunate Dislocation

Abstract

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.

Reverse Perilunate Injuries—The “Extended Scaphoid” Sign

“…Both in the REPLI literature 3 4 5 6 7 and in our series with dorsal REPLI suspicion, the PA views of the scapholunate junction displayed a step-off and overlap rather than a gap.…”

“…In one case, the loss of normal relationships between the capitate and lunate was replaced by a fracture of the body of the capitate with dorsal displacement of the distal fragment. Similarly, the PA and lateral radiographs available in the REPLI literature 3 4 5 6 7 displayed an extended position of the scaphoid, a lunotriquetral dissociation, and a dorsal dislocation of the capitate with respect to the lunate.…”

“…The PA and lateral initial emergency radiographs of our specialized wrist surgery series of 114 dorsal pure ligamentous PLI (within a 186 cases series of PLI treated between 2004 and 2020) were reviewed as well as the available figures of the current REPLI literature. [2][3][4][5][6][7] On PA radiographs, the position of the scaphoid was investigated whether it was flexed (and apparently foreshortened with scapholunate gap) or extended (whole scaphoid visible as in an ulnar inclination view and no visible scapholunate gap).…”

“…The PA and lateral initial emergency radiographs of our specialized wrist surgery series of 114 dorsal pure ligamentous PLI (within a 186 cases series of PLI treated between 2004 and 2020) were reviewed as well as the available figures of the current REPLI literature. 2 3 4 5 6 7…”