PMC6657645_01
Preoperative X-rays of the left wrist (grey arrow shows the lunate, white arrow shows the scaphoid fracture).
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Radiography examination showed a trans-scaphoid volar lunate dislocation to his left wrist, which was the dominant hand (Figures 1(a) and 1(b)).
Preoperative 3D CT/scan of the left wrist showing trans-scaphoid volar dislocation of the lunate (grey arrow shows the dislocation of the lunate and the white arrow the proximal pole of the scaphoid).
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Computed tomography examinations revealed a dorsal trans-scaphoid fracture and volar dislocation of the lunate (Figures 2(a) and 2(b)).
Palmar view of the dislocated lunate (grey arrow).
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The patient was taken to the operating theatre where, under general anesthesia and tourniquet, an extended carpal tunnel approach was performed, in which the transverse carpal ligament and forearm fascia were released and the lunate was relocated in the radiocarpal joint (Figure 3).
Dorsal view proximal pole scaphoid (white arrow).
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A scaphoid waist comminuted fracture appeared with the proximal pole of the scaphoid protruding under the dorsal capsule (Figure 4).
Immediate postoperative X-rays of the left wrist showing open reduction and internal fixation with Kirschner wires and external fixation.
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Carpal alignment and k-wire position were confirmed with a C-arm intraoperatively and X-rays postoperatively (Figures 5(a) and 5(b)).
Range of motion at one year.
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Finally, at one-year follow-up, the patient remained asymptomatic and the range of motion (measured with a handheld goniometer) was as follows: active wrist extension 40 /44 , flexion 60 /65 , radial deviation 15 /17 , ulnar deviation 33 /30 , and full range of pronation-supination of the forearm (Figures 6(a)-6(d)).