JBJS Case Connections—Wrong-Way Wrist Bones

The ability of the small and complexly connected wrist bones to function properly supports everything from activities of daily living and work to the creation of art and music. This month’s “Case Connections” article explores wrist dislocations that required open reduction and some form of fixation. Considering the high degree of anatomical derangement and instability in these cases, the outcomes were remarkably good, thanks to carefully planned and executed orthopaedic interventions.

The springboard case, from the July 27, 2016 edition of JBJS Case Connector, describes the treatment of a 47-year-old male bicyclist who was hit by a car and sustained complete scaphoid and lunate dislocations. Three additional JBJS Case Connector case reports summarized in the article focus on:

• a 22-year-old man who sustained volar dislocation of the hamate and scapholunate dissociation as a result of a motor-vehicle accident
• a 30-year-old man who experienced volar dislocation of the lunate as well as of the proximal pole of a fractured scaphoid after falling from a height of 15 feet with his outstretched hand and wrist in extension
• a 25-year-old man who fell from a height of 20 feet and dislocated the hand and wrist dorsally about the scaphoid and lunate.

Anatomical reduction frequently required both dorsal and volar exposures. In one case, a successful outcome was achieved without addressing ligamentous injuries.