Presentation
Pain and swelling following a fall on a dorsiflexed wrist.
Patient Data
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The radiograph demonstrates trans-scaphoid fracture and carpus dislocation relative to the lunate.
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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 trans-scaphoid perilunate dislocation.
Case Discussion
Perilunate dislocations 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, and around 60% are associated with trans-scaphoid fracture.
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