Management of a case of delayed presentation dorsal trans-scaphoid perilunate dislocation with distal radius physeal injury in a 10 yr old boy

Perilunate fracture dislocations are rare injuries in adults and even rarer in children. Associated distal radius physeal injuries can further complicate the situation due to possible growth arrest. Delayed presentation is common in these injuries due to lack of awareness and failure to recognise the full extent of the injury pattern. 

We report the case of a 10 yr old boy who sustained a trans-scaphoid perilunate dislocation along with a distal radius physeal injury and who presented after 3 weeks of the injury. He underwent successful Open reduction with scaphoid # fixation and Carpal realignment through a dorsal approach along with distal radius physeal fixation. at 4yr post op he presented again with a distal radius physeal arrest with mannus valgus deformity. He underwent distal ulna shortening osteotomy with distal ulna physiodesis and corrective osteotomy of distal radius to realign his wrist.  

He was followed up till skeletal maturity and at final follow up he had excellent wrist function as per the Mayo Wrist score with no recurrence of deformity and is back to his normal activities  

Pediatric dorsal perilunate fracture dislocations are rarer and more challenging to manage than the rare adult cases. Early treatment is needed to realign the carpus and fix associated fractures. Long term follow up till skeletal maturity is needed to look for growth arrest due to associated distal radius physeal injury. Increased awareness of these injuries is needed to prevent delay in diagnosis

Keywords: Pediatric Perilunate fracture dislocation, distal radius physeal injury, Pediatric Scaphoid fracture.