Dorsal Perilunate Dislocation Research Articles

Single-Stage Reduction of Neglected Perilunate Dislocation: A Case Report

Abstract Neglected perilunate dislocations are rare and challenging injuries. We report a 59 days old perilunate dislocation in a 55 year old right-handed male. X-ray and CT imaging revealed a dorsal perilunate dislocation with no additional fractures and no increased density or microarchitectural collapse of the lunate or scaphoid. A single-stage open reduction and internal K-wire fixation procedure through a dorsal and volar approach was done. Eighteen months after the procedure, the patient was pain free during movement and had a ROM of 70%. His grip strength was 80.8% the opposite side and the Mayo wrist score was calculated 75. Full range of finger movement was achieved and he carried out his routine without any other complication.

Reverse Perilunate Injuries-The "Extended Scaphoid" Sign.

Background Reverse perilunate injuries (REPLI) are rare variants of the classic radial-sided perilunate injuries (PLI) whose mechanism was described by Mayfield in 1980. Classic radial-sided nontranscaphoid dorsal PLI invariably display a flexed, foreshortened position of the scaphoid on their initial posteroanterior (PA) and lateral radiographs. We observed that some dorsal perilunate dislocations displayed an extended position of the scaphoid on their initial radiographs. Our hypothesis is that this extended position of the scaphoid was associated with a REPLI pattern. Methods The PA and lateral initial emergency radiographs of our specialized wrist surgery series of 114 dorsal pure ligamentous PLI (within a 186 cases series of PLI treated between 2004 and 2020) were reviewed as well as the available figures of the current REPLI literature. Results A total of seven cases of cases within our dorsal PLI series displayed an extended position of the scaphoid on their initial PA and lateral radiographs, while 107 cases displayed a flexed, foreshortened position. The PA and lateral radiographs available in the REPLI literature displayed an extended position of the scaphoid, a lunotriquetral dissociation, and a dorsal dislocation of the capitate with respect to the lunate. Discussion This study confirms our hypothesis. By contrast to the dorsal classic radial-sided pure ligamentous PLI pattern of scaphoid displacement (scaphoid flexed and foreshortened with scapholunate gap), the dorsal REPLI pattern displays an extended position of the scaphoid with scapholunate step-off and overlap rather than a gap. The combination of a lunotriquetral dissociation with a dorsal dislocation of the capitate from the lunate yet an extended position of the scaphoid with almost normal radioscaphoid relationships should raise a high suspicion for REPLI.

Fracture luxation trans-scapho rétrolunaire dorsale bilatérale – à propos de deux cas

Trans-scaphoid perilunate fracture–dislocations represent a rare injury. These are responsible of one of the most devastating damages of the carpus. These injuries may be easily overlooked or misdiagnosed which deteriorate its prognosis. The aim of this study is to present two unique cases of this injury, comparision to the reported cases and discuss the prognosis factors and treatment options. The first case is a 21-year-old male labourer injured secondary to a motor-cycle accident. Urgent open reduction and stabilization of both wrists was done. Currently, the wrist is stable with functional range of motion and bony union at 18 months. The second case is a 30-year-old male farmer, who presented a polytrauma of after a fall. The patient was referred to our department twelve days after the trauma. Open reduction was first done with a fixation of the carpus and stabilization of the scaphoid were performed using Kirschner wires with ligamentous repair for both wrists. Functional outcomes were satisfactory despite non-union of the scaphoid on one side at two year follow-up. Perilunate dislocations are devastating high-energy wrist injuries. These injuries combine bony avulsions, ligament disruption and fractures in different forms. The present concept of the mechanism of dorsal perilunate dislocation in literature is a fall on outstretched hand with ulnar deviation and supination of the wrist. Dislocation in this region requires rapid realignment, as untreated, it will lead to serious secondary damage. Diagnosis can be difficult as it was missed in our patient, it is frequently the case due to other associated injuries or inadequate interpretation of radiographs of the wrist. Treatment options include closed reduction and cast immobilization, closed reduction and percutaneous pinning, and open reduction. We have performed an open reduction through a dorsal approach with repair of the damaged ligaments and stabilization with K-wires of the carpus and the scaphoid fracture with good functional results for both patients. Early open reduction and restoration of carpal anatomy and repair of damaged ligaments are emphasized in order to restore the complex anatomic inter-carpal anatomy. Non-union rate of the scaphoid was relatively higher in the series treated by closed reduction. These are high velocity injuries and are often missed. Early diagnosis of this entity is essential to prevent complication, through clinical examination and careful evaluation of the radiographs. When detected and treated early patient can have a satisfactory functional outcome.

