Surgical treatment of perilunate dislocation in multiple injured patient using proximal row carpectomy – case report

Summary

Introduction:
Authors present a case report of eighteen years old patient with serious multiple trauma (ISS 41), who suffered a rare severe injury of the wrist, the surgical treatment was modified by delayed diagnosis.

Material:
Case report describes the clinical course, diagnosis and timing of the treatment of the patient. Transscaphoid-transtriquetro-perilunate dislocation was treated surgically 8 weeks after injury. Delay was caused by late diagnosis of the wrist injury and the necessity to postpone the surgery due to reactive pericarditis deve-loped as a result of a heart contusion, which led to early stage of cardiac tamponade. Because of avascular necrosis of the scaphoideum caused by dislocation of the fragments and radiocarpal joint, primary joint reconstruction was not possible and the patient was indicated for proximal row carpectomy – treatment principles are described in the text, indication is summarised in the discussion. 18 months after surgery the patient was free of residual wrist pain, he showed no signs of wrist instability, recorded range of motion of injured wrist and forearm was 80 % of the unaffected limb and hand grip strength was 95 % of unaffected limb. Treatment outcomes can be assessed as very good.

Discussion:
Associated perilunate dislocations and perilunate fracture dislocations are often primarily unde-tected in cases of serious multiple trauma. It is important to think of them and diagnose them early to prevent on set of severe complications resulting from delayed treatment, especially permanent functional consequences. Injury of the upper extremities can be expected in cases of high energy trauma, where plain wrist radiographs in two projections should be performed for primary diagnosis. Examination can be performed after overcoming of the acute phase of multiple trauma.

Conclusion:
Proximal row carpectomy is a surgical method of choice in the treatment of the most serious pe-rilunate dislocations and perilunate fracture dislocations with good functional results.

Key words:
Proximal row carpectomy, perilunate dislocations, perilunate fracture dislocations.