Bilateral dorsal trans-scaphoid perilunate fracture-dislocation: A case report.
BACKGROUND
Perilunate dislocations represent one of the most devastating injuries to the carpus. Fortunately, these injuries are relatively rare, constituting approximately 10% of all carpal injuries. One of the problems associated with this injury is the difﬁculty of its accurate and early recognition.


METHODS
In this study, an uncommon case of bilateral dorsal trans-scaphoid perilunate fracture-dislocation following trauma has been reported. The injury was missed initially and the patient was subsequently operated after two weeks. Anatomic reduction was achieved by closed reduction. After closed reduction, percutaneous pin fixation of the carpus was performed using Kirschner wires. Finally, the scaphoid was stabilized with a headless screw percutaneously. The same procedure was repeated for the other wrist. This was followed by an uneventful post-operative period, with a satisfactory functional outcome at the two-year follow-up, despite non-union of the scaphoid in one side.


CONCLUSIONS
The case was examined in detail, and compared to the findings in the literature; observations regarding fracture prognosis were also made. Most authors agree that closed reduction is the initial treatment of choice for trans-scaphoid perilunate fracture-dislocations. In addition, treatment often requires intercarpal fixation within the proximal carpal row.


CONCLUSIONS
We believe that closed reduction in these cases should be attempted regarding the potential risks of avascular necrosis and non-union of the affected carpal bones due to open reduction.
Gülhane Military Medical Academy, Haydarpaşa Training Hospital, Department of Orthopaedics and Traumatology, Tıbbiye Caddesi, Üsküdar, Istanbul, Turkey. Electronic address: drcengizyildirim@yahoo.com.
Cengiz
C
Yildirim
Hospitalist Private Hospital, Department of Orthopaedics and Traumatology, Bağcilar, Istanbul, Turkey.
Fatih
F
Unuvar
Gülhane Military Medical Academy, Haydarpaşa Training Hospital, Department of Orthopaedics and Traumatology, Tıbbiye Caddesi, Üsküdar, Istanbul, Turkey.
Kenan
K
Keklikci
Hand and Upper Extremity, Orthopaedics and Traumatology, Special Office, Iran Caddesi, No: 15/6 Kavaklidere, Ankara, Turkey.
Mehmet
M
Demirtas
Minimally invasive surgery; Non-union; Perilunate fracture–dislocation; Scaphoid fracture; Trans-scaphoid