Mid-term Outcomes in Perilunate Dislocations

Introduction: Perilunate dislocations and fracture-dislocations are often related to fair or poor results. The goal of this study is to analyze radiographic and functional outcomes of surgically treated patients with perilunate injuries. Methods: We assessed a retrospective series of 37 patients (36 male), mean age 36 (range, 17-71), with a mean follow-up of 4 years (range, 1-10.1). All were subject to worker’s compensation. All patients had dorsal perilunate dislocations; there were 13 cases of perilunate dislocation and 24 cases of perilunate fracture-dislocations. Seventeen patients had a scaphoid fracture and 7 presented other fractures (radial styloid, triquetrum, etc.). All patients had surgical treatment with k wire carpus stabilization, open ligamentous repair (24 cases), scaphoid fixation (9 k wire, 8 headless screws), and other bone fixation when indicated. The Mayo wrist score (MWS) was used for functional evaluation. Radiographic examination was focused in osteoarthritis and instability, according to Herzberg classification. We defined poor results patients with at least one of the following: MWS < 60 points, advanced osteoarthritis, scapholunate instability (SL gap > 5 mm or SL angle > 70°), scaphoid nonunion, or major surgery: proximal row carpectomy (PRC), wrist arthrodesis, or nonunion surgery. Results: Patients had a mean flexion of 44.8° (SD 15.2) and mean extension of 46.8° (SD 16.7). Two cases had severe stiffness (less than 30° arc of motion). Mean grip strength was 66% of contralateral (SD 19.2). According to MWS, 1 patient had excellent results, 7 good (19%), 18 fair (49%), and 11 patients poor results (30%). According to our definition of poor results, 24 of 37 (65%) patients had an unsatisfactory outcome. Radiographic evaluation showed 10% of advanced osteoarthritis and 45% of instability signs. Six patients were classified as Herzberg A (normal alignment without osteoarthritis) and 11 patients as A1 (normal alignment with osteoarthritis). One patient showed instability without osteoarthritis (B) and 11 patients showed instability with osteoarthritis (B1). Seven patients had x-rays modified by the treatment (C). Five patients with trans-scaphoid fracture dislocation had nonunion, 4 of them went to bone graft and only 2 of these get union. One scaphoid nonunion went directly to PRC. There were 3 total wrist arthrodesis (2 due to arthritis and 1 due to instability) and 4 PRC, 3 in context of failed nonunion treatment and 1 in a severe and complex instability. Discussion: Perilunate dislocations and fracture-dislocations are complex injuries with a high rate of unsatisfactory outcomes. Our series showed poor clinical outcomes in 65% which correlate with the poor and fair results in the MWS. We observed a high rate of nonunion in trans-scaphoid dislocations, carpal instability, and articular degenerative changes. These factors would be independent of patient functional performance.

Complete dorsal dislocation of the carpal scaphoid with perilunate dorsal dislocation.

Complete dorsal dislocation of the carpal scaphoid combined with dorsal perilunate dislocation is an extremely rare carpal injury. We describe the case of a 23-year-old man who presented with a complete dorsal dislocation of the carpal scaphoid, combined with a perilunate dislocation. Surgical treatment was performed with open reduction and interosseus ligament repair. At 4 years follow up, the patient's wrist pain had completely resolved without limitations of wrist joint motion and without evidence of avascular necrosis of the carpal scaphoid.

Arthroscopically assisted mini-invasive management of perilunate dislocations and fracture–dislocations

