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Two stage procedure for neglected transscaphoid perilunate dislocation.

Lal H, Jangira V, Kakran R, Mittal D - Indian J Orthop (2012)

Bottom Line: In the first stage, bilateral uniplanar wrist distractor was applied with the aim of stretching soft tissue.In the next stage open reduction and internal fixation was done by a combined volar and dorsal approach augmented by pronator quadratus flap.At 3 years followup the patient was pain free and had a full range of supination pronation of the forearms and radial and ulnar deviation of wrist with 10° dorsiflexion deficit.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, Chandigarh, India.

ABSTRACT
We report a two-staged surgical procedure for neglected 3 month old volar transscaphoid, transcapitate perilunate fracture dislocation wrist in an 18 year old right handed male student. The lunate with proximal scaphoid and proximal capitate maintained its articulation with distal end radius while the rest of carpal bones had dislocated volarly. In the first stage, bilateral uniplanar wrist distractor was applied with the aim of stretching soft tissue. In the next stage open reduction and internal fixation was done by a combined volar and dorsal approach augmented by pronator quadratus flap. At 3 years followup the patient was pain free and had a full range of supination pronation of the forearms and radial and ulnar deviation of wrist with 10° dorsiflexion deficit.

No MeSH data available.


Related in: MedlinePlus

(a) Preoperative antero-posterior radiograph and lateral radiograph of the left wrist. (b) Preoperative CT scan of the left wrist showing perilunate dislocation and yellow arrow showing the capitate fracture
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Figure 1: (a) Preoperative antero-posterior radiograph and lateral radiograph of the left wrist. (b) Preoperative CT scan of the left wrist showing perilunate dislocation and yellow arrow showing the capitate fracture

Mentions: An 18-year-old, right-handed male student sustained sustained fall from height on a palmar flexed hand 3 months ago. The patient was initially treated by below elbow plaster of Paris slab immobilization. He presented with a swollen, painful, stiff wrist without any neurovascular deficit. The anteroposterior and lateral X-ray of the left wrist revealed a volar transscaphoid perilunate dislocation [Figure 1a]. Comparison with the opposite side X-ray showed no density changes in lunate and scaphoid. Computed tomography (CT) of the wrist showed a fracture of capitate also with no increased density or microarchitectural collapse of lunate and scaphoid [Figure 1b]. Magnetic resonance imaging (MRI) of the wrist revealed no avascular changes in lunate or scaphoid.


Two stage procedure for neglected transscaphoid perilunate dislocation.

Lal H, Jangira V, Kakran R, Mittal D - Indian J Orthop (2012)

(a) Preoperative antero-posterior radiograph and lateral radiograph of the left wrist. (b) Preoperative CT scan of the left wrist showing perilunate dislocation and yellow arrow showing the capitate fracture
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3377149&req=5

Figure 1: (a) Preoperative antero-posterior radiograph and lateral radiograph of the left wrist. (b) Preoperative CT scan of the left wrist showing perilunate dislocation and yellow arrow showing the capitate fracture
Mentions: An 18-year-old, right-handed male student sustained sustained fall from height on a palmar flexed hand 3 months ago. The patient was initially treated by below elbow plaster of Paris slab immobilization. He presented with a swollen, painful, stiff wrist without any neurovascular deficit. The anteroposterior and lateral X-ray of the left wrist revealed a volar transscaphoid perilunate dislocation [Figure 1a]. Comparison with the opposite side X-ray showed no density changes in lunate and scaphoid. Computed tomography (CT) of the wrist showed a fracture of capitate also with no increased density or microarchitectural collapse of lunate and scaphoid [Figure 1b]. Magnetic resonance imaging (MRI) of the wrist revealed no avascular changes in lunate or scaphoid.

Bottom Line: In the first stage, bilateral uniplanar wrist distractor was applied with the aim of stretching soft tissue.In the next stage open reduction and internal fixation was done by a combined volar and dorsal approach augmented by pronator quadratus flap.At 3 years followup the patient was pain free and had a full range of supination pronation of the forearms and radial and ulnar deviation of wrist with 10° dorsiflexion deficit.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, Chandigarh, India.

ABSTRACT
We report a two-staged surgical procedure for neglected 3 month old volar transscaphoid, transcapitate perilunate fracture dislocation wrist in an 18 year old right handed male student. The lunate with proximal scaphoid and proximal capitate maintained its articulation with distal end radius while the rest of carpal bones had dislocated volarly. In the first stage, bilateral uniplanar wrist distractor was applied with the aim of stretching soft tissue. In the next stage open reduction and internal fixation was done by a combined volar and dorsal approach augmented by pronator quadratus flap. At 3 years followup the patient was pain free and had a full range of supination pronation of the forearms and radial and ulnar deviation of wrist with 10° dorsiflexion deficit.

No MeSH data available.


Related in: MedlinePlus