Jump to content
We need you! See something you could improve? Make an edit and help improve WikSM for everyone.

Perilunate Dislocation

From WikiSM
(Redirected from Perilunate dislocations)

Other Names

  • Perilunate Fracture Dislocation
  • Perilunate Dislocation (PLD)
  • Trans-scaphoid perilunate dislocation

Background

History

  • First published in the literature in 1976 by Marowa[1]

Epidemiology

  • Relatively rare with epidemiology not well discussed in the literature
  • Incidence is higher in males, average age is 35[2]
  • In general, carpal dislocations represent less than 10% of all wrist injuries

Introduction

Illustration of perilunate vs lunate dislocation

General

  • Perilunate associated with major trauma, typically in young adults
  • Relatively rare and not well discribed
  • Diagnosis is often delayed and missed on initial imaging
  • Universally considered a surgical problem precipitated by closed reduction if possible
  • Patients tend to have chronic pain and arthritis despite optimal treatment

Definition

  • Involve dislocation of other carpal bones relative to the Lunate, which remains in alignment with the distal radius

Mechanism of injury

  • Most commonly hypertextended wrist with or without forearm in supination[3]
  • Can also occur as a result of high energy trauma with wrist in extension, ulnar deviation

Pathoanatomy

Associated Injuries

Risk Factors

  • Male gender

Differential Diagnosis

Differential Diagnosis Wrist Pain

Clinical Features

History

  • Patient can typically describe a mechanism of injury
  • Reports pain, swelling, tenderness
  • Decrease function

Physical Exam: Physical Exam Wrist

  • Pain, swelling at wrist
  • Tenderness

Special Tests

  • Not applicable

Evaluation

Radiographs of perilunate dislocation[4]
Sagittal CT showing dorsal dislocation of the capitate from the lunate. Note, radiolunate space is widened but remains aligned[5]

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
    • Signet Ring Sign: rounded appearance of the scaphoid tubercle due to rotatory subluxation from injury to the scapholunate ligament
  • Lateral view
    • Easier to see
    • Capitate is not sitting in the cup of the lunate
    • Radio-lunate-capitate line is disrupted
    • Lunate remains in articulation with the distal radius
    • Abnormal Scapholunate Angle
    • Abnormal Capitolunate angle

CT

  • Evaluate for occult fractures
  • Better evaluation of osseous lesions

MRI

  • Indicated to evaluate associated soft tissue lesions

Ultrasound

  • Undefined role in diagnosing perilunate dislocation
  • Skilled sonographer should be able to identify this lesion

Classification

Types

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

Management

Illustration of closed reduction of the perilunate dislocation.[6]

Nonoperative

  • Generally requires surgical management
  • Closed reduction should be performed pending time to ORIF

Operative

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

Rehabilitation and Return to Play

Rehabilitation

  • Needs to be updated

Return to Play

  • Needs to be cleared by surgeon but minimum 6 weeks

Prognosis and Complications

Prognosis

  • Early diagnosis is important as delay in treatment adversely affects functional outcomes[7]
  • Despite optimal surgical treatment among 32 patients, 80% developed signs and symptoms of osteoarthirtis[8]

Complications

See Also

Internal

External

References

  1. ↑ MORAWA, LAWRENCE G., PAUL M. Ross, and CHARLES C. SCHOCK. "Fractures and dislocations involving the navicular-lunate axis." Clinical Orthopaedics and Related Research® 118 (1976): 48-53.
  2. ↑ Kara, Adnan, et al. "Surgical treatment of dorsal perilunate fracture-dislocations and prognostic factors." International Journal of Surgery 24 (2015): 57-63.
  3. ↑ 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
  4. ↑ Image courtesy of svuradiology.ie
  5. ↑ Case courtesy of Andrew Dixon, Radiopaedia.org, rID: 9893
  6. ↑ Image courtesy of surgeryreference.aofoundation.org
  7. ↑ 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.
  8. ↑ Garçon, Charline, et al. "Perilunate dislocation and fracture dislocation of the wrist: Outcomes and long-term prognostic factors." Orthopaedics & Traumatology: Surgery & Research 108.5 (2022): 103332.
  9. ↑ Israel, D., et al. "Peri-lunate dislocation and fracture-dislocation of the wrist: Retrospective evaluation of 65 cases." Orthopaedics & Traumatology: Surgery & Research 102.3 (2016): 351-355.
Created by:
John Kiel on 18 June 2019 23:03:12
Authors:
Last edited:
3 May 2025 17:48:35
Categories:
Retrieved from "https://wikism.org/w/index.php?title=Perilunate_Dislocation&oldid=32640"