The purpose of this study was to evaluate the outcomes of perilunate dislocations and fracture-dislocations treated with arthroscopically assisted mini-invasive reduction and fixation. Between June 2012 and May 2014, 24 patients who had a dorsal perilunate dislocation or fracture–dislocation were treated with arthroscopically assisted reduction and percutaneous fixation. The mean follow-up was 14.8 months (range, 6–32 months). Clinical outcomes were evaluated on the basis of range of motion; grip strength; Mayo wrist score; Quick Disabilities of the Arm, Shoulder and Hand questionnaire; and Patient-Rated Wrist Evaluation score. Radiographic evaluations included time to scaphoid union, carpal alignments, and any development of arthritis. The range of flexion–extension motion of injured wrist averaged 86% of the values for contralateral wrist. The grip strength of the injured wrist averaged 83% of the values for the contralateral wrists. The mean Quick Disabilities of the Arm, Shoulder and Hand score was 6, and the mean Patient-Rated Wrist Evaluation score was 10. According to the Mayo wrist scores, overall functional outcomes were rated as excellent in 13 patients (54%), good in 6 (25%), fair in 4 (17%), and poor in 1 (4%). Scaphoid nonunion developed in 1 patient. Reduction obtained during the operation was maintained within normal ranges in all patients. Arthritis had not developed in any patient at final follow-up. Arthroscopically assisted mini-invasive reduction with percutaneous fixation is a reliable and favorable alternative in the treatment of perilunate injuries according to our early follow-up results. Level IV, therapeutic.

Arthroscopically assisted mini-invasive management of perilunate dislocations.

Purpose The purpose of this study was to evaluate the outcomes of perilunate dislocations and fracture-dislocations treated with arthroscopically assisted mini-invasive reduction and fixation. Methods Between June 2012 and May 2014, 24 patients who had a dorsal perilunate dislocation or fracture-dislocation were treated with arthroscopically assisted reduction and percutaneous fixation. The mean follow-up was 14.8 months (range 6-32 months). Clinical outcomes were evaluated on the basis of range of motion; grip strength; Mayo Wrist Score; Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire; and Patient-Rated Wrist Evaluation (PRWE) score. Radiographic evaluations included time to scaphoid union, carpal alignments, and any development of arthritis. Results The range of flexion-extension motion of the injured wrist averaged 86% of the values for the contralateral wrist. The grip strength of the injured wrist averaged 83% of the values for the contralateral wrists. The mean QuickDASH score was 6, and the mean PRWE score was 10. According to the Mayo Wrist Scores, overall functional outcomes were rated as excellent in 13 patients (54%), good in 6 (25%), fair in 4 (17%), and poor in 1 (4%). Scaphoid nonunion developed in one patient. Reduction obtained during the operation was maintained within normal ranges in all patients. Arthritis had not developed in any patient at final follow-up. Conclusions Arthroscopically assisted mini-invasive reduction with percutaneous fixation is a reliable and favorable alternative in the treatment of perilunate injuries according to our early follow-up results. Level IV, Therapeutic.

Use of external fixation for perilunate dislocations and fracture dislocations.

The purpose of this study was to review clinical and radiographic outcomes of perilunate dislocations and fracture dislocations treated with external fixation and K-wire fixation. Twenty patients (18 males and two females) with a mean age of 38 years (range 18–59) who had an acute dorsal perilunate dislocation or fracture dislocation were treated with the use of wrist external fixator and K-wires. The injuries included 12 perilunate dislocations, seven trans-scaphoid perilunate fracture dislocations, and one trans-styloid perilunate fracture dislocation. The median time from trauma to operation was 8 h (2–12 h). Indirect reduction via ligamentotaxis was achieved in all perilunate dislocation, and provisional K-wire fixation was added. In five of seven trans-scaphoid perilunate fracture dislocations, indirect reduction was achieved; whereas in the other two as well as in the case of trans-styloid perilunate fracture dislocation, open reduction was required. External fixator was supplemented with K-wires for stabilization of the fractures and the intercarpal intervals. The interosseous and capsular ligaments were not repaired, even after open reduction of fracture dislocations. The mean follow-up was 39 months (range 18–68 months). Range of motion and grip strength were measured. Cooney’s scoring system was used for the assessment of clinical function. Radiographic evaluation included time to scaphoid union, measurement of radiographic parameters (scapholunate gap, scapholunate angle, lunotriquetral gap, and carpal height ratio) and any development of arthritis. The flexion-extension motion arc and grip strength of the injured wrist averaged 80 and 88%, respectively, of the corresponding values for the contralateral wrists. According to Cooney’s clinical scoring system, overall functional outcomes were rated as excellent in four patients, good in eight, fair in six, and poor in two. Eighteen patients returned to their former occupations. Two patients with a trans-scaphoid perilunate injury developed nonunion of the scaphoid; one of them required scaphoid excision and midcarpal fusion. Two patients had radiographic evidence of arthritis. The use of external fixation and provisional K-wire fixation for the treatment of acute perilunate dislocations is associated with satisfactory midterm functional and radiographic outcomes. This minimally invasive treatment option is simple, reliable, and minimally invasive method that provides proper restoration and stable fixation of carpal alignment.

