Trans-scaphoid peri-lunate dislocation of the carpus (and capitate fracture): CT findings
Fell off motorcycle at high speed. Now grossly deformed wrist
Plain films were very difficult to evaluate due to the deformity. CT recommended.
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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.
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.