Complete dorsal dislocation of the carpal scaphoid: a case r
The present case has been reported in the Indian Journal of Orthopaedics. Most dorsal dislocation of the carpal scaphoid has been reported with axial dissociation of carpus or without other carpal injury. Complete dorsal dislocation of the carpal scaphoid associated with dorsal perilunate dislocation without axial dissociation of carpus is unique carpal injury which have not been reported until now to the best of our knowledge. The authors report such a case and discuss the injury mechanism, management, and outcome.

A 23 year old man presented with painful swelling in his right wrist after falling forward from 3 m height. On clinical examination, the wrist was found to be swollen, bruised and deformed. Multiple abrasions on the thenar area of the hand suggested that the suspected injury mechanism was an extension, supination and ulnar deviation force on the outstretched wrist.

Radiographs and three-dimensional computed tomography scan (CT) revealed complete dorsal dislocation of the carpal scaphoid and dorsal dislocation of the other carpal bones over the lunate. The scaphoid dislocation from the other carpal bones resulted in the complete loss of normal intercarpal connections and articulations around scaphoid.

In other words, wide separations among the carpal bones indicated complete and simultaneous ruptures of the scapholunate, lunotriquetral, and scaphotrapezial ligaments including dislocations of scaphotrapezial, scapholunate, lunotriquetral, scaphocapitate, and radioscaphoid joint.

The patient was taken up for surgical intervention and perioperative findings revealed complete dorsal dislocation of the scaphoid without any adjacent soft tissue connections and perilunate dorsal dislocation with lunotriquetral ligament rupture.

During the surgery, the scapholunate ligament was carefully repaired using suture anchors and the midsubstance tear of the lunotriquetral ligament was repaired with simple sutures after the reduction of dislocated carpal bones.

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