Perilunate and lunate dislocations: Difference between revisions
Russellm77 (talk | contribs) |
No edit summary |
||
| Line 1: | Line 1: | ||
== Background == | == Background == | ||
*Perilunate Dislocation | |||
**Dorsal displacement of capitate in relation to lunate | |||
**Note that radius, capitate, lunate, and 3rd metacarpal form straight line on lat x-ray | |||
*Lunate Dislocation | |||
**Volar dislocation of the lunate in relation to the radius, spilled teacup<br> | |||
== Clinical Features == | == Clinical Features == | ||
*FOOSH injury with excessive hyperextension, ulnar deviation, and intercarpal supination | |||
*On exam, decreased range of motion with focal swelling | |||
*Dorsal swelling with mass in perilunate dislocation | |||
*Volar swelling with palpable mass in lunate dislocation | |||
*Median nerve compression possible, perform thorough neurovascular exam | |||
*Scaphoid fractures and scaphoid rotary subluxation are common | |||
*Degenerative arthritis is very common, 60% incidence | |||
== Workup == | == Workup == | ||
*X-ray: wrist series, minimum of three views | |||
*Perilunate dislocation | |||
**Lateral view, dorsal dislocation of capitate when an imaginary line is drawn through radius, luante, and capitate | |||
**PA view, capitate and lunate overlap | |||
*Lunate dislocation | |||
**Lateral view, lunate displaced and tilted volarly | |||
**PA view, lunate is triangular in shape | |||
==DDX == | |||
#Fractures of the distal radius | |||
#Fractures of the carpal bones, the scaphoid being the most common | |||
#Scapholunate dissociation | |||
#Ligamentous injury | |||
#Septic arthritis | |||
== | |||
== Treatment == | == Treatment == | ||
#Immediate orthopedic consult for closed vs open reduction | |||
##Longer the dislocation is left unreduced, the lower the likelihood of reduction | |||
#In ED, volar splint in neutral position | |||
== Source == | |||
*Emergency Orthopedics, The Extremeties | |||
*Radiopaedia.org | |||
== | |||
Revision as of 00:47, 15 September 2011
Background
- Perilunate Dislocation
- Dorsal displacement of capitate in relation to lunate
- Note that radius, capitate, lunate, and 3rd metacarpal form straight line on lat x-ray
- Lunate Dislocation
- Volar dislocation of the lunate in relation to the radius, spilled teacup
- Volar dislocation of the lunate in relation to the radius, spilled teacup
Clinical Features
- FOOSH injury with excessive hyperextension, ulnar deviation, and intercarpal supination
- On exam, decreased range of motion with focal swelling
- Dorsal swelling with mass in perilunate dislocation
- Volar swelling with palpable mass in lunate dislocation
- Median nerve compression possible, perform thorough neurovascular exam
- Scaphoid fractures and scaphoid rotary subluxation are common
- Degenerative arthritis is very common, 60% incidence
Workup
- X-ray: wrist series, minimum of three views
- Perilunate dislocation
- Lateral view, dorsal dislocation of capitate when an imaginary line is drawn through radius, luante, and capitate
- PA view, capitate and lunate overlap
- Lunate dislocation
- Lateral view, lunate displaced and tilted volarly
- PA view, lunate is triangular in shape
DDX
- Fractures of the distal radius
- Fractures of the carpal bones, the scaphoid being the most common
- Scapholunate dissociation
- Ligamentous injury
- Septic arthritis
Treatment
- Immediate orthopedic consult for closed vs open reduction
- Longer the dislocation is left unreduced, the lower the likelihood of reduction
- In ED, volar splint in neutral position
Source
- Emergency Orthopedics, The Extremeties
- Radiopaedia.org
File:PL 1.jpg
Perilunate lateral
File:PL 2.jpg
Perilunate AP
File:Lun 1.jpg
Lunate