title: Post Traumatic Avascular Necrosis of the Proximal Carpal Row--A Case Report.
abstract: We report a case of avascular necrosis of the scaphoid, lunate and triquetrum in a young 21-year-old patient, after a purely ligamentous peri-lunate dislocation of the wrist. He presented with a Mayfield III peri-lunate dislocation after a road traffic accident and underwent an open reduction and internal fixation. Post-operatively, the scapho-lunate gap widened after removal of the temporary K-wires, and he gradually developed avascular necrosis of the scaphoid, lunate and triquetrum, and osteoarthritis of his wrist. We present this unusual case of simultaneous avascular necrosis of multiple carpal bones and discuss the possible risk factors and subsequent management plans for this complex injury. Our patient has no identifiable contributing factors to developing avascular necrosis. We suspect that the violence of the injury and surgery may have compromised the circulation, and advise caution when treating and counseling these patients pre-operatively.
authors.affiliation: 1 Department of Hand & Reconstructive Microsurgery, University Orthopedic, Hand & Reconstructive Microsurgery Cluster, National University Health System, Singapore.
authors.forename: Ruben
authors.initials: R
authors.lastname: Manohara
authors.affiliation: 1 Department of Hand & Reconstructive Microsurgery, University Orthopedic, Hand & Reconstructive Microsurgery Cluster, National University Health System, Singapore.
authors.forename: Sandeep Jacob
authors.initials: SJ
authors.lastname: Sebastin
authors.affiliation: 1 Department of Hand & Reconstructive Microsurgery, University Orthopedic, Hand & Reconstructive Microsurgery Cluster, National University Health System, Singapore.
authors.forename: Mark Edward
authors.initials: ME
authors.lastname: Puhaindran
mesh_terms: D003937:Diagnosis, Differential; D006801:Humans; D012667:Lunate Bone / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D010020:Osteonecrosis / Q000175:diagnosis / Q000209:etiology*; D011859:Radiography; D021361:Scaphoid Bone / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology; D014954:Wrist Injuries / Q000150:complications* / Q000175:diagnosis; D055815:Young Adult
keywords: Avascular necrosis; Peri-lunate dislocation; Proximal carpal row