Late diagnosis of trans-scaphoid perilunate dislocation: A case report

Perilunate fracture dislocations are rarely seen severe injuries among wrist traumas.Trans-scaphoid perilunate fracture dislocation and dorsal perilunate dislocation are the most commonly encountered types of these injuries. In addition, other pathologies may also accompany in the same extremity. As they are rarely seen, they may be diagnosed late. When these cases are overlooked and not treated in the early stages, there is a high possibility of the development of limited wrist movements and chronic pain. In this respect, the importance of early diagnosis and treatment is evident. With accompanying literature, we present a case of 41-years old male operated for a diagnosis of perilunate dislocation due to falling down. J. Exp. Clin. Med., 2014; 31:59-61

Bipolar dislocation of the forearm (floating forearm)

Bipolar dislocation of the forearm (floating forearm) is an unusual injury and is therefore often overlooked. We report a 28-year-old male patient who presented at another center with a history of a fall while climbing a tree. The patient's left elbow was treated with closed reduction and immobilization with a long-arm cast brace due to elbow dislocation. However, the patient was admitted with pain and swelling of the wrist to our emergency department the following day. Physical and radiological examination revealed dorsal trans-scaphoid perilunate dislocation. A dorsal incision was performed for open reduction and internal fixation to provide wide surgical exposure. Concomitant occurrence of elbow dislocation and fracture-dislocation of the perilunate is infrequent. Therefore, physicians should be aware of possible additional injuries and current recommended treatment methods.

Transscaphoid–transtriquetral–transhamate perilunate fracture–dislocation: case report

A transscaphoid–transtriquetral–transhamate perilunate fracture–dislocation is a very rare pattern of injury among the known spectrum of perilunate dislocations and perilunate fracture–dislocations, and the details of the initial treatment and outcome of this injury have never been reported. We present the case of a 24-year-old, right-handed man, who presented in the emergency department with acute fracture at the waist of the scaphoid, fracture avulsion at the proximal pole of the triquetrum, and fracture of the hamate body with an associated dorsal perilunate dislocation after a fall from 3 m onto his outstretched left hand. Under general anesthesia, closed reduction was attempted with axial traction. After anatomical reduction was achieved, osteosynthesis of the scaphoid was performed using a cannulated screw, and after this was done, percutaneous pinning of the hamate with a K-wire and reconstruction of the scapholunate ligament was performed using an anchor for reinforcement of the scapholunate ligament through a minimally invasive volar approach. A short arm thumb cast splint was applied for 4 weeks, and part-time splinting was continued for another additional 4 weeks. The patient subsequently underwent 3 months of intensive range-of-motion and muscle-strengthening exercises. At the final follow-up examination, 60 months after the initial operation, the range of motion of the left wrist was 145° (extension plus flexion arc), and grip strength, 47 kg, were 91 and 98 % of the values for the unaffected wrist, respectively. Radiographs showed a bony union of the scaphoid, triquetrum, and hamate, and no sign of avascular necrosis in the proximal scaphoid fragment, as well as other carpal bones. No midcarpal or radiocarpal degenerative arthritis was observed, and the normal carpal bone relationships were still maintained, with a scapholunate angle of 49° and a scapholunate distance of 1.5 mm. We recommend closed reduction and minimally invasive volar approach for screw fixation of the scaphoid, as well as percutaneous pinning of the hamate in this case and reconstruction of the disrupted carpal ligaments to minimize the interruption of the blood supply to the carpus and also to obtain rigid fixation during the procedure.

Palmar scaphoid dislocation associated with dorsal perilunate dislocation. A case report and review of the literature

Most carpal dislocations occur in the lunate bone or around it (perilunate). An isolated dislocation of the carpal scaphoid is a rare injury. We report a case of a palmar scaphoid dislocation combined with a dorsal perilunate dislocation, which was treated with open reduction, fixed with two Kirschner wires and ligament repair, with a good result.

