Scaphoid fracture combined with triangular fibrocartilage injury and radial head fracture: a new type of forearm injury triad

Abstract

Objective To introduce a new triad of forearm injury: scaphoid fracture, triangular fibrocartilage (TFC) injury and radial head fracture, and discuss the similarities and differences comparing to Essex-Lopresti injury. Methods Six male patients of closed forearm injuries treated from October 2011 to May 2013 were involved in this study. They all had scaphoid and radial head fractures on the same side. Wrist arthroscopic examination was carried out in 3 cases that revealed injury to the radial rim of the TFC. One case had olecranon fracture on the contralateral side, while 5 cases had no other accompanying fractures.Two cases were non-surgically treated, while 4 cases were surgically managed where the scaphoid fracture was treated with percutaneous compressive cannulated screw fixation, and the laceration or perforation at the radial rim of the TFC revealed under wrist arthroscopy in 3 cases was treated with arthroscopic debridement. The radial head fracture in 3 cases was categorized as Mason type Ⅰ and treated with splint immobilization. Open reduction and internal fixation was used in 1 case of Mason type Ⅱ radial head fracture. Results All 6 patients were follow-up for 12 to 24 months. The mean follow-up period was 17 months. Fracture union was achieved in all six patients. Clinical evaluations using modified Mayo wrist scoring system and modified Morrey elbow score revealed excellent wrist and elbow functional results in all the patients. Conclusion Comparing to the typical Essex-Lopresti injury, the reported new triad of forearm injury has subtler clinical manifestations due to the relatively low energy impact despite of the similar injury mechanisms. Consequently, misdiagnosis or missed diagnosis is more likely to happen. Successful outcomes rely on prompt diagnosis and proper treatment. Key words: Scaphoid bone; Radius; Fractures, bone; Triangular fibrocartilage