Jnl Wrist Surg
DOI: 10.1055/s-0038-1675385
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

“Locked” Scapholunate Instability Diagnosed with 4D Computed Tomography Scan

Gregory I. Bain
1  Department of Orthopedic Surgery, Flinders University, Bedford Park, Adelaide, South Australia, Australia
,
Sathya Vamsi Krishna
2  Department of Orthopedics, St. John's Medical College, Koromangala, Bangalore, India
,
Simon MacLean
3  Tauranga Hospital, Bay Of Plenty District Health Board, Tauranga, New Zealand
,
Renee Carr
1  Department of Orthopedic Surgery, Flinders University, Bedford Park, Adelaide, South Australia, Australia
,
John Slavotinek
4  Department of Radiology, Flinders University and Flinders Medical Center, Bedford Park, Adelaide, South Australia, Australia
› Author Affiliations
Further Information

Publication History

05 November 2018

24 September 2018

Publication Date:
10 January 2019 (eFirst)

Abstract

Background Scapholunate instability (SLI) has a wide range of clinical and radiological presentations. The management depends on the stage of the disorder. Subluxation of scaphoid is pathognomonic feature of the SLI. We describe a patient with SLI with a dislocated proximal pole of scaphoid, out of the distal radius scaphoid fossa. The 4D (three-dimensions + time) computed tomography (CT) scan demonstrated that the scaphoid did not reduce throughout wrist motion.

Case Description A 20-year-old male presented with SLI following a fall skateboarding. The 4D CT scan revealed the dislocated scaphoid that did not reduce with wrist motion. He underwent open reduction of the proximal pole of scaphoid and SL reconstruction using flexor carpi radialis (FCR) tendon graft with the Quad tenodesis technique. At 1 year, he had improved pain, wrist functions, and maintained satisfactory radiological alignment.

Literature Review We are not aware of any previous description of the dorsal scaphoid dislocation in association with scapolunate instability.

Clinical Relevance We recommend that the SLI staging classification needs to be expanded to include dislocation (locked) stage. The 4D CT has a significant role in identifying the instability and its reducibility.

Level of Evidence This is a level V study.

Note

This study was done at Department of Orthopedic Surgery, Flinders University and Flinders Medical Center, Bedford Park, Adelaide, South Australia, Australia.