Perilunate dislocation Power Point

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Perilunate dislocation Power Point

  1. 1.  67 yo F presents after losing control of her walker and falling forward onto her outstretched, extended right hand. Pt complains of 10/10 pain in the wrist and inability to move her wrist. Denies any other injuries  T 98.4 P 87 BP 156/88 O2 97%  Gen: age approp female in obv pain but NAD  MSK: profound swelling of right wrist, no 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. 2. Posterior dislocation of capitate and distal carpal row with lunate in nl position
  3. 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. 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. 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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