Combined Reverse Perilunate and Axial–Ulnar Dislocation                     of the Wrist: A Case Report

Chin, Andrew Y.H.; García-Elias, Marc

doi:10.1177/1753193408091348

Cited by 16 publications

(12 citation statements)

References 12 publications

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“…19,20 Chin and GarciaElias 19 described an injury that was partly an ulnarsided perilunate injury. Leung et al 20 reported a transtriquetral dorsal perilunate dislocation and noted that the injury suggested a pattern opposite the Mayfield sequence of perilunate dislocation.…”

Section: Discussionmentioning

confidence: 98%

The Mechanism of Ulnar-sided Perilunate Instability of the Wrist: A Cadaveric Study and 6 Clinical Cases

Murray

Palmer

Shin

2012

The Journal of Hand Surgery

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Section: Discussionmentioning

confidence: 98%

The Mechanism of Ulnar-sided Perilunate Instability of the Wrist: A Cadaveric Study and 6 Clinical Cases

Murray

Palmer

Shin

2012

The Journal of Hand Surgery

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“…Although the mechanism of reverse perilunate injuries had been proposed, there were wide variable patterns in the ulnar or reverse perilunate injuries. [5][6][7][8] In addition to the reverse pattern from LT injury to SL injury, it also could combine the injuries toward distally, either along the ulnar or radial side of the capitate, to create intercarpal ligament tear or carpal bone fractures. Therefore, it is very crucial to evaluate the stabilities of the intercarpal ligaments and the associated fractures with radiographic and physical examinations both preoperatively and during the surgery.…”

Section: Discussionmentioning

confidence: 99%

Reduction and Association of the Lunotriquetral Ligament for Reverse Perilunate Dislocation

2019

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Background Reverse perilunate injuries are rare. Contrary to perilunate injuries, the violent force would start from the lunotriquetral ligament, go reversely toward the radial side, and cause the reverse or ulnar-sided perilunate dislocation. Case Description We describe a 31-year-old man with a reverse perilunate dislocation, who presented to our institution 3 weeks after a motorcycle accident. The patient was successfully treated with the reduction and association of the lunate and triquetrum (RALT) procedure by using closed maneuver and percutaneous headless compression screw fixation. The patient can obtain a good radiographic result and satisfactory function at the 30-month follow-up. Literature Review Many case series were reported concerning the perilunate injuries. However, few cases of reverse perilunate dislocation have been reported in the literature. No cases of reverse perilunate dislocation treated 3 weeks after the injury with the RALT procedure have been reported. Clinical Relevance In this case, we found that the dislocation could still be reduced with the closed maneuver. With the RALT procedure, the carpal alignment can be maintained and the stability can be regained. Also, the functional outcomes are good.

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“…These axial carpal injuries (involving capitohamate injury) were combined with: In addition, Chin and Garcia-Elias published a case with reverse perilunate dislocation (Type 4) relative to the capitate, hamate, and triquetrum, but without capitohamate derangement. 8 As shown earlier, an axial injury seldom involves injury of the perilunar area.…”

Section: Discussionmentioning

confidence: 86%

Combined Perilunate and Axial Ulnar Dislocation of the Wrist

2012

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Disruption of the carpal ligaments or fracture of the carpal bones can occur in almost any combination. Axial injuries are rare, devastating, and almost always open and result from disruption of the transverse carpal arches and the longitudinal columns. We investigated a clinical case of palmar dislocation and coronal fracture of the lunate, associated with axial carpal injury of the strong capitohamate and lunotriquetral ligaments with related injuries is the subject of this paper. To our knowledge, there is no previous literature on this injury combination (peri-/translunate, perihamate, peritriquetral carpal dislocation). Our aim is to present novel information on the subject. Case ReportA 54-year-old, right-dominant man presented after a road accident in which high-energy forces caused injury to his right wrist (►Figs. 1 and 2). The patient fell asleep while driving his 4-wheel-drive vehicle and collided head-on with a truck at a high speed. He sustained a mild concussion of the brain, a chest contusion, and an open injury of the wrist. Wound revision, closed reduction, and emergency-pinning of the lunate was done the day after the injury at a local hospital. The initial hospitalization was 4 days where the patient underwent antibiotic therapy 3 Â 1.2 g Phenoxymethylpenicillin intravenously, elevation of the extremity and pain treatment. On admission to our hospital, there was substantial swelling of the injured hand and wrist, but there were no signs of infection or any neurologic symptoms. We found three small wounds, all less than 1 cm in length, palmar, between the thenar and hypothenar. Plain x-rays revealed a poor position of the k-wires. There was no congruency in any of the carpal arches and further surgery was required. Accordingly, 7 days after the primary injury, we performed surgery using both a volar and dorsal approach. Starting on the volar side, with incision from the proximal palmar crease to the proximal wrist flexion crease, we found the transverse ligament of the carpal tunnel ruptured (this injury was indicative of high-energy trauma), but the median nerve was macroscopically intact. The lunate was only attached by the short radiolunate ligament and was nonviable to gross inspection. The lunate was excised using the volar approach. On the dorsal longitudinal approach (underneath the fourth extensor tendon compartment), we found that the radial styloid was fractured with some comminution of the dorsal cortex and subluxations of the 2nd and 3rd CMC joints. Proximal row carpectomy was then performed using a dorsal approach. Keywords► axial carpal injury ► capitohamate injury ► perilunar injury ► lunate fracture ► axial dissociation AbstractCarpal axial injuries are rare and devastating and can be difficult to classify because of various possible injury combinations. A 54-year-old man was involved in a road accident, resulting in serious injury to his dominant right wrist. An axial injury between the capitate and the hamate was combined with open perilunate dislocation and fracture, metacarp...

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Combined Reverse Perilunate and Axial–Ulnar Dislocation of the Wrist: A Case Report

Cited by 16 publications

References 12 publications

The Mechanism of Ulnar-sided Perilunate Instability of the Wrist: A Cadaveric Study and 6 Clinical Cases

The Mechanism of Ulnar-sided Perilunate Instability of the Wrist: A Cadaveric Study and 6 Clinical Cases

Reduction and Association of the Lunotriquetral Ligament for Reverse Perilunate Dislocation

Combined Perilunate and Axial Ulnar Dislocation of the Wrist

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