ACRT Journal

3.       Discussion

The fenton’s syndrome is a rare injury [1-11], according to Freeman et al. it has an incidence of 1.3% [10], and we found only one published case of a bilateral form of the injury [12]. This injury occurs always in young men [1-11]. Hokan et al. described a case in a child [13]. The injury mechanism is still controversial, according to many authors it is a trauma of a hand with forced extension and axial compression [1,2], But according to Fenton et al. [5] it is due to a trauma of a hand with forced hyperextension and radial deviation but Boisgard et al. [3] stipulated that this mechanism doesn’t explain the occurrence of an associated perilunate dislocation. The clinical examination is not specific [3], and the diagnosis is difficult and often delayed, that’s why we believe that a CT-Scan is almost essential not only to confirm the diagnosis but also to assess the degree of rotation of the capitate head [2]. Then we believe in accordance with other authors that the best therapeutic measure is to perform an open reduction of both fractures [2] and stabilize them with internal fixation using kirshner^® wires and or either Herbert^® Herbert wipple^® and or Acturac^® miniscrews [2]. Some complications could occur during the evolution and the most redoubted ones are the capitate head necrosis and pseudarthrosis [2]. The majority of the reported cases had a good final clinical result [3], in our case the clinical result was qualified as middle, this could be explained by the fact that no ostosynthesis of the scaphoid fracture was possible because of the communitive character of them.

4.       Conclusion

Fenton’s syndrome is a rare lesion, bilateral forms are exceptional, the mechanism is still controversial, the clinical and radiological diagnosis is difficult, and CT-scan can be very useful. The treatment should be always surgical including an open reduction using a dorsal or a palmar approach and an internal fixation.

Figure 1 and 2: Initial X-Rays of the right wrist showing a perilunate transcaphoid fracture dislocation.

Figure 3 and 4: Initial X-Rays of the left wrist showing a perilunate transcaphoid fracture dislocation.

Figure 3 and 4: Initial X-Rays of the left wrist showing a perilunate transcaphoid fracture dislocation.

Figure 5 and 6: Right wrist X-Ray three weeks after the initial trauma showing the capitate head fracture.

Figure 9 and 10: Right wrist CT- Scan three weeks after the initial trauma showing the capitate head fracture.

Figure 11and 12: Left wrist CT- Scan three weeks after the initial trauma showing the capitate head fracture.

Figure 13 and 14: Right wrist post- operative X-Ray the capitate head was totally enucleated and no ostosynthesis for the scaphoid.

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Figure 15 and 16: Left wrist post- operative X-Ray the capitate head was replaced and nailed and no ostosynthesis for the scaphoid.

Figure 17 and 18: Right wrist X-Ray at 18 months: there is a non-union of the scaphoid fracture.

Figure 19 and 20: Left wrist X-Ray at 18 months: there is a non-union of the scaphoid fracture and a union of the capitate head fracture.

1. Marcuzzi A, Ozben H, Russomando A, Petit A (2013) Chronic transscaphoid, transcapitate perilunate fracture dislocation of the wrist: Fenton’s syndrome. Chirurgie de la main 32: 100-103.
2. Natera Cisneros L, Lamas Gómez C, Proubasta Renart I, Moya Gómez E (2012) Fenton syndrome. Rev Esp Cir Ortop Traumatol 56: 369-373.
3. S Boisgard, JL Bremont, G Guyonnet, T Chatenet, JP Levai (1996) Fracture scapho- capitale A propos d'un cas, revu de la littèrature. Ann Chir Main (Ann Hand Surg) 15: 181-188.
4. Perves J, Rigaud A, Badelon L (1937) Fracture par décapitation du grand os avec déplacement dorsal du corps de los stimulant une dislocation carpienne. Rev Orthop 24: 251-253.