Trans-scaphoid perilunate fracture-dislocation requiring carpal tunnel release in college football players: a case report

Background: Trans-scaphoid perilunate fracture-dislocation (TSPLFD) is an uncommon but high-risk injury in athletes, and acute median nerve symptoms can influence surgical timing and approach. Case presentation: We report two 20-year-old collegiate football players who sustained TSPLFD during play. In Case 1, closed reduction in the emergency department restored alignment, but the patient reported mild paresthesias in the median nerve distribution. He underwent open reduction and internal fixation (ORIF) of the scaphoid with lunotriquetral stabilization and carpal tunnel release. In Case 2, closed reduction was unsatisfactory, and sensory symptoms persisted, prompting emergent ORIF with carpal tunnel release. Both athletes returned to Division I collegiate football without recurrent neurologic symptoms. Clinical discussion: These cases highlight (1) the importance of prompt recognition and advanced imaging to define the injury pattern, (2) the rationale for emergent surgical management when reduction is inadequate or neurologic symptoms persist, and (3) the need to document objective postoperative outcomes in high-demand athletes. We also discuss indications for urgent carpal tunnel release in the setting of perilunate injuries and relate decision-making to the available evidence. Conclusion: TSPLFD in competitive athletes can allow return to sport when treated with timely reduction, stable fixation, and a low threshold for carpal tunnel release when acute median nerve symptoms persist or worsen. However, short-term follow-up cannot exclude long-term risks such as post-traumatic arthritis and avascular necrosis, and athletes should be counseled accordingly.