In order to complete the full description of these injuries, apart from the acute form of perilunate dislocations and fracturedislocations, the scaphocapitate syndrome, the palmar perilunate dislocations and the delayed or chronic form of these injuries, are also studied and described in. The scaphoid fractures united well, with proper alignment of the carpal bones, regardless of the length of cast immobilization. Volar transscaphoid perilunate dislocation of the wrist. In addition, a combined approach was found effective in the management of dorsal perilunate dislocations. Perilunate dislocation with a transscaphoid fracture is commonly associated with highimpact falls with the wrist hyperextended with a degree of ulnar deviation. They can be pure perilunate dislocations plds or perilunate fracture dislocations plfds associated with carpal fractures around the lunate. Perilunate dislocation new york, ny handsport surgery. Incidence of scaphoid fractures estimated to be 15%. When describing an injury the prefix, trans, is used when describing a fracture. Spectrum of carpal dislocations and fracturedislocations. A scaphoid fracture is occasionally associated with this injury, which is then referred to as a transscaphoid perilunate dislocation. Your digital gateway to expertise, education, and innovation. Arthroscopic treatment of perilunate dislocations and fracture. Click download or read online button to get ao manual of fracture management hand wrist book now.
These findings suggest that perilunate fracturedislocations are too unstable to be treated with closed reduction. Perilunate fracturedislocations usually combine ligament. Purpose the purpose of this study was to evaluate the outcomes of perilunate dislocations and fracture dislocations treated with arthroscopically assisted miniinvasive reduction and fixation methods between june 2012 and may 2014, 24 patients who had a dorsal perilunate dislocation or fracture dislocation were treated with arthroscopically assisted reduction and percutaneous fixation. The mechanism of injury is either a dorsal force to a volarflexed wrist or a forceful extension of the wrist, as in our case. Treatment of dorsal perilunate dislocations and fracture. Immediate management of these injuries with 17 panagopoulos a.
Perilunate dislocation and transscaphoid fracturedislocation is among unusual orthopedic traumatic injuries mainly seen in youths due to high energy trauma 14. Although the main indication for arif of a distal radius fracture is an intraarticular stepoff of more than 1 mm, arthroscopy is particularly useful in the management of unstable or displaced intraarticular fractures as well as comminuted articular. Most patients present acutely after a fall from a height onto a dorsiflexed wrist. There are many variations of injury that include combinations of fractures and dislocations.
The perilunate injury should also be classified according to the time from injury, as acute, delayed, or chronic. Pdf lunate and perilunate dislocations are potentially devastating injuries that are often unrecognized at initial evaluation. Neglected transscaphoid perilunate dislocation a case. These injuries are missed clinically and radiographically in up to 25% of cases. Acute and delayed transradial perilunate dislocations. This site is like a library, use search box in the widget to get ebook that you want. While not common, lunate fractures and perilunate injuries have important potential consequences. Fractures associated with perilunate dislocations may require small compression screws or percutaneous pins. Describe the various surgical approaches for managing perilunate fracture dislocations.
We recommend open reduction, internal scaphoid fixation using a herbert screw, carpal ligament repair and early cast removal in the management of transscaphoid perilunate dislocations. Seminar on scaphoid and lunate fractures moderator. We believe that open reduction through a dorsal approach, direct repair of the scapholunate ligaments, and kwire fixation of the carpus is a reliable method for obtaining satisfactory clinical and radiographic results in the management of acute perilunate dislocations without fracture of the scaphoid. Anatomy the wrist is composed of two rows of bones that provide motion and transfer forces. Carpal dislocations can lead to chronic pain and wrist instability. Transscaphoid translunotriquetral perilunate dislocation. Acute perilunate dislocations and fracturedislocations. Original article acute and delayed transradial perilunate. A total of 45 patients 46 wrist injuries with perilunate dislocations and fracture dislocations were prospectively evaluated. Delayed avascular necrosis and fragmentation of the lunate. Perilunate dislocations represent approximately 10% of all wrist injuries and are diagnosed late in up to 25% of cases.
Open treatment of a perilunate dislocation is coded 25670 open treatment of radiocarpal or intercarpal dislocation, one or more bones. Perilunate injuries most commonly occur in high energy trauma situations. Volar transscaphoid perilunate dislocations are extremely rare injuries. Perilunate dislocation in an asymptomatic snac wrist. A case series on the management of neglected perilunate dislocation described 10 cases managed in a single centre that were missed on initial presentation. A total of 45 patients 46 wrist injuries with perilunate dislocations and fracturedislocations were prospectively evaluated. Perilunate dislocations see the image below and perilunate fracture dislocations are the most devastating closed injuries of the wrist. They are most often sustained from a fall onto an extended wrist or some other wrist hyperextension injury. For instance when a fracture passes through the scaphoid and there is a perilunate dislocation one would say, transscaphoid perilunate dislocation. Perilunate injuries and dislocations etiology, diagnosis, and management. Index terms neglected dislocation, perilunate dislocation, wrist injury, scaphoid fracture. Leeosterman md, in fractures and injuries of the distal radius and carpus, 2009. Key words perilunate dislocation, fracture dislocation, wrist, trauma. Despite the risk for damage to the vascular supply of the lunate during a perilunate dislocation, these injuries are not believed to be risk factors for avascular necrosis avn or delayed.
