Narrow Results

We report a case of avascular necrosis of the scaphoid, lunate and triquetrum in a young 21- year- old patient, after a purely ligamentous peri-lunate dislocation of the wrist. He presented with a Mayfield III peri-lunate dislocation after a road traffic accident and underwent an open reduction and internal fixation. Post-operatively, the scapho-lunate gap widened after removal of the temporary K-wires, and he gradually developed avascular necrosis of the scaphoid, lunate and triquetrum, and osteoarthritis of his wrist. We present this unusual case of simultaneous avascular necrosis of multiple carpal bones and discuss the possible risk factors and subsequent management plans for this complex injury. Our patient has no identifiable contributing factors to developing avascular necrosis. We suspect that the violence of the injury and surgery may have compromised the circulation, and advise caution when treating and counseling these patients pre-operatively.

Lunate coronal fracture is a rare injury, associated with impact along the capitate and lunate axis; neutralization of this axial force is important for satisfactory patient outcomes. This report presents a case of a 51-year-old man with a lunate coronal fracture associated with coronal fractures in the proximal carpal bones and volar and proximal dislocation of the distal carpal row. Open reduction and internal fixation with a dorsal distraction bridge plate were performed. Solid bony union was achieved at the fracture site and the patient resumed full activities without difficulty. Use of distraction bridge plate fixation can support treating this type of injury, in particular, in cases where the lunate fracture is difficult to treat with conventional osteosynthesis techniques; the presented approach provides good short-term results.