A unique case of bilateral trans-scaphoid perilunate dislocation with dislocation of lunate into the forearm.

Abstract

Perilunate dislocations are commonly seen after fall on an outstretched hand in extremes of dorsiflexion and ulnar deviation. A greater arc injury is one when there is an associated fracture of one or more bones around the lunate while a lesser arc injury is associated with pure ligamentous disruption around the lunate. We report a unique case of bilateral trans-scaphoid perilunate dislocation in a 35-year-old male labourer. This is the first reported case where the lunate dislocated into the forearm on the volar aspect. Urgent open reduction and stabilization of both wrists was done. Currently, the wrist is stable with functional range of motion with union of both scaphoid fractures at 1-year follow-up. A delay in management of perilunate dislocations is associated with unfavourable prognosis. Prompt reduction and fixation is of paramount importance. Radiocarpal arthritis is associated with delayed management. In our case, the patient has regained painless functional range of motion without any radiological evidence of arthritis. We thus conclude that all perilunate dislocations must undergo emergency reduction. Open reduction and ligamentous repair should be considered as the treatment of choice as it is associated with better functional outcomes in terms of pain and arthritis.