ABSTRACT
A patient reported that he sustained a minor fall on the outstretched hand in hyperextension, pronation, and in ulnar deviation. Initial radiographs suggested dorsal transscaphoid-transtriquetral perilunate dislocation. Traditionally, however, this injury is the result of a high-energy impact. A CT scan obtained after closed reduction of the dislocation revealed not only a fresh fracture of the triquetrum but also two corticalized fragments of the scaphoid. A former major fall on this hand and a normal scaphoid of the other hand made pseudarthrosis more likely than scaphoid bipartition. Arthrography revealed intact lunotriquetral and scapholunate ligaments, precluding the possibility of preexisting ligamentous instability. Pseudarthrosis of the scaphoid with a loss of scaphoid function as a mechanical tie-rod of the carpus is most likely responsible for this complex injury. This is the first clinical study that shows that single scaphoid discontinuity without preexisting ligamentous carpal instability may lead to complex perilunar dislocation in minor trauma.
Subject(s)
Joint Dislocations/diagnostic imaging , Pseudarthrosis/diagnostic imaging , Wrist Injuries/diagnostic imaging , Adult , Carpal Bones/diagnostic imaging , Carpal Bones/injuries , Fractures, Bone/complications , Fractures, Bone/diagnostic imaging , Humans , Joint Dislocations/complications , Male , Pseudarthrosis/complications , Radiography , Scaphoid Bone/diagnostic imaging , Scaphoid Bone/injuriesABSTRACT
Scapholunate dissociation is a well-known injury in adult patients. In pediatric patients, repair of this injury in the skeletally immature carpus has been previously reported. However, in none of these case studies is single ligamentous suture performed. We report a case of scapholunate dissociation in a 9-year-old boy after an initial Salter I injury of the distal radius. After 6 weeks of wrist immobilization, arthroscopy was performed due to persisting pain over the scapholunate gap, a positive Watson sign, and limited range of motion. This arthroscopy revealed intraligamentous rupture of the scapholunate ligament. Suture repair of the scapholunate ligament was performed. The suture was protected by a temporary K-wire arthrodesis for 8 weeks. One year after removal of the K-wire, the patient is completely free of symptoms and resumes all sport activities.
Subject(s)
Ligaments, Articular/injuries , Ligaments, Articular/surgery , Lunate Bone , Scaphoid Bone , Wrist Injuries/surgery , Arthroscopy , Child , Follow-Up Studies , Humans , Joint Instability/etiology , Joint Instability/surgery , Male , Range of Motion, Articular , Rupture , Sutures , Time Factors , Wrist Injuries/diagnosisABSTRACT
Mediastinal parathyroid adenoma located on the 5th ectopic gland is rare. We report here two new cases diagnosed by scintigraphy. In one case the adenoma was found to be located in the mediastinum prior to cervicotomy. The modern imaging methods capable of locating parathyroid adenomas are evaluated.