Concurrent scaphoid fracture with scapholunate ligament rupture

Various patterns of traumatic carpal injury have been described in the literature. Although the combination of scaphoid fracture and scapholunate ligament rupture in the same injury has been reported and these lesions can no longer be considered mutually exclusive, little information is available on management methods and the long-term results of such seemingly paradoxical complex injuries. This study reviews 11 previously described cases and reports an additional two cases of concurrent scaphoid fracture with scapholunate ligament rupture. This concurrent injury has two presentations; namely perilunate fracture-dislocation, which is the most common presentation, and complex scaphoid fracture. No single mechanism of injury exists that accounts for these complex injuries. High-energy trauma was the only characteristic common to all these cases. Most cases had unsatisfactory radiographic results including scaphoid nonunion, avascular necrosis of the lunate or the proximal pole of the scaphoid and arthrotic wrist changes at an average follow-up of 11 months. Managing these difficult problems needs critical recognition and repair of both bony and ligamentous damage. Early proximal row carpectomy or four-corner midcarpal fusion is another option when these injuries preclude stable reduction and fixation.