Luxación palmar del escafoides carpiano asociado a una luxación perilunar dorsal. A propósito de un caso y revisión de la bibliografía

Most carpal dislocations occur in the lunate bone or around it (perilunate). An isolated dislocation of the carpal scaphoid is a rare injury. We report a case of a palmar scaphoid dislocation combined with a dorsal perilunate dislocation, which was treated with open reduction, fixed with two Kirschner wires and ligament repair, with a good result.

Treatment of Dorsal Perilunate Dislocations and Fracture–Dislocations Using a Standardized Protocol

The aims of this study were to evaluate the associated injuries occurring with acute perilunate instability and to assess the clinical and radiographic outcomes of perilunate dislocations and fracture-dislocations treated with a combined dorsal and volar approach. A total of 45 patients (46 wrist injuries) with perilunate dislocations and fracture-dislocations were prospectively evaluated. The size of the mid-carpal ligament tear, the location of the scapholunate ligament tear, and the presence of osteochondral fragments and of the dorsal radiocarpal ligament avulsions were recorded at injury. Final clinical and radiographic outcomes were evaluated in 25 cases (25 wrists) with a minimum of 6months of follow-up. Intraoperative examination of the 46 cases with operative treatment showed the volar carpal ligament tear to be present 100% of the time and to be an average length of 3.4cm. Complete avulsion of the dorsal extrinsic radiocarpal ligaments was found in 65.2% of cases. The scapholunate ligament was torn in 35 cases. Osteochondral fragments were found either volarly or dorsally in 74% of the cases. The average flexion-extension arc was 82°, forearm rotation was 155°, and grip strength averaged 59% of the uninjured hand. The average final scapholunate angle was 55° and the scapholunate gap was 2.2mm. Treatment of perilunate fracture-dislocations with a combined volar and dorsal approach results in reasonable and functional clinical results. The incidence of associated injuries with these carpal dislocations is high. Although the perilunate fracture-dislocations have a slightly better radiologic alignment than the dislocation group, the clinical outcome is similar.

The Mechanism of Ulnar-sided Perilunate Instability of the Wrist: A Cadaveric Study and 6 Clinical Cases

To define the mechanism of ulnar-sided perilunate instability using a cadaveric model and correlate these biomechanical findings with 6 clinical cases. We mounted 16 fresh-frozen human cadaver arms and loaded them to failure in extension and radial deviation, recreating our understanding of the injury mechanism leading to ulnar-sided perilunate instability of the wrist. After testing, we examined the wrists clinically and radiographically. We identified, examined, and treated 6 patients with ulnar-sided perilunate instability over a period of 5 years. Based on these data, we propose a 3-stage mechanism for ulnar-sided perilunate instability of the wrist. In 13 of 16 specimens, we observed failure of ulnotriquetral, ulnolunate, and ulnocapitate ligaments as well as the dorsal scaphotriquetral and dorsal radiotriquetral ligaments. In 11 of these 13, the lunotriquetral interosseous ligament was disrupted, and in 2 of the 11, a dorsal perilunate dislocation occurred. After comparing these laboratory findings with clinical findings in 6 patients with ulnar-sided perilunate instability, we propose the following 3-stage mechanism for ulnar-sided perilunate instability: stage 1, disruption of the lunotriquetral interosseous ligament; stage 2, stage 1 plus disruption of the ulnolunate, ulnotriquetral, and ulnocapitate ligaments as well as the dorsal scaphotriquetral and radiotriquetral ligaments; and stage 3, stage 2 with progression of the injury through the midcarpal joint plus disruption of the scapholunate and radioscapholunate ligaments, potentially resulting in a dorsal perilunate dislocation. We describe a 3-stage mechanism of ulnar-sided perilunate ligamentous wrist injury that can lead to dorsal perilunate dislocation. We recommend considering ulnar-sided perilunate instability of the wrist in patients with ulnar wrist pain after a fall on the outstretched wrist. Ulnar-sided wrist injury can lead to subtle forms of perilunate instability.

