Abstract
We present the case report of a 30-year-old male who fell from a height of 15 feet on his palmar-flexed right wrist and came to us 1 month after the injury. He had a swollen, stiff wrist with painful movements and no neurovascular deficit. X-rays showed a trans-scaphoid volar perilunate dislocation. We used the volar approach for open reduction and internal fixation with a headless screw for scaphoid fracture and scapho- lunate and capito-lunate K-wires for intercarpal instability. The wrist was immobilised in a below-elbow POP slab for 6 weeks after which the K-wires were removed. The patient unfortunately developed complex regional pain syndrome (CRPS), which can be attributed to his late presentation after the injury. Active and passive range of motion exercises and contrast bath were initiated and he was kept on low dose amitriptyline. Gradually CRPS resolved and at 6-month follow-up, the patient had a wrist dorsiflexion of 30° and palmar-flexion of 45°.
Highlights
We used the volar approach for open reduction and internal fixation with a headless screw for scaphoid fracture and there was diffuse tenderness and swelling over the right wrist with restriction of movements
The patient developed complex regional pain syndrome (CRPS), which can be attributed to his late presentation after the injury
Patients presenting late are difficult to manage due to soft tissue contractures and increased chances of 1) avascular necrosis of scaphoid and lunate, 2) tractional injury to neurovascular structures, 3) wrist stiffness, and 4) complex regional pain syndrome (CRPS).[3]
Summary
Volar perilunate dislocation (VPLD) is a rare injury accounting for about 3% of perilunate dislocations which comprise of less than 10% of all wrist injuries.[1]. Open reduction and internal fixation is the ideal treatment due to variable results with closed reduction.[2] Patients presenting late are difficult to manage due to soft tissue contractures and increased chances of 1) avascular necrosis of scaphoid and lunate, 2) tractional injury to neurovascular structures, 3) wrist stiffness, and 4) complex regional pain syndrome (CRPS).[3]. We, through this case report, aim to highlight the problems faced in managing neglected VPLDs and importance of prompt restoration of intercarpal alignment in such injuries to prevent complications. We state that early recognition and treatment improves patient outcomes in CRPS
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