Abstract
Background
An osteochondral lesion at the level of the capitate head in perilunate dislocation
(PLD) may worsen the patient's overall prognosis. This case report presents two cases
of scaphoid excision and four-corner fusion (4CF) for acute PLD injury with severe
osteochondral lesion at the level of the head of the capitate.
Case Description
The first case involved a 41-year-old man with a dorsal PLD, an associated ulnar styloid
fracture and a highly comminuted radial styloid fracture involving the scaphoid facet
of the radius. The second case involved a 35-year-old-man with a dorsal PLD on a previously
unknown scaphoid nonunion (scaphoid nonunion advanced collapse [SNAC] stage 1). Both
patients underwent scaphoid excision and 4CF with Kirschner wire fixation. At last
follow-up (6 and 31 months, respectively), both patients had slight pain, had a functional
range of motion, and achieved satisfactory functional outcomes. Radiographs confirmed
4CF union. No complications were reported.
Literature Review
Only two other cases of scaphoid excision and 4CF for acute PLD with osteochondral
lesion at the capitate head have been reported, with minimal information on clinical
outcomes.
Clinical Relevance
This article reports two cases of acute PLD with severe osteochondral lesions at the
level of the head of the capitate, accompanied by poor local conditions (SNAC stage
1 or a comminuted scaphoid facet of the radius). It highlights the interest of scaphoid
excision and 4CF in the acute setting with favorable short-term outcomes, where traditional
open reduction and internal fixation or carpal row carpectomy would have been unreliable.
Keywords
perilunate - four-corner fusion - four-corner arthrodesis
