Trans-scaphoid peri-lunate dislocation of the carpus (and capitate fracture): CT findings

Case contributed by Dr Chris O'Donnell

Presentation

Fell off motorcycle at high speed. Now grossly deformed wrist

Patient Data

Age: 25
Gender: Male

Plain films were very difficult to evaluate due to the deformity. CT recommended.

Modality: CT

The carpus and attached fingers are dislocated posteriorly and to the radial side except for the lunate that still retains its relationship ro the radius albeit flipped anteriorly.  Scapho-lunate ligament remains intact, maintaining its relationship to the proximal pole of the scaphoid.  The distal pole has been dislocated with the remainder of the carpus.  There is a further fracture to the inferior pole of the capitate.

Case Discussion

These fractures are complex and can be difficult to interpret on x-rays due to the distortion and difficulty in obtaining orthoganol views.  CT data can be manipulated into these anatomically recognizable planes using workstation software.  These fracture-dislocations need to be reduced rapidly as there is a high risk of median nerve palsy and arterial compromise to the hand.

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Case Information

rID: 42352
Case created: 17th Jan 2016
Last edited: 17th Jan 2016
Inclusion in quiz mode: Excluded

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