Wrist Fracture Dislocations

Wrist Fracture Dislocations

Wrist fracture dislocations represent a spectrum of the perilunate wrist dislocation. As in the perilunate dislocations, they are the result of high energy trauma resulting from a fall from a height, a motor vehicle collision or a high impact sporting event. A transscaphoid perilunate dislocation (TSPLD) implies a dislocation of the lunate, with an associated fracture of the scaphoid with the proximal scaphoid fragment carried along with the lunate dorsally. A TSPLD is more frequent than a lunate dislocation. When a TSPLD has occurred, it is necessary to attempt immediate reduction of the scahoid fracture to avoid progressive swelling and kinking of the remaining blood supply to the scaphoid. This is rarely achieved by closed manipulation in the emergency room. Because it represents a high energy injury, thorough assessment of associated injuries at the wrist, forearm or elbow is necessary. The median nerve should be assessed for acute compartment carpal tunnel syndrome and decompressed if necessary.


If the bones are successfully repositioned at the emergency room, the patient can be splinted for comfort and final treatment scheduled within days once the swelling has subsided. This injury requires surgery to fix the scaphoid fracture (open reduction and internal fixation) in combination with pins to maintain carpal bone alignment while the ligaments that are repaired heal. Immobilization for 8 – 12 weeks is done to allow ligamentous healing and therapy for digital motion is instituted immediately. The wrist should remain supported by a splint with no to minimal motion since the pins can easily toggle, loosen and become infected. The pins are removed after 8-12 weeks when enough time has elapsed for the ligaments to heal.