Chronic Trans-Radial Styloid, Trans-Scaphoid, Trans-Triquetral Perilunate Fracture Dislocation in Football-Athlete: Case Report

Perilunate fracture dislocations display a continuum of severity, but trans-radial styloid, trans-scaphoid, trans-triquetral perilunate fracture dislocations are extremely rare carpal dislocations and can be easily missed at the initial treatment. Early treatment may prevent or lessen the chance of median neuropathy, post-traumatic wrist arthrosis, chronic instability and fracture nonunion. Chronic trans-radial styloid, trans-scaphoid, trans-triquetral perilunate fracture dislocations are often difficult to manage and delayed presentation leads to poor functional outcomes. Various treatment modalities have been described which range from open reduction and internal fixation, staged reduction, proximal row carpectomy and wrist arthrodesis.

We report a 19-year-old male football-athlete who presented with this rare injury pattern seven weeks after sustaining trauma. The patient underwent open reduction and internal fixation via dorsal and volar approach. Open reduction and internal fixation (ORIF)of radial styloid, scaphoid and triquetrum with headless screws were all done.

Scaphoid fracture healed by 24 weeks. At 2 years follow-up patient has good range of motion around wrist without any discomfort. Radiographic examination showed united of all fractures with normal joint congruity, no signs of subluxation or early osteoarthritis.

Greater arch injuries are difficult to be diagnosed and treated, posing a challenge to surgeon due to the complex anatomy. The combination of fractures resulting in a trans-radial styloid, trans-scaphoid, and trans-triquetral perilunate fracture dislocation is extremely rare. From previous case reports it seems that open reduction and internal fixation joined with ligamentous repair are most likely to maximize return of function especially in acute setting. Post-operative follow up is crucial to evaluate patient's outcome and identify any inadequate ligament treatment avoiding late arthritis.

Keywords: Chronic, Perilunate, Trans-Radial Styloid, Trans-Scaphoid, Trans-Triquetral