Chronic Neglected Scapho-capitate Syndrome: A Rare Case Report with Management

INTRODUCTION: Scapho-capitate syndrome is a rare variety, usually occur during high-energy trauma leads to fracture of scaphoid and capitate with 180 rotation of proximal fragment of capitate. CASE REPORT: We present a unique case of chronic neglected scapho-capitate syndrome, in which the rotated proximal fragment of capitate along with the early degenerative changes in capitate and lunate. RESULT: Exploration of the wrist by dorsal approach, fracture fragment was resorbed and non-amenable for fixation. The scaphoid and triquetrum were excised. The cartilage between the lunate and capitate was denuded and arthrodesis was performed by 2.5 mm headless compression screw. The articular branch of the posterior interosseous nerve (PIN) was excised for pain relief. CONCLUSION: Accurate diagnosis in acute injury is essential for functional outcome. In chronic cases, magnetic resonance imaging is necessary to know the status of cartilage for planning of surgery. Limited carpal fusion with neurectomy of articular branch of PIN can give adequate pain relief and improvement in wrist function.