Palmar-divergent dislocation of the scaphoid and the lunate

Shingo Komura,Yasushi Suzuki,Tatsuo Yokoi

doi:10.1007/s10195-011-0131-5

Abstract

We describe a patient with palmar-divergent dislocation of the scaphoid and lunate. After successful closed reduction, the scapholunate and lunotriquetral ligaments were sutured through the dorsal approach, and the anterior capsule was sutured through the palmar approach. The scapholunate and lunotriquetral joints were fixed with Kirschner wires for 7 weeks. At the 1-year follow-up, magnetic resonance imaging showed no evidence of avascular necrosis of the scaphoid or lunate, and radiographs showed no evidence of the dorsal and volar intercalated segment instability patterns associated with carpal instability. However, flexion of the scaphoid and a break in Gilula’s line remained. To our knowledge, this is the first report showing treatment of palmar-divergent dislocation of the scaphoid and lunate by suturing the carpal interosseous ligaments.

Highlights

We describe a patient with palmar-divergent dislocation of the scaphoid and lunate
The scapholunate and lunotriquetral ligaments were sutured through the dorsal approach, and the anterior capsule was sutured through the palmar approach
The scapholunate and lunotriquetral ligaments were sutured through the dorsal approach, the anterior capsule was sutured through the palmar approach, and the scapholunate and lunotriquetral joints were fixed with Kirschner wires

Summary

Case report

A 46-year-old man who fell from a height of 1.5 m onto his left hand was brought to the emergency center of our hospital and underwent a medical examination. Radiography of the wrist revealed palmar-divergent dislocation of the scaphoid and lunate (Fig. 1) but with no neurovascular disturbance in the hand. Two hours after the injury, we performed closed reduction under local anesthesia. Closed reduction was successful, severe carpal instability was observed. Seven days after the injury, open surgery was performed through the palmar and dorsal approaches. The dorsal approach showed ruptures of the scapholunate and lunotriquetral ligaments, which were sutured with anchors. The palmar approach showed an oblique tear of the anterior capsule, which was sutured with absorbable threads. The scapholunate and lunotriquetral joints were fixed with two Kirschner wires, inserted from the scaphoid to the lunate and from the triquetrum to the lunate, respectively, and the wires were buried under the skin (Fig. 2).

Anterior capsule suture

Discussion