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Perilunate injuries and lunate dislocations [Autosaved].pptx
- 1. Perilunate injuries and lunate dislocations BY; AHMAD DASHT BOZORG MD AHVAZ JOUNDISHAPUR UNIVERSITY OF MEDICAL SCAIENCES
- 2. 5–7 % of all wrist injuries high energy trauma most frequently involved is young male individuals, in the second or third decade of life
- 3. These injuries prone to being missed on initial presentation which can occur in up to 25% of cases
- 4. Misdiagnosis can be attributed to the: 1. Severity of associated injuries 2. Inadequate radiographs 3. Inexperienced doctors 4. Underestimation because of spontaneous reduction
- 5. Plain radiographs are the key to diagnosis An inadequate x-ray evaluation is a common cause of missed diagnosis
- 7. Lateral radiological outline of the radius, lunate, and the head of the capitate, which should be in almost coaxial alignment
- 8. Nomenclature the lateral view is the most important in diagnosing a perilunate injury
- 12. Disruption Mechanisms of the Wrist Graham supported that carpal instability is best considered either as 1. compressive 2. transverse
- 13. Classification The classification of lunate and perilunate injuries is a difficult task A classification no matter how comprehensive and detailed it is, there will always be unclassified cases since the spectrum of these injuries is unlimited
- 14. Classification In terms of instability since the derangement, is both within and between carpal rows, these injuries are considered as carpal instabilities complex (CIC), which is a combination of dissociative (CID) and non-dissociative (CIND) instabilities
- 15. Disruption Started from the Radial Side of the Wrist Application of force at the thenar area produces a three- dimensional mechanism of injury: hyperextension, midcarpal supination, and ulnar deviation
- 16. Mayfield et al. (1980)
- 17. It does not include 1. Transscaphoid variants 2. Ulnar-sided injuries 3. Volar dislocations of the capitate
- 18. Perilunate fracture-dislocations are twice as frequent as the pure ligamentous perilunate dislocations
- 19. Johnson , introduced the concept of greater and lesser arc injuries later in 1980
- 20. ‘‘vulnerable zone ’’ Johnson supported that most of the carpal fractures and dislocations, are confined to a ‘‘vulnerable zone ’’
- 21. Most common are osseoligamentous injuries, with one or two bones fractured around the lunate, which only constitutes a partial greater arc injury
- 22. Graham 2003 A pattern of injury in which the intercarpal region is spared and the lesion extends from radial to ulnar and through the radiocarpal joint
- 23. Herzberg et al. (1993) volar perilunate dislocation quantify the degree of lunate displacement
- 26. concerning soft tissue injuries
- 27. concerning soft tissue injuries stage I, the capitate remains in approximately normal position stage II, it is displaced but still remains within the limits of the distal radius stage III, it is displaced outside the limits of the distal radius
- 28. Disruption Started from the Ulnar Side of the Wrist if the load is applied to the hypothenar area, an intercarpal pronation component is produced, which in combination with extension and radial deviation, ‘‘reverse perilunate instability’’
- 29. ‘‘reverse perilunate instability’’ Viegas et al. reported a separate classification system to describe ulnar-sided perilunate injury in 1990.