Trans-Scaphoid, Transtriquetral, Volar Lunate Fracture-Dislocation of the Wrist. A Case Report*

Abstract

Fracture-dislocations of the carpus represent a spectrum of complex injuries1-3,5-12,14. Accurate description of a specific injury may be difficult because of the number of skeletal and ligamentous structures involved. Some authors have suggested that these injuries represent so-called perilunate injuries, as the mechanism of injury has been noted to follow a pattern about the lunate5,9,10. Moneim described greater arc injuries as those including trans-scaphoid, transcapitate, trans-hamate, and transtriquetral perilunate fracture-dislocations. When the lunate itself is dislocated, the injury is more extensive and classification is more difficult. We report the case of a patient who had an unusual fracture-dislocation of the wrist. The lunate was displaced volarly in conjunction with displaced fractures of the adjacent scaphoid and triquetrum. A twenty-six-year-old, female, right-hand-dominant law student fell from a height of approximately twenty-four feet (7.3 meters). She could not recall the position of the upper extremity at the time of the impact. On examination, the right wrist was markedly swollen and any attempt at motion produced pain. Sensibility was diminished in the distribution of the median nerve and, although deep-pressure sensation was present, light-touch sensation was absent. Circulation to the hand was intact. The only associated injury was a compression fracture of the second lumbar vertebra without neurological deficit. Radiographs of the right wrist showed displaced fractures of the scaphoid and triquetrum as well as volar dislocation of the lunate (Figs. 1-A, 1-B, 1-C, 2-A through 2-B). Fig. 1-A Posteroanterior, oblique, and lateral radiographs showing the trans-scaphoid, transtriquetral, volar lunate fracture-dislocation. Fig. 1-B Posteroanterior, oblique, and lateral …