Download - Perilunate dislocation
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Wrist Case 4
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History and Physical67 yo F presents
after losing control of her walker and falling forward onto her outstretched, extended right hand. Pt complains of 10/10 pain in the wrist and inability to move her wrist. Denies any other injuries
T 98.4 P 87 BP 156/88 O2 97%
Gen: age approp female in obv pain but NAD
MSK: profound swelling of right wrist, no laceration, 2+ distal pulses. TTP over right wrist and prox right metacarpals.
Neuro- limited flexion/extension of right wrist, otherwise 5/5 strength, nl sensation
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Radiographs
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Diagnosis: Perilunate Dislocation
Posterior dislocation of capitate and distal carpal row with lunate in nl position
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Pain ManagementReduction of carpal dislocation with
longitudinal traction and dorsal pressureOrtho consultation needed as often
associated carpal fx present and significant ligamentous injury requiring open repair
ED Management
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Often missed due to inadequate radiographsImportant to get good lateral view to see
dislocationHigh frequency of associated carpal
fractures, usually scaphoid or radial styloidMust be cautious of median nerve palsy; can
have an acute carpal tunnel syndromeImmediate ortho consultation preferred
Pearls
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More Images
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http://www.wheelessonline.com/ortho/perilunate_dislocation
http://radiopaedia.org/articles/perilunate-dislocationhttp://www.eorif.com/WristHand/
perilunatedislocation.htmlhttp://www.ispub.com/journal/
the_internet_journal_of_orthopedic_surgery/volume_8_number_1_8/article/concomitant_elbow_and_perilunate_dislocation_floating_forearm.html
http://www.feinberg.northwestern.edu/emergencymed/residency/ortho-teaching/wrist/case67/case67background.html
References