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Case Reports
. 2017 Aug;11(8):RD06-RD08.
doi: 10.7860/JCDR/2017/29750.10509. Epub 2017 Aug 1.

Perilunate Dislocation - Case Report and Review of Literature

Karthik Subramanian  1 , Bakul Arora  2 , Abhinav Bhatnagar  3 , Imran Jan  4
Affiliations
Case Reports

Perilunate Dislocation - Case Report and Review of Literature

Karthik Subramanian et al. J Clin Diagn Res. 2017 Aug.

Abstract

Perilunate dislocations are rare injuries comprising of less than 10% of all wrist injuries. These usually occur after high-energy trauma to the wrist. One-fourth (25%) of perilunate dislocations are missed at the initial presentation. We report a case of perilunate dislocation in a patient who presented late, about two months after trauma. He underwent open reduction through a single dorsal approach and internal fixation with K-wires. Aggressive physiotherapy exercises were started after removal of K-wires. He regained near normal full range of motions at the wrist by the end of four months and showed no recurrence of the dislocation. In conclusion, perilunate dislocations should be considered as one of the important differential diagnosis in patients with history of high-energy trauma to the wrist. Early diagnosis and treatment is necessary to prevent the potential risk of avascular necrosis of lunate and scaphoid and secondary osteoarthritis. The best results can be obtained with open reduction and internal fixation with K-wires via a single dorsal approach.

Keywords: Avascular necrosis; Carpal injuries; Dorsal approach; Wrist injuries.

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Figures

[Table/Fig-1]:
[Table/Fig-1]:
Radiograph of the right wrist (anteroposterior and lateral views) showed increased scapholunate interval in the anteroposterior view and characteristic-spilled teapot sign in the lateral view. Proximal row (from left to right): S – scaphoid, L – lunate, T – triquetrum, P – pisiform. Distal row (from left to right): T – trapezium, T – trapezoid, C – capitate, H – hamate.
[Table/Fig-2]:
[Table/Fig-2]:
CT scan with 3D reconstruction films showed loss of congruity of the articular surfaces and confirmed the diagnosis of dorsal perilunate dislocation.
[Table/Fig-3]:
[Table/Fig-3]:
Immediate radiograph of the right wrist joint showed reduction and fixation of the dislocation with the three k-wires in situ.
[Table/Fig-4]:
[Table/Fig-4]:
Nine months follow up radiograph of the right wrist joint showed satisfactory alignment of the carpal bones and no recurrence of the dislocation.
See this image and copyright information in PMC

References

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