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Perilunate Dislocation
From WikiSM
Contents
Other Names
- Perilunate Fracture Dislocation
- PLD
Background
- Involve dislocation of other carpal bones relative to the Lunate, which remains in alignment with the distal radius
- Involves injuries to Scapholunate Ligament, Lunotriquetral Ligament, Capitolunate Ligament
- Not to be confused with Lunate dislocation
- Frequently missed on initial imaging
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
- Fractures
- Dislocations
- Instability & Degenerative
- Tendinopathies & Ligaments
- Neuropathies
- Pediatric Considerations
- Distal Radial Epiphysitis (Gymnast's Wrist)
- Torus Fracture
- Arthropathies
- Cartilage
- Vascular
- Other
Clinical Features
- General: Physical Exam Wrist
- Pain, swelling at wrist
- Tenderness
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
- Medial Nerve Injury
- Chronic carpal instability
- Degenerative arthritis
- Radiocarpal Arthritis
- Avascular Necrosis
- Scapholunate Instability
- Lunotriquetral Instability
See Also
- Internal
- External
- Sports Medicine Review Wrist Pain: https://www.sportsmedreview.com/by-joint/wrist/
References
- ↑ 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
- ↑ 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
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Last edited:
13 October 2022 21:48:12
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