Perilunate Dislocations

Michael Moustoukas

Nileshkumar M. Chaudhari

INTRODUCTION

Overview
- High-energy injury resulting in dislocation of capitate while lunate remains in lunate fossa.
  - Dorsal dislocation is most common
- Carpal instability complex
  - Derangement within proximal row and between rows
- Lesser arc injuries
  - Purely capsuloligamentous
- Greater arc injuries
  - Concomitant fractures
    - Radial styloid, scaphoid, lunate, capitate, triquetrum, or ulna
Anatomy¹
- Volar extrinsic ligaments
  - Provide primary stabilization of carpus
    - Long radiolunate ligament
    - Radioscapholunate
    - Short radiolunate
    - Ulnolunate
    - Radioscaphocapitate
    - Ulnotriquetrocapitate complex
- Intrinsic carpal ligaments
  - Scapholunate interosseous ligament (SLIL)
  - Lunotriquetral interosseous ligament
  - Dorsal intercarpal ligament
  - Triquetrum-hamate-capitate complex
  - Dorsolateral scapho-trapezio-trapezoid ligament
  - Scaphocapitate ligament
Greater arc injuries
- Transscaphoid perilunate fracture-dislocations
  - Most common perilunate injury
- Transscaphoid, transcapitate perilunate fracture-dislocations
  - Capitate fracture often missed and results in nonunion, necrosis
- Transtriquetrum perilunate fracture-dislocations
Mechanism of injury
- Axial load with wrist hyperextension, ulnar deviation, midcarpal supination
- Mayfield classification
  - Predictable pattern of carpal injury
    - Scapholunate dissociation or scaphoid fracture
    - Lunocapitate dislocation
    - Lunotriquetrum dissociation or triquetrum fracture
      - ▲ Perilunate dislocation
    - Lunate dislocation
Epidemiology

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