Open Reduction and Internal Fixation of Trans-scaphoid Perilunate Fracture Dislocation

Acute carpal fracture dislocations. After 2 to 3 weeks, the surgeon should consider a salvage procedure.

Closed reduction of the midcarpal joint just prior to incision will facilitate the dissection.

Arc of injury noted to enter through the scaphoid (S), extend ulnarly across the midcarpal joint, and exit through the lunotriquetral joint (Fig. 41-1).
Dorsal longitudinal incision
Release the extensor pollicis longus from the third compartment and retract, with the radial wrist extensors in a radial direction.
Open the radial wall of the fourth extensor compartment and retract retinaculum and the common extensors in an ulnar direction.
Inspect the dorsal wrist capsule. The capsule is often avulsed from the distal radius. Identify the radiolunotriquetral ligament so that it can be repaired at the end of the case.
Split the capsule along the dorsal radiocarpal and intercarpal ligaments raising a radially based flap (Fig. 41-2).
Reduce the radiocarpal and midcarpal joint.
Flex the wrist to expose and reduce the proximal fragment of the scaphoid.