Case report 35 year old male sustained injury to the left wrist following. Pdf evaluation, management, and outcomes of lunate and. Evaluation, management, and outcomes of lunate and. Arthroscopically assisted miniinvasive management of. Surgical management approach of perilunate dislocation dorsal approaches are typically performed through longitudinal incisions, centering on to the lister tubercle. Home january 1987 volume 214 issue difficult wrist fractures perilunate fracturedislocations o. Perilunate fracture dislocations usually combine ligament. These dislocations can be classified into three phases.
Perilunate fracture dislocations clinical presentation. Perilunate dislocations and plfds typically result from a fall on an outstretched hand in which an axial force is directed on the carpus with the wrist in hyperextension dorsiflexion, ulnar. Prompt recognition and surgical treatment with anatomic reduction of carpal malalignment improve the likelihood of optimal, longterm clinical success and patient satisfaction. Perilunate injuries and dislocations etiology, diagnosis. In treating a fracture, the objectives of the treatment are as follows. Research article open access management of acute trans.
Perilunate dislocations, perilunate fracture dislocations plfds, and lunate dislocations are highenergy wrist injuries that can and should be recognized on radiographs. The majority of the patients had satisfactory results at 24 months of followup. If surgical management of the perilunate dislocation or fracture dislocation is delayed, closed management of the radiocarpal and midcarpal joints must proceed on an emergency basis. Transscaphoid perilunate dislocation radiology case. Scaphoid fractures often accompany perilunate dislocation.
The most common carpal dislocations are the lunate, the lunate with a scaphoid fracture, and perilunate dislocation. Scaphoid fracture introduction anatomy biomechanics mechanism of injury. The acute phase is defined as within the first week after injury, the delayed phase is the period between the seventh and the 45th day, and after 45 days the injury is considered to be in the chronic. In the vast majority of cases, the carpus dislocates in a dorsal direction. One patient with a scaphoid nonunion required surgical repair with bone grafting. Transcaphoid perilunate luxation c2231 gilberto consoli hand lunate dislocation perilunate.
Patients with perilunate dislocations and perilunate fracture dislocations may demonstrate obvious clinical deformities, such as marked swelling, or they can present rather innocuously, complaining of a sprained wrist. Perilunate dislocations and fracture dislocations are highenergy injuries that can result in pain, stiffness, weakness, or disability if inappropriately treated. Treatment of transscaphoid perilunate dislocations using a volar. Typical appearances of a transscaphoid perilunate dislocation. Perilunate dislocations and fracture dislocations are most often a result of highenergy trauma, exerting an axial load with hyperextension and ulnar deviation of the wrist, along with intercarpal. Perilunate dislocations, perilunate fracturedislocations plfds, and lunate dislocations are highenergy wrist injuries that can and should be recognized on radiographs. Volar perilunate and dorsal lunate dislocations are uncommon. Management of transscaphoid perilunate dislocations. The results of this study suggest that a minimally invasive technique for treating acute transscaphoid perilunate fracturedislocations can be considered as an alternative to open approaches.
Perilunate dislocations and perilunate fracturedislocations plfds typically result from highenergy injuries. Difficult wrist fractures perilunate fracturedislocations. Transscaphoid perilunate dislocation a tale of two. Radiographs suggested a scaphoid fracture with perilunate dislocation. Familiarity with the complex bony and ligamentous anatomy is required to fully understand these complex injury patterns. Fracture of the scaphoid with dorsal dislocation of the carpus relative to the lunate. Lunate dislocation perilunate dissociation 942015 612. Two patients had radiographic evidence of midcarpal arthritis. Ao manual of fracture management hand wrist download. The size of the midcarpal ligament tear, the location of the scapholunate ligament tear, and the presence of osteochondral fragments and of the dorsal radiocarpal ligament avulsions were recorded at injury.
Ankle fracture is one of the most common lower limb fractures for they account for 9% of all frac. For example, the term transscaphoid transtriquetral dorsal perilunate dislocation. Furthermore, fusions do not transmit stresses well and have a predisposition to fracture. The average final scapholunate angle was 55 and the scapholunate gap was 2. They often are missed on initial evaluation, leading to devastating complications. Correct diagnosis and treat ment of these injuries is imperative to restore functional wrist motion and minimize wrist pain. Do you want to use the redesigned ao sr like an app. Finally, open reduction presupposes reparation of the torn scapholunate ligament, to obtain normal carpal kinematics. Perilunate dislocations and fracture dislocations hand clinics. Perilunate dislocations and fracture dislocations journal of hand. Perilunate dislocations of the wrist have a common pathway of disruption that occurs from extensive. Chronic transscaphoid perilunate fracture dislocation. Perilunate dislocation and perilunate fracturedislocation.
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