Traumatic volar dislocation of a hemi-scaphoid-lunate compound over the carpal ligament: Case report

Abstract

A 16-year-old, right-handed male sustained an isolated closed injury to the left wrist after falling from a one storey building rooftop there was no neurovascular impairment, with preservation of the sensory function of the median nerve. Wrist motion was compromised and a 3 x 3 x 2 cm palpable mass on the mid-portion of the volar forearm was evident. Posteroanterior and lateral x-ray revealed a volar transscaphoid peri-lunate fracture-dislocation migrated into the forearm. The whole lunate and the proximal pole of scaphoid joined by the scapho-lunate ligament were initially released through a volar approach, and then were reduced into place through a dorsal approach. The scaphoid fracture was fixed with a Herbert screw and the lunate was stabilized with 3 Kirschner wires. At 3 years follow up, patient reported no wrist pain. He presented good mobilities and satisfactory pinch and grip strength in comparison with the contralateral side. The image study revealed mild degenerative changes of the radiocarpal articulation and although necrosis of the lunate cannot be excluded, there is no loss of height when compared to the contralateral wrist.