Acute proximal row carpectomy to treat a transscaphoid, transtriquetral perilunate fracture dislocation: case report and
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CASE REPORTS
Acute proximal row carpectomy to treat a transscaphoid, transtriquetral perilunate fracture dislocation: case report and review of the literature Eric G. Huish Jr. & Mark A. Vitale & Alexander Y. Shin
Published online: 23 October 2012 # American Association for Hand Surgery 2012
Case Report A 68-year-old right hand dominant female sustained a direct trauma to her right wrist during a motorcycle accident resulting in an open right index finger proximal interphalangeal (PIP) joint laceration, small finger metacarpophalangeal (MCP) joint collateral ligament injuries with a stable metacarpal shaft fracture, and a transscaphoid, transtriquetral perilunate fracture dislocation with the lunate rotated 180° on the volar aspect of the distal radius and the carpus and hand translated volarly (Fig. 1a, b). The patient was brought to the operating room on the day of injury for irrigation and debridement and a plan for open reduction and internal fixation (ORIF) of the carpus. After extending the dorsal wrist laceration and releasing the extensor retinaculum with an ulnarly based flap, a traumatic dorsal wrist capsulotomy along the dorsal intercarpal ligament was visible with multiple extruded bony fragments from the triquetrum and scaphoid. The remainder of the capsule was divided via a ligament sparing capsulotomy. The lunate, scaphoid, and triquetrum were dislocated volarly. The lunate remained attached only by a small portion of the short radiolunate ligament with the long radiolunate ligament completely avulsed. The scaphoid was free floating with only minor attachments to the intact trapezium. The triquetrum was still attached to the hamate but was fractured dorsally and volarly with significant E. G. Huish Jr. Midwestern School of Medicine, 1955 North 59th Avenue, Glendale, AZ 85308, USA M. A. Vitale : A. Y. Shin (*) Division of Hand Surgery, Department of Orthopaedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA e-mail: [email protected]
comminution. The scapholunate ligament was ruptured. Attempts were made to reduce the scaphoid and lunate together, but after appreciating the gross instability from ligamentous disruption and the severity of articular injury, a decision was made to perform an acute salvage procedure. Based on the significant articular damage to the cartilage on the radiolunate side of the lunate but preservation of the articular surface of the capitate and lunate fossa of the distal radius, a proximal row carpectomy (PRC) was performed. The scaphoid, lunate, and triquetrum were removed with minimal dissection, and the remaining small proximal carpal fragments were debrided. The capitate was then seated into the lunate fossa and given significant laxity of the radiocapitate articulation temporarily secured with two 0.045 Kwires. Instability was attributed to the loss of support of the volar extrinsic ligaments, in particular the long radiolunate ligament, which was completely avulsed from the lunate. For this reason, the radiolunate ligament was repaired direct
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