Irreducible trans-scaphoid perilunate dislocation.

Two cases of irreducible trans-scaphoid perilunate dislocation are described. In each case there was soft tissue interposition between the proximal and distal elements of the fracture-dislocation and this prevented capitolunate and scaphoid reduction. The dorsal capsule was impaled on the distal scaphoid fragment in one case, and a flap of dorsal capsule was entrapped between the capitate and the lunate in the other. In light of these findings, we recommend a dorsal approach for open reduction of trans-scaphoid perilunate dislocation when the capitolunate joint cannot be reduced by closed manipulation.