JCOT Vol 2 No 1 51 ©2011, DOA *Assistant Professor, **Associate Professor, † Professor, Department of Orthopedics, BRD Medical College, Gorakhpur, Uttar Pradesh. Correspondence: Dr. Vikas Saxena, Assistant Professor, Department of Orthopedics, BRD Medical College, Gorakhpur, Uttar Pradesh – 273001. E-mail: doctorvikas2002@yahoo.co.in flexion. Check X-ray showed satisfactory reduction (Figures 3 and 4). There was no evidence of post reduction sensorimotor neural deficit in either hand. The patient was discharged and at 8 weeks, cast were removed and range of motion excercises started. At 16 weeks, patient had pain-free wrists with a range of mo- tion of 40° of dorsiflexion, 35° of palmar flexion, 40° of pronation and 75° of supination. He could resume his duties after 16 weeks. Six months post-reduction radiographs of both wrists showed scaphoid fracture union with no evidence of avascular necrosis (Figures 5 and 6). At 1-year follow-up, range of motion was satisfactory with terminal limitation of movements in both wrists. DISCUSSION Bilateral trans-scaphoid perilunate fracture dislocation is a rare injury and only few cases have been reported in international literature till date. 1 The prognosis of this kind of injury is un- certain to predict. 2 Mechanism of injury is fall on the dorsum of flexed wrist. Perilunate dislocation indicates extensive injury to intercarpal ligaments, with only the lunate maintaining its normal relationship with the radius. Extensive ligamentous dis- ruption makes the reduction of this dislocation easier than the reduction of lunate dislocation. Palmar trans-scaphoid perilu- nate dislocations are extremely rare. Dorsal trans-scaphoid peri- lunate dislocation like the fracture scaphoid bone alone is diagnosed late and may be associated with other injuries of upper extremity. The key to diagnosis of these injuries of the wrist is the lat- eral X-ray. Normally the axis of radius, the lunate, the capitate and the third metacarpal should fall in a straight line with the wrist in neutral position and the half moon-shaped profile of lunate articulates with the cup of distal radius proximally and with the rounded proximal capitate distally. On the AP view the lunate has rectangular profile normally which when dislo- cated becomes triangular because of its tilt. Early reduction by closed manipulation is best. Reduction of the dislocation is carried out by traction and flexion of the distal portion with direct pressure over the displaced fragment. A closed reduction usually can be carried out up to 3 weeks after injury. The reduction tends to be unstable due to exten- sive ligamentous damage and it may be impossible to obtain and maintain accurate reduction of the scaphoid fragments so open reduction and internal fixation is the preferred treat- ment of choice for such displaced fractures. The risk of avascu- lar necrosis as well as early and severe radiocarpal arthrosis after trauma is likely to happen. The prognosis of this kind of injury is uncertain to predict. In our case we could achieve satisfactory reduction by closed means and patient was able to perform early rehabilitation program about 8 weeks post reduction. He recovered with a good range of movement in both hands. Recently the open reduction and internal fixation with early and aggressive rehabilitation for trans-scaphoid injury was pro- posed by several authors. 3–6 Early internal fixation of scaphoid Bilateral symmetrical trans-scaphoid perilunate dislocation—a rare injury Vikas Saxena, MS (Ortho)* Pavan Pradhan, MS (Ortho)** Ashok Yadav, MS (Ortho)* Vineet Mehrotra, MS (Ortho) † INTRODUCTION There have been only 6 reports of bilateral scaphoid fractures without dislocation and 3 cases of bilateral scaphoid fractures associated with perilunate dislocation in the international liter- ature. We present a case of bilateral symmetrical scaphoid frac- ture associated with perilunate dislocation. This patient received immediate closed reduction and cast application with early and aggressive rehabilitation program. After 4 months’ follow-up, there was no local site tenderness or deformity. Minimal functional impairment was noted in both wrists at 1-year follow-up. CASE REPORT A 35-years-old policeman fell down from a height of around 20 feet bearing bodyweight over both pronated hand. Following in- jury patient had bilateral wrist pain, swelling and deformity. The patient was brought to BRD Medical College, Gorakhpur 2 hours after the injury. Roentgenograms revealed dorsal perilu- nar dislocation with scaphoid fracture in both wrists as lunate bone along with proximal fragment of scaphoid was in align- ment with distal radius articular margin in lateral view while perilunate carpal bones were dorsally displaced on both sides and normal quadrilateral appearance of lunate turned into tri- angular appearance in anteroposterior roentgenogram (Figures 1 and 2). There was no evidence of sensorimotor deficit in either hand. Both fractures were reduced by closed manipulation under general anesthesia and below elbow cast applied in palmar