PMC5470063_01
(Case Presentation, preoperative radiographic course over 7 years in comparison to the uninjured right wrist as reference: blue longitudinal and green transverse lines): (a) PA radiograph of the left wrist showing primary fractures of the radial and ulnar styloid without SLL disruption and without PUCT; (b) PA radiograph of the left wrist 7 years after primary injury showing PUCT type I involving the entire carpus (red longitudinal and transverse lines) in comparison to the uninjured right wrist, less than 50% of the left lunate bone articulates in its fossa of distal radius whereas more than 50% of the right lunate bone articulates with the opposing bone, there is no positive ring sign in left scaphoid bone detecting scapholunate instability, note that the 2 screws for ORIF of radial and ulnar styloid were formerly removed.
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A 24-year-old and right-hand-dominant male presented with left intraarticular displaced radial styloid fracture accompanied with an ulnar styloid base fracture after a fall on his left wrist (Fig.  1). Radiographically, there was advanced stage of posttraumatic wrist joint OA due to a distinctive PUCT type I without signs of disruption of the scapholunate ligament (SLL) (Fig. 1b), accompanied with marked loss of wrist and forearm function (Figs. 2a-b).
(Case Presentation, pre- and intraoperative findings): (a) Clinical photographs demonstrating impaired wrist joint motion in comparison to the uninjured right wrist; (b) Clinical photographs demonstrating impaired supination and pronation in comparison to the uninjured right wrist; (c) Intraoperative clinical photograph demonstrating posttraumatic pancarpal wrist joint OA, note the disruption of LTL (arrow) in the absence of disruption of SLL that confirmed the preoperative radiographic finding of PUCT type I.
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Indiana / USA)) was detected by us. Intraoperatively, macroscopic findings confirmed pancarpal wrist joint OA in the absence of a SLL disruption, whereas a disruption of the lunotriquetral ligament (LTL) was present (Fig. 2c).
(Case Presentation, 1-year follow-up): (a) PA radiographs in terms of terminal ranges of motion showing unchanged correct positioning of TWA without implant loosening or subsidence or impingement or instability, note that the entire scaphoid bone was excised and a carpal plate utilizing a scaphoid augment (arrow) was used that allows its sufficient support onto the base of trapez bone without the necessity of fusion between the distal part of scaphoid bone to the surrounding carpal bones; (b) Lateral radiographs in terms of terminal ranges of motion showing no instability of implant; (c) Clinical photographs demonstrating 90  supination and 90  pronation of both forearms.
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At the 1-year follow-up, there was unchanged correct positioning of TWA without implant loosening or subsidence, and an excellent functional outcome without any signs of instability in terms of terminal ranges of motion radiographically (Fig. 3). Supination and pronation had improved to 90  (100% to right), extension had improved to 44  (73,3% to right), flexion had improved to 42  (84% to right), ulnar deviation had improved to 32  (64% to right), and radial deviation had improved to 24  (96% to right) (Figs. 3a-c) in comparison to (Figs. 2a-b).
(Case Presentation, 16-months follow-up): Self made photographs by the patient demonstrating complete reemployment in his original occupation and leisure, note that the patient loads his left wrist with the TWA more than 10 pounds.
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At the 16-months follow-up, the patient could be reemployed completely in his original occupation as a mechanic for agriculture machines, and he is able to carry out heavy works with loads more than 10 pounds again (Fig. 4).