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
CT

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

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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