Imaging a neglected transradial, trans-scaphoid volar perilunate fracture dislocation in a skeletally mature adult: a novel constellation

A well-built 31-year-old man presented with deformity and restricted movements of the left wrist joint. He gave a history of injury due to a fall 8 months earlier, for which he was initially treated with a wrist slab for 3 months. Clinical examination revealed palmar flexion deformity with restricted movements in all directions at the left wrist joint. Neurovascular examination was unremarkable. Plain film radiograph showed diffuse osteopaenia, overlapping of the two carpal rows, distracted fractures of radial styloid process and scaphoid with associated midcarpal volar dislocation (figure 1A, B). CT scan demonstrated a fracture across the waist of scaphoid with volar displacement of the distal scaphoid fracture fragment along with the distal row carpus (figure 2A). The lunate showed mild volar tilt but was adequately aligned with the radial articular surface, while capitate along with distal scaphoid fragment was dislocated volarly (figure 2B). The distal carpal row bones were well aligned with each other and showed maintained distal articulations with the metacarpal heads (figure 2C). Features of midcarpal osteoarthritic changes were also seen (figure 2D). Three-dimensional (3D) CT scan reconstruction demonstrated the maintained alignment between the individual carpi of the proximal and distal carpal rows with fractured proximal fragment of scaphoid remaining with the …