Concurrent Palmar Lunate Dislocation and Posterior Elbow Dislocation With a Distal Radius Fracture: A Rare Case Report

TL;DR

A 23-year-old man suffered rare simultaneous wrist and elbow injuries after a fall, which were successfully treated with surgical and external fixation methods.

Contribution

This case report highlights a rare combination of wrist and elbow injuries and their successful treatment approach.

Findings

The patient had a trans-scapho-retro-lunate wrist dislocation and a posterolateral elbow dislocation with a distal radius fracture.

Closed reduction and percutaneous screw fixation successfully treated the injuries.

After 1 year and 3 months, the patient experienced no elbow pain and minimal wrist discomfort.

Abstract

We present an unusual case involving the simultaneous dislocation of the trans-scapho-retro-lunate in the right wrist and a posterolateral dislocation in the right elbow joint with a distal radius fracture in a 23-year-old male with no notable medical history. These injuries occurred when he fell from a height of around 12 meters onto his outstretched right hand. The patient presented to the hospital in a normal upper limb trauma position with no discomfort to critical functions. Predominant symptoms at the emergency department were discomfort in the right wrist, hand, and ipsilateral elbow, as well as the entire upper limb functional impairment. Both the wrist and the elbow seemed distorted on examination, with considerable edema and loss of bone landmarks. Passive mobilization was hampered by pain, but peripheral pulses were detectable. The radial, ulnar, and median nerves' autonomous sensory-motor domains were intact, with a cutaneous opening classified as stage 2 by the Cauchoix-Duparc classification. The elbow dislocation was successfully treated using a closed reduction method. External manipulation was employed to reduce the trans-scaphoid perilunate dislocation, which was subsequently stabilized through percutaneous screw fixation of the scaphoid using a triquetrum-lunate pin. Additionally, a styloid pin was utilized to address and manage a distal radius fracture, followed by the implementation of a radiometacarpal external fixator. After one year and three months, the patient reported no pain in his elbow and minimal wrist discomfort during heavy lifting.

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