- Annakan V Navaratnam, foundation year 2 doctor,
- Simon Ball, hand surgery fellow,
- Claire Emerson, emergency medicine consultant,
- Rupert Eckersley, consultant hand surgeon
- 1Chelsea and Westminster Hospital, London SW10 9NH, UK
- Correspondence to: A V Navaratnam
- Accepted 8 October 2012
A 30 year old, right hand dominant mechanic presented to the emergency department with a swollen, painful right wrist after he fell on to an outstretched right hand from a motorcycle travelling at high speed. Radiographs were interpreted as normal and the patient was discharged with a diagnosis of a wrist sprain. The next morning he presented again to the same emergency department with a new symptom: numbness of the right thumb and index, middle, and ring fingers. The radiographs were reviewed and a perilunate dislocation with median nerve compression was diagnosed. That afternoon the patient had median nerve decompression and open reduction and stabilisation of the perilunate dislocation with ligament repair.
What are perilunate and lunate dislocations?
Perilunate dislocations usually result from high energy hyperextension injuries to the wrist. In perilunate dislocations, the capitate and other carpal bones are displaced dorsal to the lunate, which remains located in the lunate fossa of the distal radius (fig 1⇓). Lunate dislocation is the final stage in the continuum of perilunate dislocation and refers to the volar displacement of lunate from the lunate fossa of the distal radius.1
How common is perilunate dislocation?
Perilunate dislocation is a rare presentation
Associated with scaphoid fractures in 61% of cases1
Why is perilunate dislocation missed?
A case series on the management of neglected perilunate dislocation described 10 cases managed in a single …