Asymptomatic Nonunion Scaphoid Fracture After Kirschner Wire Fixation of Trans-Scaphoid Lunate Dislocation: A Case Report with 3 Years of Follow-up
DOI:
https://doi.org/10.3889/oamjms.2022.10805Keywords:
Trans-scaphoid lunate dislocation, Non-union, K-wire fixationAbstract
Background: Trans-scaphoid lunate dislocation is an orthopaedic injury, mostly because of high energy trauma. Due to subtle clinical and radiological findings, it might be easily left undiagnosed, with estimated 25% cases are missed at initial assessment in emergency department. Non-union scaphoid, which accounts for 5-10% of all scaphoid fractures treated with K-wires fixation, mostly occurs in young and active individual.
Case Presentation: Thirty-seven-years-old right-handed man complained pain, and restricted range of motion (ROM) on his right wrist after fell from 2m height. Loss of symmetry and parallelism of joint space in Gilula's line shown in X-ray, possible for a trans-scaphoid lunate dislocation. We performed dorsal approach and internal fixation using Kirschner wire (1.0). The patient had a short arm cast for 4 weeks. The K-wires were removed 5 weeks postoperatively. We achieved good result clinically in 3, 9, and 36 months of follow up (Mayo Wrist Score of 70, 80, 90, respectively). The ROM of wrist is preferable than pre-surgery (RD 20o, UD 20o, and WF-WE 60o) with avascular necrosis of scaphoid in 9th month follow up (in 2019). Unfortunately, at 3 years of follow up, X-ray showed non-union scaphoid, avascular necrosis, and osteophytes between scaphoid and radius.
Discussion: Unless it is asymptomatic, surgery is the recommended treatment for scaphoid non-union in order to limit further morbidity from pain, weakness, and stiffness of the wrist joint. However, in this case, the patient has been doing any activities with his right hand normally and never felt any pain in the last 2 years, eventhough the X-ray shows fracture line at distal of scaphoid. Thus, we choose not to do any treatment for it.
Conclusion: In the case of trans-scaphoid lunate dislocation, the use of K-wire fixation shows excellent clinical outcome, but radiological finding shows non-union scaphoid with osteophytes, thus it has possibility to develop degenerative disease in the future.
Keywords: Trans-scaphoid Lunate dislocation; Non-union; K-wire Fixation
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Kural C, Tanriverdi B, Erçin E, Baca E, Yilmaz M. The surgical outcomes of trans-scaphoid perilunate fracture-dislocations. Turk J Med Sci. 2020;50(1):25-30. https://doi.org/10.3906/sag-1710-163 PMid:31655521 DOI: https://doi.org/10.3906/sag-1710-163
Bagheri F, Taraz-Jamshidi MH, Birjandinejad A, Sharifi-Daloei SR, Mirkazemi M, Choghadeh MF, et al. Trans-scaphoid perilunate fracture-dislocation and isolated perilunate dislocations; Surgical versus non surgical treatment. Arch Bone Jt Surg. 2013;1(2):74-7. PMid:25207292
Aslani H, Bazavar MR, Sadighi A, Tabrizi A, Elmi A. Trans-scaphoid perilunate fracture dislocation; A technical note. Bull Emerg Trauma. 2016;4(2):110-2. PMid:27331069
Capo JT, Corti SJ, Shamian B, Nourbakhsh A, Tan V, Kaushal, et al. Treatment of dorsal perilunate dislocations and fracture-dislocations using a standardized protocol. Hand (N Y). 2012;7(4):380-7. https://doi.org/10.1007/s11552-012-9452-y PMid:24294157 DOI: https://doi.org/10.1007/s11552-012-9452-y
Melsom DS, Leslie IJ. Carpal dislocations. Curr Orthop. 2007;21(4):288-97. https://doi.org/10.1016/j.cuor.2007.03.006 DOI: https://doi.org/10.1016/j.cuor.2007.03.006
Inoue G, Tanaka Y, Nakamura R. Treatment of trans-scaphoid perilunate dislocations by internal fixation with the herbert screw. J Hand Surg Br. 1990;15(4):449-54. https://doi.org/10.1016/0266-7681(90)90088-L PMid:2269835 DOI: https://doi.org/10.1016/0266-7681(90)90088-L
Herzberg G, Comtet JJ, Linscheid RL, Amadio PC, Cooney WP, Stalder J. Perilunate dislocations and fracture-dislocations: A multicenter study. J Hand Surg Am. 1993;18(5):768-79. https://doi.org/10.1016/0363-5023(93)90041-Z PMid:8228045 DOI: https://doi.org/10.1016/0363-5023(93)90041-Z
Buijze GA, Ochtman L, Ring D. Management of scaphoid nonunion. J Hand Surg Am. 2012;37(5):1095-100; quiz 1101. https://doi.org/10.1016/j.jhsa.2012.03.002 PMid:22541157 DOI: https://doi.org/10.1016/j.jhsa.2012.03.002
Yeo JH, Kim JY. Surgical strategy for scaphoid nonunion treatment. J Hand Surg Asian Pac Vol. 2018;23(4):450-62. https://doi.org/10.1142/S2424835518300049 PMid:30428803 DOI: https://doi.org/10.1142/S2424835518300049
Wong WY, Ho PC. Minimal invasive management of scaphoid fractures: From fresh to nonunion. Hand Clin. 2011;27(3):291-307. https://doi.org/10.1016/j.hcl.2011.06.003 PMid:21871352 DOI: https://doi.org/10.1016/j.hcl.2011.06.003
Pinder RM, Brkljac M, Rix L, Muir L, Brewster M. Treatment of scaphoid nonunion: A systematic review of the existing evidence. J Hand Surg Am. 2015;40(9):1797-1805.e3. https://doi.org/10.1016/j.jhsa.2015.05.003 PMid:26116095 DOI: https://doi.org/10.1016/j.jhsa.2015.05.003
Wingelaar M, Newbury P, Adams NS, Livingston AJ. Lunate dislocation and basic wrist kinematics. Eplasty. 2016;16:ic37. PMid:27610210
Jones DB Jr., Kakar S. Perilunate dislocations and fracture dislocations. J Hand Surg Am. 2012;37(10):2168-73; quiz 2174. https://doi.org/10.1016/j.jhsa.2012.07.034 PMid:22960028 DOI: https://doi.org/10.1016/j.jhsa.2012.07.034
Al Assiri K, Iqbal J, Raja MA. Lunate dislocation. Pak J Med Res. 2012;51(3): 101-103.
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Copyright (c) 2022 Thomas Erwin Christian Junus Huwae, Respati Suryanto Dradjat, Adytia Andreyta Refa (Author)
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