Perilunate and lunate dislocations: Difference between revisions
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== Background== | ==Background== | ||
*Occur via high-energy FOOSH injury (fall from height, MVC) | *Occur via high-energy FOOSH injury (fall from height, MVC) | ||
**Perilunate Dislocation = Lunate stays in place, capitate is displaced | **Perilunate Dislocation = Lunate stays in place, capitate is displaced | ||
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*Must rule out carpal bone fractures | *Must rule out carpal bone fractures | ||
== Clinical Features== | ==Clinical Features== | ||
*Perilunate dislocation: dorsal swelling with palpable mass | *Perilunate dislocation: dorsal swelling with palpable mass | ||
*Lunate dislocation: volar swelling with palpable mass | *Lunate dislocation: volar swelling with palpable mass | ||
== Diagnosis== | ==Diagnosis== | ||
[[File:Perilunate Dislocation.jpg|thumb|Perilunate Dislocation]] | [[File:Perilunate Dislocation.jpg|thumb|Perilunate Dislocation]] | ||
[[File:Lunate_Dislocation.jpg|thumb|Lunate Dislocation]] | [[File:Lunate_Dislocation.jpg|thumb|Lunate Dislocation]] | ||
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{{Carpal fractures}} | {{Carpal fractures}} | ||
== Treatment== | ==Treatment== | ||
*Closed reduction and long-arm splint | *Closed reduction and long-arm splint | ||
**Likely requires emergent ortho consultation (very difficult to reduce) | **Likely requires emergent ortho consultation (very difficult to reduce) | ||
Revision as of 17:39, 8 July 2016
Background
- Occur via high-energy FOOSH injury (fall from height, MVC)
- Perilunate Dislocation = Lunate stays in place, capitate is displaced
- Lunate Dislocation = Capitate stays in place, lunate is displaced
- Must rule-out median nerve injury
- Must rule out carpal bone fractures
Clinical Features
- Perilunate dislocation: dorsal swelling with palpable mass
- Lunate dislocation: volar swelling with palpable mass
Diagnosis
Perilunate Dislocation
- Lateral view
- Capitate displaced dorsal to lunate
- Lunate retains its normal contact w/ radius
- PA view
- Capitolunate joint space is obliterated as the bones overlap one another
Lunate Dislocation
- Lateral view
- Lunate is pushed off the radius into the palm ("spilled teacup" sign)
- PA view
- Lunate has triangular shape ("piece-of-pie sign")
Differential Diagnosis
Carpal Dislocations
Carpal fractures
- Scaphoid fracture
- Lunate fracture
- Triquetrum fracture
- Pisiform fracture
- Trapezium fracture
- Trapezoid fracture
- Capitate fracture
- Hamate fracture
Treatment
- Closed reduction and long-arm splint
- Likely requires emergent ortho consultation (very difficult to reduce)
See Also
References
- Emergency Orthopedics, The Extremeties
- Radiopaedia.org