Perilunate dislocations Dr. P Kruger. General points Can be missed easily If left untreated lead to high incidence of long term functional disability.
Post on 16-Dec-2015
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General pointsGeneral points
• Can be missed easily
• If left untreated lead to high incidence of long term functional disability and chronic pain.
• Perilunate dislocations more common than lunate dislocations
Mechanism of injuryMechanism of injury
• Hyperdorsiflexion of wrist• Hyperextension of wrist• Usually due to high-energy trauma to
the wrist e.g.- Fall on outstretched hand- Motor vehicle and motorcycle accidents
DiagnosisDiagnosis• Clinical history• Index of suspicion• Examination of hand• X-Ray + other views if indicated
- closed fist ulnar/radial stress view
- Scaphoid view- Supination oblique view- Carpal tunnel view
ManagementManagement
• ABC
• Splint immobilization or backslab
• Analgesia
• Elevation
• IV antibiotics if open fracture
• Refer to hand surgeon
- Closed reduction or ORIF
StagesStages
• 4 stages
• Originally described by Mayfield.
• Each stage represent a sequential intercarpal injury.
• Can be associated with specific bony fractures including the radial styloid, scaphoid, capitate and triquetrum.
Stage 1Stage 1 – Scapholunate dissociation
Widening of scapholunate joint > 2mm on PA viewTerry Thomas sign
Stage II Stage II - Capitate - Capitate dislocationdislocation
• Dislocation or subluxation of capitate
• Best seen on lateral view
• Lunate remains in normal position in relation to distal radius, capitate is dislocated. ( usually dorsally )
• Scaphoid fracture or subluxation can also occur.
Stage III Stage III – Triquetrum – Triquetrum dislocationdislocation
• Perilunate dislocation
• Triquetral and scaphoid malrotation
• Lunate remains normal position, other carpal bones dislocated posteriorly
• May be associated with triquetrial fracture
Stage IVStage IV - Lunate - Lunate dislocationdislocation
• Most severe of carpal instabilities• Most commonly associated with trans
scaphoid fracture• Produces volar dislocation and forward
rotation of lunate. Capitate drops into place vacated by lunate
• Lunate appears triangular in shape on frontal view ( piece of pie sign )
• Spilled tea cup sign
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