Carpal dislocation and fracture dislocation are uncommon and difficult to treat. Early diagnosis and treatment of such injuries are necessary to prevent progressive carpal instability and traumatic arthritis. Perilunate fracture dislocation is a combination of ligamentous and osseous injuries that involve the 'greater arc' of the perilunate. Despite being severe, these injuries often go unrecognised in the emergency department, leading to delayed diagnosis and treatment. We present a case of greater arc injury of the right wrist with fractures of the lunate and ulnar styloid without perilunate dislocation. This pattern of injury cannot be classified in the available literature on greater arc injury.
We read with interest the article by D'Souza et al. 1 We are concerned with a statement in the conclusion that "There is no correlation between the development of infection in open fractures with… the interval between injury and debridement." This may be due to a small sample size (a type-II error). There is evidence that early debridement significantly reduces the rate of infection in open fractures 2 and improves outcomes. 3-5 In our institutions, patients with open fractures receive primary debridement and stabilisation within 6 hours and this continues until there is sufficient evidence to the contrary.
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