Practice Easily Missed?

Perilunate dislocation

BMJ 2012; 345 doi: (Published 06 November 2012) Cite this as: BMJ 2012;345:e7026

Re: Perilunate dislocation

I am surprised that such a blatantly obvious velar lunate dislocation was missed. What is often missed, is the scapho-lunate disassociation by virtue of the rupture of the scapho-lunate ligament, leading to a gap, often called the Terry Thomas sign by the older generation. Careful observation of the PA & lateral films of Gilula's lines, the "3Cs" sign - ie the normal articular gaps seen between the distal radius, lunate and capitate as shown in the poor quality later radiograph of figure2, will reduce the risk of missing these injuries.
Robert's first figure on the anatomy of the carpal tunnel is more accurate. The transverse section of the wrist going through the proximal carpal row and not the distal carpal bones, would be more relevant. As most A&E radiography technicians do and interpret/report, and nurse practitioners & junior doctors are in the forefront, it is important that education should be focused on these groups, by constructive feedback.

Competing interests: No competing interests

30 December 2012
Sidha Sambandan
Orthopaedic GPwSI
Norwich Community Hospital
44Brettingham Avenue, Cringleford, NR4 6XQ