Perilunate and lunate dislocations: Difference between revisions
Russellm77 (talk | contribs) No edit summary |
Russellm77 (talk | contribs) |
||
| Line 1: | Line 1: | ||
== Background == | |||
• Perilunate Dislocation<br> | • Perilunate Dislocation<br> | ||
| Line 13: | Line 13: | ||
· Volar dislocation of the lunate in relation to the radius, spilled teacup<br> | · Volar dislocation of the lunate in relation to the radius, spilled teacup<br> | ||
== Clinical Features == | |||
• FOOSH injury with excessive hyperextension, ulnar deviation, and intercarpal supination | • FOOSH injury with excessive hyperextension, ulnar deviation, and intercarpal supination | ||
| Line 27: | Line 29: | ||
• Degenerative arthritis is very common, 60% incidence | • Degenerative arthritis is very common, 60% incidence | ||
== Workup == | |||
• X-ray, wrist series, minimum of three views<br> | • X-ray, wrist series, minimum of three views<br> | ||
| Line 43: | Line 47: | ||
· PA view, lunate is triangular in shape | · PA view, lunate is triangular in shape | ||
== Differential Diagnosis == | |||
• Fractures of the distal radius | • Fractures of the distal radius | ||
| Line 55: | Line 61: | ||
• Septic arthritis | • Septic arthritis | ||
== Treatment == | |||
• Immediate orthopedic consult for closed vs open reduction | • Immediate orthopedic consult for closed vs open reduction | ||
| Line 72: | Line 80: | ||
[[Image:Lun 1.jpg|thumb|left|201x299px|Lun 1.jpg]] | [[Image:Lun 1.jpg|thumb|left|201x299px|Lun 1.jpg]] | ||
[[Category:Ortho]] | |||
Revision as of 15:35, 11 September 2011
Background
• Perilunate Dislocation
· Dorsal displacement of capitate in relation to lunate
· Note that the radius, capitate, lunate, and third metacarpal form a straight line on lateral x-ray
• Lunate Dislocation
· 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
Differential Diagnosis
• 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
· The longer the dislocation is left unreduced, the lower the likelihood of reduction
• In ED, volar splint in neutral Sources • Emergency Orthopedics, The Extremeties • Radiopaedia.org
