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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Trans-scaphoid perilunate dislocation in a pediatric patient: a 10-month follow up

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  • presenting/speaker Francesca Teodonno - Hospital Universitario Infanta Elena, Valdemoro, Spain
  • Marta Olmeda Lozano - Hospital Universitario Infanta Elena, Valdemoro, Spain
  • Armando Macera - Hospital Universitario Infanta Elena, Valdemoro, Spain
  • Daniel López Dorado - Hospital Universitario Infanta Elena, Valdemoro, Spain
  • Hugo Garlito Díaz - Hospital Universitario Infanta Elena, Valdemoro, Spain
  • Raquel Serrano Serrano - Hospital Universitario Infanta Elena, Valdemoro, Spain
  • Rocio Mascaraque Ortiz - Hospital Universitario Infanta Elena, Valdemoro, Spain
  • Juan Carlos Márquez Ambite - Hospital Universitario Infanta Elena, Valdemoro, Spain

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-194

doi: 10.3205/19ifssh0030, urn:nbn:de:0183-19ifssh00305

Published: February 6, 2020

© 2020 Teodonno et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objectives/Interrogation: Transcarpal fractures and dislocations are uncommon in the pediatric population, although studies suggests that the incidence is increasing.

Both conservative treatment and surgery are described in these particular cases.

To the best of our knowledge, no clear guidelines exist to treat these injuries in pediatric patients, due to its uncommonness.

Methods: We present the case of a 12-year-old boy who sustained a trans-scaphoid perilunate dislocation due to fall on the outstretched hand from a motorbike (Figure 1 [Fig. 1]).

The patient was sedated in the ER and a closed reduction was accomplished. The wrist was immobilised with a closed cast including the proximal phalanx of the thumb and with the wrist in slight flexion.

A radiography and a CT scan post-reduction were performed, validating a correct alignment of the carpal bones. The CT clarified the fracture pattern, showing an undisplaced fracture of the waist of the scaphoid and a marginal fracture of the radial proximal pole of the triquetral bone.

Results and Conclusions: The cast was removed at six weeks.

At 8 weeks, the patient started the rehabilitation program.

At 12 weeks, radiography showed a dorsal intercalated segment instability (DISI) of the scaphoid, with a scapholunate angle of 76° and a normal radiolunate angle of 37°. At 7 months follow up, the patient presented an asymptomatic non-union of the scaphoid fracture. Physiotherapy was prescribed. At final follow up of 10 months, the fractures healed well with a full return of good wrist function (Figure 2 [Fig. 2]).

This unusual injury is described so that it may be better acknowledged in the future.