Late diagnosis and treatment of palmar trans-scapholunate dislocation: A case report

Abstract

Palmar trans-scapholunate dislocation is an uncommon injury. It requires an immediate and accurate diagnosis and surgical treatment in emergency room, in order to obtain early decompression of the median nerve and to avoid necrosis of the scaphoid or lunate. After open reduction, the lunate is usually stabilized using Kirschner wires. The scaphoid is stabilized with a Herbert's screw. We describe a case of palmar trans-scapholunate dislocation, with palsy of the median nerve, treated surgically 25 days after trauma. We performed decompression of the median nerve, open reduction of the lunate and stabilization of the scaphoid using a Herbert's screw. The clinical, radiographic and neurophysiological results at the follow-up performed 18 months after surgery are shown. We believe that early diagnosis and treatment are necessary. Moreover, we think that, if the scapholunate ligaments are intact, the volar wrist capsule is accurately sutured, and the stabilization of the scaphoid fracture is correct, it is not necessary to use Kirschner wires to fix the lunate. © Springer-Verlag Italia 2006.