Trans-scaphoid perilunate dislocation

Case contributed by Mostafa Elfeky
Diagnosis almost certain

Presentation

Fall on hand since one year, with chronic wrist pain.

Patient Data

Age: 30 years
Gender: Male

Displaced fracture waist of scaphoid. The distal pole of the scaphoid maintains its articulation with trapezium, trapezoid and capitate. The proximal pole of the scaphoid maintains its articulation with the lunate with normal scapholunate distance. 

There is perilunate dislocation, the lunate maintains its articulation with the radius.

Secondary osteoarthritic changes with bone erosions, few loose bodies and subchondral cystic changes are seen involving distal end of radius, capitate and fractured distal pole of scaphoid. 

Case Discussion

Appearances of a trans-scaphoid perilunate dislocation, in which the capitate is dislocated dorsal to lunate, the proximal pole of scaphoid has remained aligned with the lunate, whereas the distal pole has followed the capitate dorsally. The lunate and the distal radius remain normally aligned. Perilunate dislocation has 60% association with scaphoid fractures. This old neglected displaced fracture waist of scaphoid resulted in secondary osteoarthritis.

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