Scaphocapitate Syndrome With Associated Trans-Scaphoid, Trans-Hamate Perilunate Dislocation

Abstract

Background: Perilunate fracture dislocations are often associated with fractures of the distal pole of the scaphoid or the proximal pole of the capitate. However, the combination of perilunate dislocation with multiple carpal fractures and associated scaphocapitate syndrome is very rare. Methods: We report a unique case of scaphocapitate fracture syndrome with perilunate dislocation and fracture of the hamate resulting from a high-energy injury to the wrist during a dirt-bike competition. Results: Open reduction and internal fixation of the scaphoid fracture with a 3.0-mm headless screw, the head of the capitate with a 1.5-mm lag screw, and the hamate fracture with a 1.3-mm lag screw was performed. The lunotriquetral dissociation was reduced, with the ligament repaired and the joint stabilized using a Kirschner wire. All screw heads are carefully buried under the articulate cartilage. Conclusions: Prompt anatomic reduction and stable osteosynthesis of all fractures in this patient resulted in successful healing and return to activity.

Features of intra-hamate vascularity and its possible relationship with avascular risk of hamate fracture

“…However, according to our follow-up results and the published researches of complex carpal injuries with transhamate fractures, the outcomes were generally good. [27,28,29] It was assumed that the tough ligament connecting the capatite will provide rigid stability of hamate fractures. [28] In addition, the axial load helps to maintain the stability of transversal fractures.…”

Trans-styloid, trans-hamate dorsal lunate dislocation: A case report

“…When the treatment is delayed, lunate dislocations are more difficult to reduce, and outcomes may be jeopardized, leading to nonunion, carpal arthritis, and collapse [10]. Therefore, this case was managed urgently after ruling out life-threatening conditions.…”

A Unique Presentation of Scaphocapitate Syndrome With Extrusion Into the Carpal Tunnel: A Case Report

“…11 Diagnosis of this rare perilunar fracture is often initially missed, as was the instance in this case presentation, highlighting the need for CT imaging in the setting of carpal injury. 2,6,7 Delays in diagnosis further complicate management, leading to an increased risk of posttraumatic carpal arthritis, avascular necrosis, and/or carpal collapse. 2,12 There is a general consensus among authors that injuries of this variety require open anatomic reduction of both the capitate and scaphoid, followed by internal fixation.…”

“…2,6,7 Delays in diagnosis further complicate management, leading to an increased risk of posttraumatic carpal arthritis, avascular necrosis, and/or carpal collapse. 2,12 There is a general consensus among authors that injuries of this variety require open anatomic reduction of both the capitate and scaphoid, followed by internal fixation. 2,5,7,[11][12][13] Although the proximal portions of both the capitate and scaphoid are vulnerable to posttraumatic avascular necrosis due to the retrograde blood supply of these fragments, the capitate head is nourished by synovial fluid and has demonstrated the ability to revascularize when anatomically reduced.…”

“…Scaphocapitate syndrome, an exceedingly rare variety of carpal instability, is no exception as a delay in diagnosis has been reported in up to 25% of cases. 1,2 This carpal injury is characterized by transverse fractures of both the scaphoid and capitate with subsequent rotation of the proximal capitate to either 90° or 180°. 3,4 Few cases of this unusual fracture pattern have been reported since 1956, 2,3,[5][6][7] when Fenton first defined this phenomenon.…”