Perilunate dislocation

Case contributed by Dr Sakher Alkhaderi

Diagnosis certain

Presentation

Pain and swelling following a fall on a dorsiflexed wrist

Patient Data

Age: 35 years

Gender: Male

From the case: Perilunate dislocation

X-ray

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Lateral

The radiograph demonstrates trans-scaphoid fracture and carpus dislocation relative to the lunate .

From the case: Perilunate dislocation

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sagittal 3D reconstruction images

There is evidence of fracture of the lateral aspect of distal radius and trans-scaphoid fracture with multiple bone fragments seen in the dorsal aspect of the intercarpal joint , the carpus is dislocated dorsally relative to the lunate which remains normal alignment with the radius ( slight widening of the radiolunate joint is noted ) , appearances are consistent with tran-scaphoid perilunate dislocation

Case Discussion

Perilunate dislocation are potentially devastating high energy closed wrist injuries and are often missed on initial imaging , these injuries involve dislocation of the carpus relative to the lunate which remains in normal alignment with the distal radius , around 60% are associated with trans-scaphoid fracture .