Four-Corner Fusion Technique in Two Cases of Acute Perilunate Injury 4C Arthrodesis in Acute Perilunate.

BACKGROUND: An osteochondral lesion at the level of the capitate head in perilunate dislocation (PLD) may worsen the patient's overall prognosis. This case report presents two cases of scaphoid excision and four-corner fusion (4CF) for acute PLD injury with severe osteochondral lesion at the level of the head of the capitate.

CASE DESCRIPTION: The first case involved a 41-year-old man with a dorsal PLD, an associated ulnar styloid fracture and a highly comminuted radial styloid fracture involving the scaphoid facet of the radius. The second case involved a 35-year-old-man with a dorsal PLD on a previously unknown scaphoid nonunion (scaphoid nonunion advanced collapse [SNAC] stage 1). Both patients underwent scaphoid excision and 4CF with Kirschner wire fixation. At last follow-up (6 and 31 months, respectively), both patients had slight pain, had a functional range of motion, and achieved satisfactory functional outcomes. Radiographs confirmed 4CF union. No complications were reported.

LITERATURE REVIEW: Only two other cases of scaphoid excision and 4CF for acute PLD with osteochondral lesion at the capitate head have been reported, with minimal information on clinical outcomes.

CLINICAL RELEVANCE: This article reports two cases of acute PLD with severe osteochondral lesions at the level of the head of the capitate, accompanied by poor local conditions (SNAC stage 1 or a comminuted scaphoid facet of the radius). It highlights the interest of scaphoid excision and 4CF in the acute setting with favorable short-term outcomes, where traditional open reduction and internal fixation or carpal row carpectomy would have been unreliable.