A 67-year-old female presented with severe pain and inability to move her right wrist after falling forward onto her outstretched hand. Examination revealed profound swelling of the right wrist with tenderness over the wrist and metacarpals and limited range of motion. Imaging showed a posterior dislocation of the capitate and distal carpal row with the lunate in a normal position. Treatment involved pain management, closed reduction of the carpal dislocation with traction and dorsal pressure, and consultation with orthopedics due to the high likelihood of associated carpal fractures requiring open repair.

2.  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

4. Posterior dislocation of capitate and distal carpal row with lunate in nl
position

5.  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

6.  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

8.  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