1. 4304 10.13107jocr.2022.v12.i11.3390 1-4.cdr

Introduction

Bilateral combined fractures of the scaphoid and distal radius are

an extremely rare association in trauma injuries and probably

result from a high-energy trauma [1]. In fact, there are only two

cases reported in the literature thus far [1]. In the current paper,

the authors described an extremely rare entity of fracture

association in a 22-year-old female who was victim of physical

exercise accident.

Case Presentation

A 22-year-old female was admitted to the emergency department

after a sport-related fall causing severe pain in both wrists,

without skin or neurovascular damage. The radiographs showed

combined bilateral fractures of the scaphoid and distal radius.

Both distal radial fractures and scaphoid fractures were Type A

according to the AO classification and the Herbert classification

respectively (Fig.1A, 1B). The patient was operated on under

general anesthesia. Starting with the left wrist, first, we

proceeded to a closed reduction and fixation of the distal radius

fractures with Kirschner wires under fluoroscopic control. Then,

the scaphoid fracture was stabilized with percutaneous

Kirschner wires from distal to proximal. The same procedures

were performed on the right limb (Fig. 2a, 2b). This was followed

by immobilization using cast. Three month post-surgery, the cast

was removed and wrist range-of-motion exercises were started.

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DOI: https://doi.org/10.13107/jocr.2022.v12.i11.3390

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Dr. Mohamed A LahlaliDr. Nadhir Meraghni Dr. Ali Mohand-Oussaid

Case Report

Access this article online

Website:

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DOI:

https://doi.org/10.13107/jocr.2022.v12.i11.3390

Department of Orthopaedic Surgery, Centre Hospitalier Universitaire Mustapha Bacha, Algiers - Algeria.

Address of Correspondence:

Dr. Nadhir Meraghni,

Department of Orthopaedic Surgery, Centre Hospitalier Universitaire Mustapha Bacha, Place du 1er Mai, 16000, Algiers - Algeria.

E-mail: nadhir.meraghni@gmail.com

Submitted: 19/08/2022; Review: 27/09/2022; Accepted: October 2022; Published: November 2022

Dr. Mohamed Derradji

Journal of Orthopaedic Case Reports 2022 November:12(11):Page 1-4

Nadhir Meraghni¹, Mohamed A Lahlali¹, Ali Mohand-Oussaid¹, Mohamed Derradji¹, Zoubir Kara¹

Introduction: A combination of bilateral scaphoid and distal radius fractures is extremely rare. It may occur as a result of high-energy trauma and

can be neglected. The current paper described a case study of this rarely combined fracture.

Case Report: A 22-year-old female was admitted to the emergency department following a fall while exercising which resulted in severe pain in

both wrists without any neurovascular deficit. X-ray imaging showed bilateral combined fractures of the scaphoid and distal radius. To fix the

fractures, the patient underwent closed reduction and internal fixation with Kirschner wires along with immobilization for 3 months. The radius

and scaphoid fractures were united within approximately 6 and 10 weeks, respectively.

Conclusion: Combined bilateral scaphoid and distal radius fractures are extremely rare resulting from high-energy trauma. The associated

fractures require a precise diagnosis and appropriate therapeutic management.

Keywords: distal radius, scaphoid, fracture, bilateral, reduction.

Abstract

Learning Point of the Article:

The association of bilateral scaphoid and distal radius fractures is extremely rare, can be neglected, requires a precise diagnosis and appropriate

therapeutic management.

Bilateral Combined Fractures of the Scaphoid and Distal Radius: A Case

Report

Dr. Zoubir Kara

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The radius fractures and the scaphoid fractures were united

within 6 weeks and 10 weeks, respectively.

The wrist range of motion was measured using a goniometer.

On the right side, the mean range of motion at 12 months

follow-up was of 110 degrees for combined extension and

flexion, 30 degrees for combined arc of radial and ulnar

deviation, and 135 degrees for the combined pronation and

supination. For the left side, it was of 105 degrees for extension

and flexion, 28 degrees for radial and ulnar deviation, and 140

degrees for pronation and supination. (Fig. 3A, 3B, 3C, 3D).

The Visual Analogic Scale (VAS) was of 1 on the right wrist and

of 2 on the left side. The Quick Dash score was of 4.5 for both

sides on the last follow-up.

Discussion

Simultaneous fractures of the distal radius and scaphoid are

uncommon [2, 3, 4, 5].

