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Perilunate dislocation
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Perilunate dislocation

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  • 1.  67 yo F presents after  T 98.4 P 87 BP 156/88 O2 losing control of her walker 97% and falling forward onto  Gen: age approp female in her outstretched, extended obv pain but NAD right hand. Pt complains of  MSK: profound swelling of 10/10 pain in the wrist and inability to move her wrist. right wrist, no Denies any other injuries laceration, 2+ distal pulses. TTP over right wrist and prox right metacarpals.  Neuro- limited flexion/extension of right wrist, otherwise 5/5 strength, nl sensation
  • 2. Posterior dislocation of capitate and distal carpal row with lunate in nlposition
  • 3.  Pain Management Reduction of carpal dislocation with longitudinal traction and dorsal pressure Ortho consultation needed as often associated carpal fx present and significant ligamentous injury requiring open repair
  • 4.  Often missed due to inadequate radiographs Important to get good lateral view to see dislocation High frequency of associated carpal fractures, usually scaphoid or radial styloid Must be cautious of median nerve palsy; can have an acute carpal tunnel syndrome Immediate ortho consultation preferred
  • 5.  http://www.wheelessonline.com/ortho/perilunate_dislocat ion http://radiopaedia.org/articles/perilunate-dislocation http://www.eorif.com/WristHand/perilunatedislocation.ht ml http://www.ispub.com/journal/the_internet_journal_of_or thopedic_surgery/volume_8_number_1_8/article/concomi tant_elbow_and_perilunate_dislocation_floating_forearm. html http://www.feinberg.northwestern.edu/emergencymed/res idency/ortho- teaching/wrist/case67/case67background.html

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