Treatment of an Unusual Trans-Scaphoid Perilunate Avulsion Fracture Dislocation: A Case Report

Abstract

We describe an unusual case of trans-scaphoid perilunate injury where the proximal half of the scaphoid avulsed from all attaching ligaments and extruded into the forearm. Treatment involved anatomic reduction and internal fixation of the fracture, scapholunate (SL) ligament repair, temporary K-wire fixation, and prolonged immobilization. At 19-month follow-up, the fracture healed, SL ligament remained intact, and the patient recovered much of his hand function.

A Narrative Review on Avulsion Fractures of the Upper and Lower Limbs

“…18,19 The fracture can occur after falling on an outstretched hand and the patient will present with swelling, pain, and paresthesias. 19,20 The most common location of such an injury is at the…”

“…19 Scaphoid avulsion fractures fixed surgically are treated with a compression screw; stabilization of the fracture may be supplemented with K-wires, which can be removed once x-rays show evidence of bridging callus and there is a lack of tenderness. 20 Immobilization may last for up to 8 weeks postoperatively. 20 Other procedures may also be considered, such as carpectomy, fusion, or removal of the avulsed fragment, but these are salvage therapies reserved for more chronic cases (Figure 4).…”

“…20 Immobilization may last for up to 8 weeks postoperatively. 20 Other procedures may also be considered, such as carpectomy, fusion, or removal of the avulsed fragment, but these are salvage therapies reserved for more chronic cases (Figure 4). 20 Triceps tendon.…”

“…20 Other procedures may also be considered, such as carpectomy, fusion, or removal of the avulsed fragment, but these are salvage therapies reserved for more chronic cases (Figure 4). 20 Triceps tendon. The literature on treatment options for triceps tendon avulsions is limited to case reports and small case series.…”

“…18,19 The fracture can occur after falling on an outstretched hand and the patient will present with swelling, pain, and paresthesias. 19,20 The most common location of such an injury is at the tuberosity in the distal region of the scaphoid, but it can also occur at the proximal pole. 21–24…”