| Popis: |
Simultaneous palmar dislocation of scaphoid and lunate is rare and currently classified into palmar dislocation as a unit and palmar-divergent dislocation. Up to now, nine cases of palmar-divergent dislocation of scaphoid and lunate have been reported, with one case associated with ipsilateral radial head fracture and another trapezium fracture. Here we presented a 31-year-old male who fell from a three-storey building and diagnosed as palmar-divergent dislocation of scaphoid and lunate associated with ipsilateral humeroradial joint dislocation and open humeral shaft fracture. To raise our awareness of concomitant dislocations or fractures resulting from the same violence transmission in the ipsilateral upper extremity and avoid missed diagnosis and thoroughly evaluate injuries severity, we proposed this injury should be an additional third subtype of palmar dislocation of scaphoid and lunate. Surgical sequence and options consider the location of concomitant dislocations or fractures. This report first performed debridement and internal fixation for humerus fracture and then close reduction for humeroradial joint dislocation. Finally, palmar-divergent dislocation of scaphoid and lunate was treated with open reduction and fixation by Kirschner's wires and only repaired the stronger palmar scapholunate ligament through a single volar approach. At a 3-year follow-up, the patient gained satisfactory wrist function and the humeral fracture healed without evidence of recurrent dislocations, collapse or avascular necrosis of scapholunate. We discussed the potential benefits of the stronger palmar scapholunate ligament repair through a single volar approach to treat palmar-divergent dislocation of scaphoid and lunate. In conclusion, we report a rare case of palmar-divergent dislocation of scaphoid and lunate associated with other ipsilateral dislocations or fractures originating from the same violence traveling and propose that these complex injuries should be subdivided into a third subtype in the modified classification of palmar dislocation of scaphoid and lunate. Once diagnosed, palmar-divergent dislocation of scaphoid and lunate is fit to receive an open reduction and fixation with Kirschner's wires and the stronger palmar scapholunate ligament repair through a single volar approach. A good outcome with an almost full range of motion and freedom from pain can achieve using this method. |