Bilateral combined

association of these

fractures is extremely

rare and results due to

high-energy trauma [1,

6 ] . T h e r e i s n o

consensus regarding

the mechanism o f

injury [7]. Because

f r a c t u r e s o f t h e

s c a p h o i d i n v ol ve

extension and ulnar

deviation of the wrist to

place the scaphoid in a

vertical and vulnerable

position with three-point bending stresses applied, it seems

likely that the scaphoid fracture occurs first and then continued

axial loading and extension of the wrist results in the fractures of

the radius [8, 9]. Frykman noted that for this combined injury

to occur, the required loads must be in a radial direction and

higher than the ones required for the radius to fracture alone. In

his experiment, the distal radial fracture occurred first, followed

by the scaphoid fracture. Stother proposed that fractures of the

scaphoid and the distal radius can occur only if the radius is

relatively strong so that hyperextension at the wrist and fracture

of the scaphoid occurs before the distal radial fracture [2].

Operative treatment is recommended even if fractures are not

displaced [1]. In addition, to stabilizing the lesions, it reduces

the risk of secondary displacement and allows early

rehabilitation. Different methods are used to treat distal radial

fractures including percutaneous pinning using Kirschner

wires, plates, and external fixation. For the case described in this

paper, we opted for the first method as the fractures were not

complex. With the regards to the scaphoid

fractures, we can use fixation with Herbert screws

or Kirschner wires and we chose fixation with

Kirschner wires. The advantages of wires are

reduction of the risk of infection and facilitation of

functional recovery. The inconveniences are the

difficulty to obtain anatomical reduction and the

increased risks of complications: including

secondary displacement, migration of wires and

damage to tendons. A precise diagnosis and

appropriate therapeutic management are required

for this rare association of fractures.

This case highlights the importance of careful

examination for concomitant injuries following

upper extremity fractures. Scaphoid fractures can

easily be neglected as they are not readily visualized

Journal of Orthopaedic Case Reports Volume 12 Issue 11 November 2022 Page 1-4 | | | |

Meraghni N, et al

Figure 2A: postoperative X-ray of the right

distal radius and scaphoid fractures.

Figure 2B: postoperative X-ray of the left

distal radius and scaphoid fractures..

Figure 1A: fractures of the right distal radius and scaphoid

Figure 1B fractures of the left distal radius and

scaphoid.

www.jocr.co.in

Journal of Orthopaedic Case Reports Volume 12 Issue 11 November 2022 Page 1-4 | | | |

on initial plain radiographs. Scaphoid nonunion and carpal

instability are the major complications of scaphoid fractures.

Early diagnosis and treatment are crucial to such complications

[10].

Conclusion

A combination of bilateral scaphoid and distal radius fractures is

very rare resulting from high-energy traumas. This association

requires a precise diagnosis and appropriate therapeutic

management.

Meraghni N, et al

Figure 3A and B: 12 months X-ray follow-up.

Figure 3C and D: 12 months clinical follow-up.

Clinical Message

The association of bilateral scaphoid and distal radius fractures is

extremely rare in trauma and it is highly likely a result of a high-

energy trauma. Although this extremely rare entity of injury

association would rest in serious complications if left untreated,

commonly it is neglected due to missed diagnosis on plain

radiographs. Radiography diagnostic assessment accuracy followed

by appropriate surgical therapy and postoperative management are

pivotal for the treatment of simultaneous bilateral scaphoid and

distal radius fractures.

References

Declaration of patient consent: The authors certify that they have obtained all appropriate patient consent forms. In the form,

the patient has given the consent for his/ her images and other clinical information to be reported in the journal. The patient

understands that his/ her names and initials will not be published and due efforts will be made to conceal their identity, but

anonymity cannot be guaranteed.

Conflict of interest: Nil Source of support: None

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Journal of Orthopaedic Case Reports Volume 12 Issue 11 November 2022 Page 1-4 | | | |

Meraghni N, et al

How to Cite this Article

Meraghni N, Lahlali MA, Mohand-Oussaid A, Derradji M, Kara Z. Bilateral

Combined Fractures of the Scaphoid and Distal Radius: A Case Report.

Journal of Orthopaedic Case Reports 2022 November;12(11): 1-4.

Conflict of Interest: Nil

Source of Support: Nil

______________________________________________

Consent: The authors confirm that informed consent was obtained

from the patient for publication of this case report

scaphoid fractures in a child. Journal of Hand Surgery

(British and European Volume, 1999) 24B: 2: 255–257.