Arthroscopic Reduction and Percutaneous Fixation of Perilunate Dislocations and Fracture-Dislocations

The purpose of this study was to review clinical and radiographic outcomes of perilunate dislocations and fracture-dislocations treated with arthroscopic reduction and percutaneous fixation. Twenty patients who had an acute dorsal perilunate dislocation or fracture-dislocation were treated with an arthroscopic technique at a median interval of 3.9 days from the time of injury. They were retrospectively reviewed at a mean follow-up of 31.2 months (range, 18 to 61 months). Range of motion and grip strength were measured. Radiographic evaluations included time to scaphoid union, measurement of radiologic parameters, and any development of arthritis. Functional outcomes were determined by the modified Mayo wrist score; Disabilities of the Arm, Shoulder and Hand questionnaire; and Patient-Rated Wrist Evaluation score. The flexion-extension motion arc and grip strength of the injured wrist averaged 79% and 78%, respectively, of the corresponding values for the contralateral wrists. The mean Disabilities of the Arm, Shoulder and Hand score was 18, and the mean Patient-Rated Wrist Evaluation score was 30. According to modified Mayo wrist scores, overall functional outcomes were rated as excellent in 3 patients, good in 8, fair in 7, and poor in 2. Nonunion developed in 2 patients with a trans-scaphoid perilunate injury; 1 of the 2 underwent scaphoid excision and midcarpal fusion. On the basis of radiographic parameters, reduction obtained during the operation was maintained within normal ranges in 15 patients. Arthritis had not developed in any patient by the last follow-up. This study suggests that arthroscopic reduction with percutaneous fixation is a reliable minimally invasive surgical method for acute perilunate injuries in that it provides proper restoration and stable fixation of carpal alignment and results in satisfactory functional and radiologic outcomes on a midterm basis. Level IV, therapeutic case series.

Functional outcome of neglected perilunate dislocations treated with open reduction and internal fixation

Introduction:Management of neglected perilunate dislocations is controversial. The various procedures such as open reduction and internal fixation (ORIF), proximal row carpectomy, lunate excision, and wrist arthrodesis have been advocated. The aim of our study was to evaluate the functional outcome of neglected perilunate dislocations managed by ORIF.Materials and Methods:Over a period of 10 years (1996 to 2006), 14 patients with neglected perilunate dislocations (undiagnosed or untreated for 6 weeks or more) were managed by ORIF. Six patients had dorsal trans-scaphoid perilunate dislocation, 6 patients had volar lunate dislocation while the remaining two had a dorsal perilunate dislocation The results were evaluated by clinical scoring system of Cooney et al.Results:The average followup was 4.1 years (range 2-12 years). All except one of the patients operated earlier than 5 months had good results. Of the four patients operated after 5 months, two had a fair result while two had a poor outcome. Chondral damage to the capitate was noted intraoperatively in both the cases with poor outcomes. The two patients were found to have avascular necrosis (AVN) of the lunate; however, functional outcome was fair in both, and both were able to return to their profession.Conclusion:We observed favorable functional results of ORIF in neglected perilunate dislocations up to 5 months after injury. The development of AVN or midcarpal arthritis was not a major disabling factor as long as stability of wrist has been restored. Beyond 5 months, an alternative surgical procedure such as proximal row carpectomy should be contemplated as results of ORIF have not been good uniformly.

Palmar Scaphoid Dislocation Associated With Dorsal Perilunate Dislocation: Case Report

Most dislocations of the carpal bones present as a lunate or perilunate dislocation. We report a case of a palmar scaphoid dislocation combined with a dorsal perilunate dislocation.

Bilateral dorsal perilunate dislocation of wrist

We present a case of simultaneous dorsal perilunate dislocation of both wrists, without a history of fall on outstretched hands. In contrast, it appeared that the mechanism was reverse. His hands were held in radial deviation with wrists in full palmar flexion. The forearms were in neutral position and elbows in mid-flexion. The wrists were suddenly and forcibly pronated. The radiographs of both wrists showed dorsal perilunate dislocation with avulsion fracture of the tip of ulnar styloid process and avulsion fracture of posterior horn of lunate. Radial translation of the carpal bones was also noted. The mechanism is proposed and discussed.

Luxation ouverte transscaphorétrolunaire du carpe avec avulsion antébrachiale du semi-lunaire et du fragment scaphoïdien

The authors report a case of dorsal transscaphoid perilunate dislocation which is noteworthy because there was significant anterior displacement of the lunate together with the proximal part of the scaphoid. The lunate was propelled in front of the radial epiphysis and the proximal part of the scaphoid ended up in front of the metaphyseal part of the radius. An emergency partial proximal row carpectomy was performed, preserving the distal part of the scaphoid. Good anatomic and functional result was observed at 6 years follow-up.