CMC COMPENDIUM
  • RESIDENCY
    • About CMC
    • Curriculum
    • Benefits
    • Explore Charlotte
    • Official Site
  • FELLOWSHIP
    • EMS
    • Global EM
    • Pediatric EM
    • Toxicology >
      • Tox Faculty
      • Tox Application
    • (All Others)
  • PEOPLE
    • Program Leadership
    • PGY-3
    • PGY-2
    • PGY-1
    • Alumni
  • STUDENTS/APPLICANTS
    • Medical Students at CMC
    • EM Acting Internship
    • Healthcare Disparities Externship
    • Resident Mentorship
  • #FOAMed
    • EM GuideWire
    • CMC Imaging Mastery
    • Pediatric EM Morsels
    • Blogs, etc. >
      • CMC ECG Masters
      • Core Concepts
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
  • Chiefs Corner
    • Top 20
    • Current Chiefs
    • Schedules >
      • Conference/Flashpoint
      • Block Schedule
      • ED Shift Schedule
      • AEC Moonlighting
      • Journal Club/OBP/Audits Schedule
      • Simulation
    • Resources >
      • Fox Reference Library
      • FlashPoint
      • Airway Lecture
      • Student Resources
      • PGY - 1
      • PGY - 2
      • PGY - 3
      • Simulation Reading
      • Resident Wellness
      • Resident Research
      • Resume Builder
    • Individualized Interactive Instruction

Perilunate Dislocations

2/23/2015

0 Comments

 
HPI: Young male presents after a fall while skiing with right shoulder and wrist pain.

PE: Obvious deformity of the right wrist. No abrasions or ecchymosis. Full thumb abduction, able to flex at DIP and PIP joint of all 5 fingers, full abduction of all 4 palmar fingers, 5/5 strength to finger grip. Unable to range wrist, elbow or glenohumeral joint secondary to pain. Normal sensation to pinprick and two point discrimination of all five fingers. 2+ radial pulse with normal cap refill.  

Imaging:
Picture
Anatomy:
-    Normal wrist anatomy consists of two rows of bones:
      o   Proximal row: Scaphoid, lunate, triquetrum, pisiform
      o   Distal row: trapezium, trapezoid, capitate, hamate
-    Ligaments of the wrist:
      o   Interosseous ligaments run between the carpal bones and stabilizes proximal carpal bones.
      o   Intrinsic ligaments insert and originate among the carpal bones to internally stabilize them.
      o   Extrinsic ligaments connect radius and ulna to the carpus. 
Picture
Picture
How to make diagnosis:
  • Traumatic high energy mechanism when wrist is extended and ulnarly deviated. 
  • Can lead to either Perilunate dislocation where lunate stays in position and carpus dislocates or Lunate dislocates by being forced volar or dorsal while carpus remains aligned
  • Can see median nerve symptoms in ~25% of patients – most common with lunate dislocation into carpal tunnel.

Treatment:
o   Require emergent closed reduction and splinting into sugar tong splint. 
  • Place hand in finger traps at 90 degrees of elbow flexion with 5-10lbs of traction. 
  • Wrist traction with one hand and recreate deformity (volar or dorsal dislocation) and pressing with thumb of the non-extending hand onto dislocated carpal bone attempting to press it back into place. 
  • Reduces median nerve injury and minimizes cartilage damage. 
o   Require open reduction, ligament repair, fixation and possible carpal tunnel release. 
  • Even with reduction and operative treatment may still not return to full function with reduced grip strength and stiffness. 

Pearls:
  • Must obtain a lateral to evaluate for fracture as AP may not reveal obvious carpal misalignment. 
  • Diagnosis missed 25% of the time. 
  • Either lunate stays in position and carpus dislocates or carpus stays in position and lunate dislocates. 
  • Emergent reduction/splinting to reduce incidence of median nerve injury and cartilage damage. 
0 Comments

Your comment will be posted after it is approved.


Leave a Reply.

    Orthopedics Blog

    Picture

    Author 

    CMC ER Residents 
    (for learning purposes, imagine all cases present to a free standing ED for dispo and treatment options)

    Subscribe To Blog

    Archives

    June 2018
    April 2018
    March 2018
    October 2017
    September 2017
    February 2016
    January 2016
    December 2015
    November 2015
    October 2015
    September 2015
    August 2015
    July 2015
    June 2015
    May 2015
    April 2015
    March 2015
    February 2015
    January 2015
    December 2014
    November 2014

    Categories

    All
    Lower Extremity
    Nerve Injury
    Spine
    Sports Medicine
    Upper Extremity
    Vascular Injury

    RSS Feed

    Disclaimer: All images and x-rays included on this blog are the sole property of CMC EM Residency and cannot be used or reproduced without written permission.  Patient identifiers have been redacted/changed or patient consent has been obtained.  Information contained in this blog is the opinion of the author and application of material contained in this blog is at the discretion of the practitioner to verify for accuracy.
Powered by Create your own unique website with customizable templates.
  • RESIDENCY
    • About CMC
    • Curriculum
    • Benefits
    • Explore Charlotte
    • Official Site
  • FELLOWSHIP
    • EMS
    • Global EM
    • Pediatric EM
    • Toxicology >
      • Tox Faculty
      • Tox Application
    • (All Others)
  • PEOPLE
    • Program Leadership
    • PGY-3
    • PGY-2
    • PGY-1
    • Alumni
  • STUDENTS/APPLICANTS
    • Medical Students at CMC
    • EM Acting Internship
    • Healthcare Disparities Externship
    • Resident Mentorship
  • #FOAMed
    • EM GuideWire
    • CMC Imaging Mastery
    • Pediatric EM Morsels
    • Blogs, etc. >
      • CMC ECG Masters
      • Core Concepts
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
  • Chiefs Corner
    • Top 20
    • Current Chiefs
    • Schedules >
      • Conference/Flashpoint
      • Block Schedule
      • ED Shift Schedule
      • AEC Moonlighting
      • Journal Club/OBP/Audits Schedule
      • Simulation
    • Resources >
      • Fox Reference Library
      • FlashPoint
      • Airway Lecture
      • Student Resources
      • PGY - 1
      • PGY - 2
      • PGY - 3
      • Simulation Reading
      • Resident Wellness
      • Resident Research
      • Resume Builder
    • Individualized Interactive Instruction