IPSILATERAL BOTH-BONE FOREARM FRACTURE ASSOCIATED WITH TRANS-SCAPHO-LUNATE FRACTURE-DISLOCATION: A RARE OCCUPATIONAL INJURY CASE REPORT

Background: Combined both-bone forearm fractures associated with carpal fracture-dislocations are exceptionally rare and usually result from high-energy trauma. Careful assessment of the entire upper limb is mandatory to avoid missed injuries. Case Presentation: We report the case of a 42-year-old right-handed male with no significant medical history who sustained a closed injury to the left upper limb following a fall from height during a work-related accident. On admission, the patient was conscious and hemodynamically stable. Clinical examination revealed deformity of the left forearm with complete functional impairment, without signs of compartment syndrome or distal neurovascular deficit. Radiographic evaluation showed a displaced mid-diaphyseal fracture of both bones of the left forearm, associated with a small ulnar fragment, with no involvement of the proximal or distal radioulnar joints. Wrist radiographs demonstrated a trans-scapho-lunate fracture-dislocation with proximal migration of the scaphoid fragment and an associated radial styloid fracture, reflecting the high-energy mechanism of injury. Computed tomography allowed better assessment of the lesions. Surgical management was performed in two stages: open reduction and internal fixation of both forearm bones using plates, followed by reduction of the perilunate dislocation, fixation of the scaphoid fracture, and stabilization with Kirschner wires. Conclusion: This case illustrates an exceptional pattern of upper limb trauma caused by a high-energy mechanism, highlighted by proximal migration of the scaphoid fragment. Early diagnosis and prompt surgical management are essential to achieve satisfactory outcomes and prevent long-term complications.