Lack of experience is a significant factor in the missed diagnosis of perilunate fracture dislocation or isolated dislocation

Abstract

ObjectiveThe aim of this study was to analyze the risk factors contributing to the misdiagnosis of perilunate injuries.MethodsThe study included patients who had perilunate dislocation or fracture dislocation correctly or incorrectly diagnosed on initial examination between 2008 and 2014. Data related to the length of time until correct diagnosis of the perilunate injury; cause of injury; presence of associated fractures, polytrauma or concomitant trauma in the ipsilateral upper extremity; time between injury and first presentation; first treatment applied; presence of ligamentous perilunar injuries only or fracture and dislocation; inadequate radiographic assessment; and experience of the physicians were recorded and analyzed.ResultsA total of 44 wrists were included in the study. Of those, 10 (22.7%) wrists (mean patient age: 44.4 years [28 ± 58 years]) with perilunate injuries were misdiagnosed in the initial evaluation. All of the risk factors were found to be similar between the group of patients with correct initial diagnosis and missed diagnosis group, except for the experience of the orthopedic surgeon assessing the injury (p = 0.0001). Of the surgeons who missed the diagnosis, 70% reported that it was their first encounter with a perilunate injury.ConclusionThe results of this study indicated that lack of experience was the most important factor in the misdiagnosis of perilunate fracture dislocation or isolated dislocation. Level of Evidence: Level IV, diagnostic study.

Ultrasound Findings in Less Frequent Causes of Carpal Tunnel Syndrome

“…58,59 Trauma Anterior Lunate Dislocation Anterior lunate dislocation (ALD) generally results from high-energy trauma such as a fall or motor vehicle collision. [60][61][62] The diagnosis of ALD relies on careful inspection of plain radiographs. Early detection is important to minimize carpal instability, degenerative changes, and CTS.…”

“…61,62 Since many patients with acute and chronic ALD present with symptoms of CTS, the sonologist should be familiar with the US appearance of ALD. [61][62][63] In ALD, sagittal and axial sonograms show the displacement of the lunate and compression by its anterior pole against the FDTs and MN (Figure 14). Ultrasound visualization of the distal articular face of the lunate, which usually articulates with the proximal pole of the capitate, is the hallmark of ALD.…”

“…Anterior lunate dislocation (ALD) generally results from high‐energy trauma such as a fall or motor vehicle collision 60‐62 . The diagnosis of ALD relies on careful inspection of plain radiographs.…”

“…Early detection is important to minimize carpal instability, degenerative changes, and CTS. Nevertheless, the diagnosis of ALD is delayed in up to 27.5% of cases 61,62 . Since many patients with acute and chronic ALD present with symptoms of CTS, the sonologist should be familiar with the US appearance of ALD 61‐63 .…”

“…Nevertheless, the diagnosis of ALD is delayed in up to 27.5% of cases 61,62 . Since many patients with acute and chronic ALD present with symptoms of CTS, the sonologist should be familiar with the US appearance of ALD 61‐63 . In ALD, sagittal and axial sonograms show the displacement of the lunate and compression by its anterior pole against the FDTs and MN (Figure 14).…”