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Perilunate Dislocation

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Other Names

  • Perilunate Fracture Dislocation
  • PLD

Background


Pathophysiology

  • Most commonly hypertextended wrist with or without forearm in supination[1]
  • Can also occur as a result of high energy trauma with wrist in extension, ulnar deviation
  • Associated injuries

Risk Factors

  • Unknown

Differential Diagnosis


Clinical Features


Evaluation

Radiographs

  • Standard Radiographs Wrist
  • Lunate remains normal relationship with radius
  • Capitate most often displaced dorsally
  • AP View
    • Easily missed even by radiologist
    • Carpal alignment or Gilulas Lines needs to be carefully assessed
    • Piece of pie sign: abnormal triangular appearance of lunate
    • sometimes termed pie-in-the-sky and more classically seen with lunate dislocation
  • Lateral view: Easier to see

CT

  • Evaluate for occult fractures

Classification

  • Types
    • Transscaphoid-perilunate
    • Perilunar
    • Transscaphoid-trans-capitate-perilunar
    • Transradial-styloid

Management

  • Early diagnosis is important as delay in treatment adversely affects functional outcomes[2]

Nonoperative

  • Generally requires surgical management

Operative

  • Most cases are surgical and hand surgeon should be consulted for all management decisions

Return to Play

  • Needs to be cleared by surgeon but minimum 6 weeks

Complications


See Also


References

  1. AITKEN AP, NALEBUFF EA. Volar transnavicular perilunar dislocation of the carpus. J Bone Joint Surg Am. 1960 Sep;42-A:1051-7. PubMed PMID: 14448241
  2. Herzberg G, Comtet JJ, Linscheid RL, Amadio PC, Cooney WP, Stalder J.
    • Perilunate dislocations and fracture-dislocations: a multicenter study. J Hand Surg Am. 1993 Sep;18(5):768-79. PubMed PMID: 8228045.
Created by:
John Kiel on 18 June 2019 23:03:12
Authors:
Last edited:
13 October 2022 21:48:12
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