Posters
Presenting Author Academic/Professional Position
Medical Student
Academic Level (Author 1)
Medical Student
Academic Level (Author 2)
Medical Student
Academic Level (Author 3)
Medical Student
Academic Level (Author 5)
Other
Discipline/Specialty (Author 5)
Surgery
Presentation Type
Poster
Discipline Track
Community/Public Health
Abstract Type
Case Report
Abstract
Background: A trans-scaphoid perilunate dislocation often results from a loaded hyperextension and intracarpal axial rotation. The uncommon nature of this injury stems from the high energy required to fracture the scaphoid and disrupt the overlapping ligaments simultaneously. Surgical intervention is required in these injuries to repair fractures and ligaments. The complex nature of wrist anatomy potentiates complications such as stiffness, pain, infections, and post traumatic arthritis. Successful recovery depends on rigorous compliance with post operative care that often includes immobilization, physical therapy, and follow up visits. Noncompliance is particularly concerning in trauma patients, as many of these patients are lost to follow up, often due to financial constraints. There is significant evidence pointing to correlations between improved outcomes and higher compliance. This case highlights the critical challenges of providing follow up care in the Rio Grande Valley, where a larger percentage of patients may face financial barriers that can hinder compliance and negatively impact recovery.
Case Presentation: A 28-year-old Hispanic gentleman presented to the emergency department after an ATV rollover. Initial examination showed left wrist pain, swelling and limited range of motion. Neural examination referred to paresthesia. CT showed a trans-scaphoid perilunate dislocation of the left wrist. There was a displaced fracture fragment of the dorsal lunate and a displaced fracture of the inferior triquetrum. Surgery consisted of the release of the median nerve at the wrist, and open reduction internal fixation of the scaphoid, lunate, and capitate with screws and pins. A mini anchor with sutures was used in the distal radius. Despite adhering to initial follow-up, the patient missed a 3-week post-op visit and returned unannounced the next day, admitting noncompliance with recommendations. He arrived for both hardware removal and the corresponding 3-week follow-up but showed decreased range of motion compared to standard clinical expectations. He missed his 6-week appointment and was lost to follow-up thereafter.
Conclusion: This case demonstrates the potential interplay of Social Determinants of Health (SDoH) affecting patient compliance and its profound impact on the postoperative outcomes in trauma cases. Optimal results cannot be attained through surgical intervention alone. Strict postoperative care and rehabilitation adherence is necessary to ensure proper healing and recovery. Non-compliance not only jeopardizes patient improvement but also strains the healthcare system through post-operative complications, revisions, or the need for extended rehabilitation. While structured follow-up can address these issues, SDoH outside of healthcare—socioeconomic status, built environment, community context, and education— play a critical role in patients’ ability to access healthcare and adhere to postoperative plans, highlighting the reciprocal nature of SDoH. The Rio Grande Valley is uniquely susceptible to facing challenges in these domains and amplifies the risk of losing patients to follow-up. Physicians must recognize potential barriers to adherence before discharge to tailor a postoperative plan that accommodates the patient’s needs. A multidisciplinary approach involving patient education programs, social workers, and telehealth may address these barriers, enhancing healthcare access and postoperative outcomes.
Recommended Citation
Bonilla, Paul; Harris, Chloe; Murambadoro, Anesu K.; and Rodriguez, Sergio, "Challenges in Postoperative Compliance and Follow-Up in Trauma Patients: A Trans-scaphoid Perilunate Dislocation Case Report" (2025). Research Symposium. 127.
https://scholarworks.utrgv.edu/somrs/2025/posters/127
Included in
Challenges in Postoperative Compliance and Follow-Up in Trauma Patients: A Trans-scaphoid Perilunate Dislocation Case Report
Background: A trans-scaphoid perilunate dislocation often results from a loaded hyperextension and intracarpal axial rotation. The uncommon nature of this injury stems from the high energy required to fracture the scaphoid and disrupt the overlapping ligaments simultaneously. Surgical intervention is required in these injuries to repair fractures and ligaments. The complex nature of wrist anatomy potentiates complications such as stiffness, pain, infections, and post traumatic arthritis. Successful recovery depends on rigorous compliance with post operative care that often includes immobilization, physical therapy, and follow up visits. Noncompliance is particularly concerning in trauma patients, as many of these patients are lost to follow up, often due to financial constraints. There is significant evidence pointing to correlations between improved outcomes and higher compliance. This case highlights the critical challenges of providing follow up care in the Rio Grande Valley, where a larger percentage of patients may face financial barriers that can hinder compliance and negatively impact recovery.
Case Presentation: A 28-year-old Hispanic gentleman presented to the emergency department after an ATV rollover. Initial examination showed left wrist pain, swelling and limited range of motion. Neural examination referred to paresthesia. CT showed a trans-scaphoid perilunate dislocation of the left wrist. There was a displaced fracture fragment of the dorsal lunate and a displaced fracture of the inferior triquetrum. Surgery consisted of the release of the median nerve at the wrist, and open reduction internal fixation of the scaphoid, lunate, and capitate with screws and pins. A mini anchor with sutures was used in the distal radius. Despite adhering to initial follow-up, the patient missed a 3-week post-op visit and returned unannounced the next day, admitting noncompliance with recommendations. He arrived for both hardware removal and the corresponding 3-week follow-up but showed decreased range of motion compared to standard clinical expectations. He missed his 6-week appointment and was lost to follow-up thereafter.
Conclusion: This case demonstrates the potential interplay of Social Determinants of Health (SDoH) affecting patient compliance and its profound impact on the postoperative outcomes in trauma cases. Optimal results cannot be attained through surgical intervention alone. Strict postoperative care and rehabilitation adherence is necessary to ensure proper healing and recovery. Non-compliance not only jeopardizes patient improvement but also strains the healthcare system through post-operative complications, revisions, or the need for extended rehabilitation. While structured follow-up can address these issues, SDoH outside of healthcare—socioeconomic status, built environment, community context, and education— play a critical role in patients’ ability to access healthcare and adhere to postoperative plans, highlighting the reciprocal nature of SDoH. The Rio Grande Valley is uniquely susceptible to facing challenges in these domains and amplifies the risk of losing patients to follow-up. Physicians must recognize potential barriers to adherence before discharge to tailor a postoperative plan that accommodates the patient’s needs. A multidisciplinary approach involving patient education programs, social workers, and telehealth may address these barriers, enhancing healthcare access and postoperative outcomes.
