Neglected Trans-Scaphoid Volar Perilunate Dislocation with Post-Operative Complex Regional Pain Syndrome: A Case Report

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Apoorv Sehgal
Apoorv Sehgal
σ
Pratyush Shahi
Pratyush Shahi
ρ
Aarushi Sudan
Aarushi Sudan
Ѡ
Sushil Kamal
Sushil Kamal
¥
Umesh Meena
Umesh Meena
§
Debasish Meher
Debasish Meher
α to σ University College of Medical Sciences

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Neglected Trans-Scaphoid Volar Perilunate Dislocation with Post-Operative Complex Regional Pain Syndrome: A Case Report

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Abstract

We present the case report of a 30-year-old male who fell from a height of 15 feet on his palmar-flexed right wrist and came to us 1 month after the injury. He had a swollen, stiff wrist with painful movements and no neurovascular deficit. X-rays showed a trans-scaphoid volar perilunate dislocation. We used the volar approach for open reduction and internal fixation with a headless screw for scaphoid fracture and scapho-lunate and capito-lunate K-wires for intercarpal instability. The wrist was immobilised in a below-elbow POP slab for 6 weeks after which the Kwires were removed. The patient unfortunately developed complex regional pain syndrome (CRPS), which can be attributed to his late presentation after the injury. Active and passive range of motion exercises and contrast bath were initiated and he was kept on low dose amitriptyline. Gradually CRPS resolved and at 6-month follow-up, the patient had a wrist dorsiflexion of 30° and palmar-flexion of 45°.

References

8 Cites in Article
  1. B Youssef,S Deshmukh (2008). Volar Perilunate Dislocation: A Case Report and Review of the Literature.
  2. John Adkison,Michael Chapman (1982). Treatment of Acute Lunate and Perilunate Dislocations.
  3. Hitesh Lal,Vivek Jangira,Rahul Kakran,Deepak Mittal (2012). Two stage procedure for neglected transscaphoid perilunate dislocation.
  4. Roger Johnson (1980). The Acutely Injured Wrist and its Residuals.
  5. M Kammano,Y Honda,K Kazuki (2001). Palmar lunate transscaphoid fracture dislocation caused by a palmar flexion injury.
  6. F Howard,P Dell (1986). The unreduced carpal dislocation. A method of treatment.
  7. G Inoue,K Shinova (1999). Late treatment of unreduced perilunate dislocation.
  8. Stephen Bruehl,David Warner (2010). An Update on the Pathophysiology of Complex Regional Pain Syndrome.

Funding

No external funding was declared for this work.

Conflict of Interest

The authors declare no conflict of interest.

Ethical Approval

No ethics committee approval was required for this article type.

Data Availability

Not applicable for this article.

How to Cite This Article

Apoorv Sehgal. 2020. \u201cNeglected Trans-Scaphoid Volar Perilunate Dislocation with Post-Operative Complex Regional Pain Syndrome: A Case Report\u201d. Global Journal of Medical Research - H: Orthopedic & Musculoskeletal System GJMR-H Volume 20 (GJMR Volume 20 Issue H2): .

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Journal Specifications

Crossref Journal DOI 10.17406/gjmra

Print ISSN 0975-5888

e-ISSN 2249-4618

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GJMR-H Classification: NLMC Code: WE 175
Version of record

v1.2

Issue date

May 9, 2020

Language
en
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We present the case report of a 30-year-old male who fell from a height of 15 feet on his palmar-flexed right wrist and came to us 1 month after the injury. He had a swollen, stiff wrist with painful movements and no neurovascular deficit. X-rays showed a trans-scaphoid volar perilunate dislocation. We used the volar approach for open reduction and internal fixation with a headless screw for scaphoid fracture and scapho-lunate and capito-lunate K-wires for intercarpal instability. The wrist was immobilised in a below-elbow POP slab for 6 weeks after which the Kwires were removed. The patient unfortunately developed complex regional pain syndrome (CRPS), which can be attributed to his late presentation after the injury. Active and passive range of motion exercises and contrast bath were initiated and he was kept on low dose amitriptyline. Gradually CRPS resolved and at 6-month follow-up, the patient had a wrist dorsiflexion of 30° and palmar-flexion of 45°.

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Neglected Trans-Scaphoid Volar Perilunate Dislocation with Post-Operative Complex Regional Pain Syndrome: A Case Report

Apoorv Sehgal
Apoorv Sehgal University College of Medical Sciences
Pratyush Shahi
Pratyush Shahi University College of Medical Sciences
Aarushi Sudan
Aarushi Sudan
Sushil Kamal
Sushil Kamal
Umesh Meena
Umesh Meena
Debasish Meher
Debasish Meher

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