gms | German Medical Science

Objectives/Interrogation: Perilunate dislocations (PD) and perilunate fracture dislocations (PFD) are uncommon, challenging, generally high energy injuries that carry a guarded prognosis. These injuries are commonly missed in up to 25% cases due to other associated injuries requiring urgent attention and delayed or chronic injuries have worse outcomes as retrospective analysis demonstrating.

Methods: We present a case of simultaneous perilunate dislocation in right wrist and transcapoid perilunate dislocation in the contralateral wrist which occurred simultaneously in a young male following a two wheeler accident. Meanwhile, the patient sustained right fronto-temporal subdural hemorrhage, right parietal subarachnoid hemorrhage, right temporal bone fracture and comminuted facial bone in the primary survey. In the emergent room, upon diagnosis, we performed close reduction for the bilateral perilunate dislocation but failed. One week later, after stabilizing the patient's condition, delayed operation of open reduction and internal fixation along with ligament repair was performed.

Results and Conclusions: The operation includes bilateral open reduction and internal fixation for the perilunate dislocation with pinning and ligamentous repair by transosseous maneuver for SLIL rupture; concurrently, open reduction and fixation with headless screw (Depuy Synthesis, PA, USA)) for left scaphoid fracture was performed. The pins were removed at approximately 8 weeks post-operatively and ROM exercise was initiated after the removal of cast. Nowadays, the patient was subsequently followed up for a period of two months and the preliminary results revealed good and progressing clinical and radiological outcome.

These injuries occurring simultaneously in bilateral wrists are exceptionally rare. These are high-velocity injuries and are often missed, particularly in presence of other major injuries. Accurate early diagnosis is essential and early intervention should be arranged to optimize the prognosis; delayed treatment worsens outcomes. Initial gentle, closed reduction is performed, followed by delayed open reduction, ligamentous and bony repair, and internal fixation. Despite optimum treatment, this injury carries a guarded prognosis, with permanent partial loss of wrist motion and grip strength.