Perilunate Dislocations



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



          • â–² Perilunate dislocation


        • Lunate dislocation


  • Epidemiology

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May 7, 2019 | Posted by in ORTHOPEDIC | Comments Off on Perilunate Dislocations

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