Transdis

2. LUNATE
AP and lateral radiograph of a transscaphoid perilunate dislocation.

3. The lunate is facing directly volar and is located in the carpal canal.

4. LUNATE CAPITATE
After attempt at closed reduction in the emergency room, the
patient’s lunate was repositioned against the distal radius,
however the midcarpus is still dislocated as the capitate remains
dorsal to the capitate fossa of the lunate.

5. LUNATE CAPITATE
The patient’s neurologic status was intact, with normal peripheral
nerve sensation, including 2 point discrimination.

6. EPL
LISTER’S
TUBERCLE
INCISION
Dorsal view of the wrist showing the extensor pollicus longus
(EPL) tendon. The EPL tendon passes ulnarward of Lister’s
tubercle before angling toward the thumb. The incision is based
as seen (between the third and fourth dorsal compartment).

7. EXTENSOR RETINACULUM
The incision is brought down through the soft tissue
and the extensor retinaculum is identified.

8. EPL
2nd DORSAL
COMPARTMENT
After the release of the extensor retinaculum between the
third and fourth dorsal compartments, the extensor pollicus
longus and second dorsal compartment tendons are
visualized.

9. The EPL and second compartment are retracted radially,
while the common extensor tendons are retracted laterally,
exposed the wrist capsule.

10. LUNATE CAPITATE
EPL
SCAPHOID
(PROXIMAL FRAGMENT)
SCAPHOID
(DISTAL FRAGMENT)
After the capsule is incised, the carpal bones are visualized.
The lunate is visualized adjacent to the distal radius. The capitate
is seen dorsally dislocated from the lunate.

11. SCAPHOID
(PROXIMAL FRAGMENT)
SCAPHOID
(DISTAL FRAGMENT)
Using a Freer elevator, luno-capitate joint is reduced.

12. LUNATE CAPITATE
SCAPHOID
SCAPHOID
FRACTURE
The capitate is now within the confines of the lunate. The lunate
and proximal scaphoid are in their normal relationship as this
interval is not interrupted. The scaphoid fracture is visualized
adjacent to the capitate.

13. CAPITATE
As visualized from distally, looking down at the articular surface
of the scaphoid that articulates with the capitate, the reduction
is achieved.

14. SCAPHOID
(REDUCED)
CAPITATE
As visualized from distally, looking down at the articular surface
of the scaphoid that articulates with the capitate, the reduction
is achieved.

15. After reduction of the scaphoid and radiographic confirmation,
K-wires are placed at the radial and ulnar border of the scaphoid,
allowing a central screw to be positioned between the two K-wires.

16. These K-wires are necessary, as without two points of K-wire
stabilization the fragments will rotate on one another during
screw placement

17. A P and lateral radiographs of the scaphoid reduction,
with K-wires and cannulated screw guidewire.

18. After appropriate drilling and tapping, the cannulated screw
is placed into the scaphoid, maintaining the reduction.

19. The screw is seated below the articulate surface of
the scaphoid.

20. TRIQUETRUM
SCAPHOID
DISTAL RADIUS
CAPITATE
PROXIMAL
DISTAL
Next, the lunotriquetral interval is explored and cleaned. Notice that the
scaphoid to capitate relationship is normal. By holding the triquetrum away
from the lunate, a pin can be placed retrograde through the center of the
triquetral articular surface that will articulate with the lunate once it is reduced.

21. VIEW IS FROM ULNAR SIDE OF HAND
A K-wire is driven through the center of the articular
surface of the triquetrum.

22. VIEW IS FROM ULNAR SIDE OF HAND
The K-wire is then driven through skin and withdrawn such
that it lies completely within the triquetrum.

23. LUNATE TRIQUETRUM CAPITATE
SCAPHOID
After reduction of the triquetrum to the lunate under direction vision,
the previously placed K-wire is then driven back across the lunate,
holding stability.

24. LUNATE TRIQUETRUM CAPITATE
SCAPHOID
A second K-wire should be placed so that there are two
fixation points across the triquetrum to the lunate.

25. The closure includes the capsule as well as the extensor
retinaculum. The patient is then placed into a short-arm
thumb-spiked cast.

26. AP and lateral radiographs demonstrating the reduction of the
transscaphoid perilunate fracture dislocation.