Asymptomatic Nonunion Scaphoid Fracture After Kirschner Wire Fixation of Trans-Scaphoid Lunate Dislocation: A Case Report with 3 Years of Follow-up

Background: Trans-scaphoid lunate dislocation is an orthopaedic injury, mostly because of high energy trauma. Due to subtle clinical and radiological findings, it might be easily left undiagnosed, with estimated 25% cases are missed at initial assessment in emergency department. Non-union scaphoid, which accounts for 5-10% all scaphoid fractures treated K-wires fixation, occurs young active individual.
 Case Presentation: Thirty-seven-years-old right-handed man complained pain, restricted range motion (ROM) on his right wrist after fell from 2m height. Loss symmetry parallelism joint space Gilula's line shown X-ray, possible a trans-scaphoid dislocation. We performed dorsal approach internal fixation using Kirschner wire (1.0). The patient had short arm cast 4 weeks. were removed 5 weeks postoperatively. achieved good result clinically 3, 9, 36 months follow up (Mayo Wrist Score 70, 80, 90, respectively). ROM preferable than pre-surgery (RD 20o, UD WF-WE 60o) avascular necrosis 9th month (in 2019). Unfortunately, 3 years up, X-ray showed non-union necrosis, osteophytes between radius.
 Discussion: Unless asymptomatic, surgery the recommended treatment order limit further morbidity weakness, stiffness joint. However, this case, has been doing any activities hand normally never felt pain last 2 years, eventhough shows fracture distal scaphoid. Thus, we choose not do it.
 Conclusion: In case dislocation, use K-wire excellent outcome, but finding osteophytes, thus possibility develop degenerative disease future.
 Keywords: Lunate dislocation; Non-union; Fixation