A 31-year-old Caucasian man presented with a greater arc perilunate variant injury after falling from a friend’s shoulders onto an outstretched hand. Imaging revealed a minimally displaced scaphoid waist fracture and a nondisplaced transverse fracture through a previously unrecognized lunotriquetral coalition. A volar intercalated segmental instability (VISI) deformity was present. Open reduction with osseous fixation (a headless compression screw for the scaphoid waist fracture and 3 Kirschner wires across the midcarpal joint) and repair of the torn volar ligaments partially restored the carpal alignment. At 1 year postoperatively, the patient had regained approximately 90% of grip and pinch strength, 70% of wrist flexion, and 80% of wrist extension when compared with the contralateral, uninjured side. Despite persistent VISI alignment, he was satisfied with the outcome and had returned to his preoperative employment and recreational activities.
A high index of suspicion for a perilunate injury should be maintained for all scaphoid fractures, particularly when abnormal anatomy is present.
1Division of Plastic Surgery, University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada
2Department of Orthopaedic Surgery, University of Michigan Health System, Ann Arbor, Michigan