Closed Reduction of Acute Dislocations of the Semilunar Carpal Bone

Abstract

THESE particular cases are reported because of the successful attempts at the closed method of reduction, the full functional results obtained and the complications of a fractured scaphoid and fracture of the styloid process of ulna in case one, and a fracture of the styloid process of the ulna in case three.Dislocations of the semilunar carpal bone are frequently undiagnosed because of the failure to make a thorough physical examination with proper radiographic interpretation in every suspicious injury to the wrist-joint. Because of these incomplete examinations marked disabilities have resulted.If semilunar dislocations are diagnosed immediately following injury and the closed method of reduction attempted, as described by Davis, the majority can be reduced', thereby lessening a long period of disability as well as obtaining good functional results. In this method care should be taken that too much trauma is not used because marked injury can be done to wrist-joint structures causing greater disability than if the dislocation had been left alone and later the bone removed. However, no disability resulted from trauma in any of these cases. The use of the fluoroscope is indispensable in this type of case and should always be used.Briefly outlined, the closed, reduction method, or broomstick method of Davis, is as follows: The curved surface of the side of a broomstick handle is placed at the lower tip of the semilunar bone on its radial articular aspect. By increasing the deformity of the dislocation, that is, extreme extension of the wrist, and by gradually making traction on the hand, with broomstick in place making pressure against the dislocated semilunar, the hand and wrist are acutely flexed, causing the semilunar to be reduced. The traction on the hand' is important, because this increases the space between the radius and os magnum, making room for the semilunar carpal bone. Extreme flexion is also necessary.In this series of cases it was found that when the wrist remained in right angle flexion without force and did not have a tendency to rise up, the semilunar was always reduced.Diathermy in sedative doses, with radiant light, was found to relieve the pain and rapidly diminish swelling as well as lessen the period of functional disability. Immediate mobilization of wrist as soon as possible is very important.The force producing the dislocations was found to be directed from the 19 289

Perilunate Dislocations

“…3 In 1925, Conwell followed up on the broomstick technique but modified it by utilizing fluoroscopy to check for the quality of reduction. 4 Later in 1925, Adams advised against the use of a hard surface, which could result in damage to tendons and soft tissues within the wrist, and proposed using the thumb as a fulcrum. 5 Current improvements in the treatment of perilunate injuries have evolved into debates involving surgical correction and fixation.…”