Introduction: Peri-lunate dislocations, the most recurrent high-energy injuries are associated with disruption of adjoining ligaments and capsular attachments. Scaphoidectomy and lunocapitate fusion are better compared to fourcorner fusion for SNAC and SLAC. The radial artery when stripped from the bone in four-corner fusion can lead to osteonecrosis of the scaphoid followed by SNAC lesion. This case study proposes acute scaphoidectomy and lunocapitate fusion for the surgical treatment of compound trans-styloid, trans-scaphoid, peri-lunate fracture dislocation with extensor tendon injury.

Materials and Methods: A 54-year-old male patient, manual worker with alleged history of trauma 6 hours prior was treated using this procedure. He had peri-lunate fracture dislocation with scaphoid bone avulsion, torn dorsal ligaments and tendon injury. The fractured scaphoid bone was removed followed by exposing the articular surfaces of lunate and capitate, denuding their cartilage, and passing a 2.5mm headless compression screw followed by packing fusion sites with cancellous bone graft, repairing with dorsal capsule-ligamentous complex with suture and mobilizing the tendons. The patient tolerated the surgery well.

Results: No infection was seen in the wound however, the dorsal skin around the compounding wound got avascular and developed eschar. Post 6 weeks of surgery, the screw was well placed, ROM (range of motion) of the wrist was 20 degrees of DF and PF. Pronation supination was normal. There was stiffness in fingers due to immobilization. Physiotherapy was started for the same.

Conclusion: Trans-scaphoid peri-lunate fracture-dislocations can be challenging to hand surgeons such as in this case. Understanding the blood supply of scaphoid and the mechanism of peri-lunate dislocation is of prime importance. Thus, a displaced scaphoid fracture stripped of all its soft tissue attachments and less chances of union should be managed by primary scaphoidectomy and lunocapitate fusion in patients of lower socio-economic strata with high functional demand avoiding secondary surgery and favouring early return to work.

Shivam Mehra is an orthopedics professional and researcher based in the Department of Orthopaedics at the Padmashree Dr. D.Y. Patil School of Medicine in Navi Mumbai, India. In the year 2016, he was the Organizing secretory for an undergraduate International Medical Research Conference, MEDICON 2016 and has attended various CME and conferences focused on research. His clinical focus and research contributions span various complex orthopaedic conditions, surgeries, and musculoskeletal disorders. He has been involved in several key clinical studies and case reports published in medical literature.