Isolated Scaphoid Dislocation: A Case Report and Review of the Literature

Abstract

Background Isolated scaphoid dislocation is an exceedingly rare event with only 55 cases described. Closed reduction followed by operative intervention with Kirschner's wires (K-wire) fixation and ligamentous reconstruction are the mainstays of treatment. Case Description We describe a patient with a solitary scaphoid dislocation treated with initial closed reduction and urgent open reduction with K-wire stabilization and ligamentous repair. The patient was immobilized for 6 weeks and on 24-month follow-up, the patient was doing well with no limitations in his daily living, no pain, and acceptable range of motion. Literature Review A literature review was performed on the 55 cases described in the English language. The majority of the patients were males, aged between 18 and 79 years, and presented with motor vehicle accidents as the most common mechanism. Historically, isolated scaphoid dislocations were treated with closed reduction. However, K-wire fixation and, now, K-wire fixation coupled with ligamentous injury repair remain the current treatments of choice. Avascular necrosis of the scaphoid remains a rare event with only one documented case. Overall, patients do well with only minor pain and limited wrist movements. Notably, only eight cases were associated with type-II lunates. Type-II lunates appear to be protective for carpal injury. Clinical Relevance Although isolated scaphoid dislocations remain a rare event, understanding the anatomy and the current ability to restore carpal anatomy is important. Type-II lunates appear to confer protection from carpal injuries.

Isolated Scaphoid Dislocation From Low-Energy Wrist Trauma

“…The patient’s wrist was dorsiflexed with ulnar deviation, like the anatomic positioning first described by Buzby 2 and found in many other reported cases. 1 However, this case was critically different in that the dislocation was not the result of a traumatic event, such as a motor vehicle accident or a fall from height. His dislocation could have been secondary to his presumed diagnosis of MFS.…”

“…First described by Higgs 6 in 1930, there have only been isolated published case reports, and the epidemiology is currently unexplored. 1 A recent literature review by Amundsen et al 1 identified a total of 55 documented cases of isolated scaphoid dislocation, with the majority of these injuries in males with ages between 18–79 years. Notably, the 20-year-old man we saw is one of the younger reported cases of isolated scaphoid dislocation.…”

“…To date, few cases have been published, and no formal investigation into incidence, classification, or management have been performed. 1 , 2 These injuries are characteristically associated with high-energy trauma but have occasionally been seen in other scenarios. Currently, diagnosis and management rely on physician experience and preference, although there have been attempts to develop a classification system and management algorithm.…”

Open Dislocation of the Scaphoid With an Associated Hamate Fracture and Fourth Metacarpal Fracture

“…Because of the unconventional nature of this injury, the diagnosis of a scaphoid dislocation is often initially missed, with a delay to diagnosis representing the greatest risk factor for poor outcome. 2 , 3 , 4 , 5 …”

“… 6 Partial dislocations are more common, where the distal pole of the scaphoid remains attached distally by the scaphotrapeziotrapezoid ligaments and scaphotrapezial articulation. 2 When identified early, treatment options for scaphoid dislocation have been successful and include either closed or open reduction followed by cast immobilization, K-wire fixation, and/or ligamentous repair/reconstruction. 7 , 8 …”