Isolated fracture-dislocation of the scaphoid's proximal pole treated by scaphoid internal fixation and scapho-lunate ligament reconstruction.
We present a case of irreducible palmar dislocation of the proximal fragment of a scaphoid fracture without carpal dislocation. We observed this lesion 2 days after the injury and we immediately operated the patient with a combined volar and dorsal access: using the Henry access we reduced the fracture and we inserted a cannulated screw to synthesize the scaphoid, using the dorsal access we repaired the complete rupture of the scapho-lunate ligament using a mini anchor. Stabilization among scaphoid, lunate and capitate was performed using Kirschner wires. X-ray showed fracture healing after 90 days. No clinical or radiographic evidence of carpal instability was revealed, on standard X-rays or on dynamic evaluations. No sign of avascular necrosis or degenerative arthritis was observed after 9 months.
Rosati
Marco
M
1st Orthopaedic Department, University of Pisa, 56100 Pisa, Italy. rosati61@virgilio.it
Parchi
Paolo
P
Lisanti
Michele
M
D000063:Accidents, Traffic; D001863:Bone Screws; D001864:Bone Wires; D005593:Fracture Fixation, Internal / Q000379:methods*; D005596:Fractures, Closed / Q000601:surgery*; D006801:Humans; D008023:Ligaments, Articular / Q000293:injuries* / Q000601:surgery; D012667:Lunate Bone / Q000601:surgery; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods*; D021361:Scaphoid Bone / Q000293:injuries* / Q000601:surgery; D014954:Wrist Injuries / Q000209:etiology; D055815:Young Adult