Shih Wen KAO, I Chang CHANG, Chih Lung WU

Palmar-divergent dislocation of the scaphoid and lunate treated using percutaneous pinning and pin-in-plaster: A case report

Acute lunate and perilunate dislocations are not commonly observed injuries. In particular, palmar-divergent dislocation is a very rare injury with only a few cases reported in the literature. In this report, we describe the case of a 37-year-old patient with palmar-divergent dislocation of the scaphoid and lunate and discuss the mechanism of this type of injury. We also report a potential treatment for this pattern of palmar-divergent dislocation. The scapholunate and scaphocapitate joints were stabilized with K-wires and a modified pin-in-plaster fixation for 5 weeks after successful closed reduction. At the 1-year follow-up, magnetic resonance imaging showed no evidence of avascular necrosis of the scaphoid or lunate. However, radiographs showed mild dorsal intercalated segment instability deformity. The patient experienced no intermittent wrist pain or limitation in motion, with only 15% loss in grip strength. The Mayo wrist score was 90/100, and the patient resumed work as a craftsman. The carpal height ratio at the 4-year follow-up was 1.51 and 1.52 for the left and right wrists, respectively. In conclusion, we recommend this treatment method due to its benefits of being relatively simple, easy to perform, and having a relatively short operation time. Essentially, a good outcome was achieved using this method, including full range of motion and freedom from pain.

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