Nuanced Trans-scaphoid, Perilunate Fracture Dislocations With Complete Scapholunate Dissociation: Two Cases With Proximal Row Preservation.

We offer two reports of trans-scaphoid perilunate fracture dislocations, both involving complete dissociations and loss of vascular supply to the proximal scaphoid poles. Case 1 involves a 25-year-old man who fell on an outstretched hand and suffered a trans-styloid, trans-scaphoid, perilunate fracture dislocation. The patient underwent open reduction and screw fixation of the scaphoid using a dorsal approach. Kirchner wire fixation and suture anchor ligamentous repairs were used to reduce the scapholunate, lunar-triquetral, and radioscaphocapitate intervals. At 6 months, the patient was released to work without restrictions. Case 2 is a 66-year-old man who suffered a trans-scaphoid, perilunate fracture dislocation after a fall from a horse. A portion of the completely torn scapholunate ligament remained intact to the proximal pole, but no soft-tissue attachment to the rest of the carpus remained. The patient underwent open reduction of the scaphoid with compression screw and Kirschner wire fixation to repair the scapholunate and lunar-triquetral ligaments. At 1-year, the patient was released to full activity. Intraoperatively, the proximal scaphoid poles were completely devoid of any uninterrupted soft-tissue attachments, elevating concern for osteonecrosis. Although both patients showed radiographic signs of transient ischemia, neither patient displayed osteonecrosis or proximal pole collapse at their terminal visits.