Meleppuram Jimmy Joseph, Jacob Bobby
Department of Orthopaedics, Centre of excellence in Orthopaedics and Rheumatology, Aster Medcity Hospital, Kochi, Kerala, India.
J Orthop Case Rep. 2022 Sep;12(9):65-68. doi: 10.13107/jocr.2022.v12.i09.3020.
Perilunate injuries are rare, complex, and high velocity trauma associated injuries accounting to <10% of wrist joint trauma. Volar peri-lunate dislocations account for <3% of these injuries. Perilunate injuries should, therefore, be focused and ruled out while examining a patient complaining wrist pain after high-energy accidents which are often missed.
We report a case of, missed dislocation in a patient who presented delayed with wrist pain, post 4 months road traffic accident associated with heterotrophic ossified mass in a united scapular fracture. He underwent open reduction through a combined approach and internal fixation with K-wires. Aggressive wrist physiotherapy retrieved near-normal range of motion at the wrist by the end of 5 months as well as neither revealed recurrence of the dislocation nor signs of avascular necrosis.
Successful results in perilunate injuries can be obtained with open reduction, ligament reconstruction with K-wires fixation through a single combined approach in delayed presentation resulting in achieving near normal range of movements.
月骨周围损伤罕见、复杂，是与高速创伤相关的损伤，占腕关节创伤的不到10%。掌侧月骨周围脱位占这些损伤的不到3%。因此，在检查因高能事故导致手腕疼痛的患者时，应重点排查月骨周围损伤，此类损伤常被漏诊。
我们报告一例患者，在道路交通事故4个月后因手腕疼痛前来就诊，漏诊了脱位情况，同时该患者还伴有肩胛骨骨折愈合后形成的异位骨化肿块。他通过联合入路进行了切开复位并用克氏针内固定。积极的手腕物理治疗在5个月末使手腕活动范围恢复至接近正常，且未出现脱位复发及缺血性坏死迹象。
对于延迟就诊的月骨周围损伤，通过单一联合入路进行切开复位、用克氏针固定韧带重建，可取得成功的治疗效果，使活动范围接近正常。
