title: Trans-Scaphoid Perilunate Dislocation: Union of an Extruded Scaphoid Proximal Pole Fragment.
abstract: We present an unusual case of a closed perilunate dorsal-dislocation of the carpus, with an associated scaphoid fracture. In this extreme case, the proximal scaphoid pole was extruded volarly and proximally. After closed manipulation, the proximal pole of the scaphoid was further dislocated dorsally, a phenomenon not previously described in the literature. At open reduction this fragment was noted to have no soft tissue attachment but after reduction, distal radius bone graft and compression screw fixation the scaphoid went on to unite with a good functional result. This case highlights a rare but serious injury to the wrist with an unusual dislocation pattern not previously described. It demonstrates that early surgical intervention to fix such fractures with an avascular fragment can still achieve fracture union, despite the severity.
authors.affiliation: † Department of Hand Surgery, Orthopaedics and Trauma, Norfolk and Norwich University Hospital, Norwich, United Kingdom.
authors.forename: Pky
authors.initials: P
authors.lastname: Goon
authors.affiliation: * Department of Hand Surgery, Orthopaedics & Trauma, Lister Hospital, Stevenage, United Kingdom.
authors.forename: K R
authors.initials: KR
authors.lastname: Vaghela
authors.affiliation: † Department of Hand Surgery, Orthopaedics and Trauma, Norfolk and Norwich University Hospital, Norwich, United Kingdom.
authors.forename: A J
authors.initials: AJ
authors.lastname: Chojnowski
mesh_terms: D006801:Humans; D004204:Joint Dislocations / Q000209:etiology / Q000601:surgery*; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods*; D021361:Scaphoid Bone / Q000293:injuries*; D014954:Wrist Injuries / Q000150:complications / Q000601:surgery*; D014955:Wrist Joint / Q000601:surgery
keywords: Fracture dislocation; Perilunate; Proximal pole; Scaphoid fracture; Trans-scaphoid