Radiology of trauma to the wrist: Dislocations, fracture dislocations, and instability patterns

Yeager, Bradford A.; Dalinka, Murray K.

doi:10.1007/bf00352082

Cited by 32 publications

(12 citation statements)

References 21 publications

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“…The proposed mechanism Lateral view of left wrist is that the primary dislocation occurs at the midcarpal joint, with the capitate usually displaced dorsal to the lunate [3,6]. As the scaphoid bridges both the rows, it may either fracture or rotate when the capitate dislocates dorsally, leading to ligamentous instability and a perilunate dislocation [3,9]. Following the groundbreaking 1980 study of Mayfield et al [7], the manifestation of the most severe form of this injury was believed to be lunate dislocation into the carpal canal.…”

Section: Discussionmentioning

confidence: 99%

Unusual Proximal Dislocation without Fracture: A Case Report

Akinleye

Makani

Dalinka

et al. 2012

Hand (New York, N,Y.)

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Carpal instability includes a broad spectrum of osseous and ligamentous injuries which have been subclassified into greater and lesser arc injuries, in addition to combinations of both (Mayfield et al. J Hand Surg [Am] 5:226-241, 1980; Yaeger et al. Skeletal Radiol 13(2):120-30, 1985). The injuries typically occur from a fall on the outstretched hand with the wrist in ulnar deviation, hyperextension, and intercarpal supination (Yaeger et al. Skeletal Radiol 13(2):120-30, 1985). The force classically propagates from the radial to the ulnar side of the wrist resulting in a fracture (greater arc) or dislocation (lesser arc) pattern with the extent of the injury occurring in an orderly pattern depending upon the degree of hyperextension and the duration and magnitude of the force (Mayfield et al. for many years, the mechanisms and classification have only been recently clarified. We report a case of a complex dislocation involving the entire proximal carpal row without an associated fracture. While this type of complex carpal dislocation has been previously described, to our knowledge, it has never been reported without a fracture of the forearm, wrist, or hand. Case ReportA 44-year-old female with known schizophrenia presented to a level 1 trauma center following an unwitnessed fall from a second story window. The patient's daughter reported finding her mother down, but conscious. In the trauma bay, the patient was found to have a Glascow Coma Scale of 14 with confusion and multiple injuries including a subdural hematoma, T5, T12, and L1 burst fracture, distal sacral fracture, a left navicular foot fracture, and left proximal carpal dislocation.Figures 1 and 2 are the posterior-anterior (PA) and lateral views of the left wrist which demonstrate traumatic volar dislocation of the proximal carpal row, with respect to the radius. The distal carpal row has also migrated proximally along with mild subluxation of the ulna at the distal radialulnar joint. No fractures of the left wrist or hand are detected. All of the carpometacarpal joints along with the forearm osseous structures remain intact.The patient underwent a closed reduction of the left carpal dislocation in the trauma bay. Subsequent postreduction films demonstrated that the lunate was still volarly displaced in relation to the radius (Figs. 3 and 4) with interval reduction of the scaphoid and triquetrum.The scaphoid and triquetrum, however, did align with the radius and ulna respectively. The patient had no symptoms of compression neuropathy at this time.The patient was taken to the operating room where an open reduction of the lunate and repair of perilunate ligaments was performed. A volar approach was used initially, which allowed for reduction of the lunate and repair of the volar capsule. Following carpal tunnel release, the median nerve and flexor

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Section: Discussionmentioning

confidence: 99%

Unusual Proximal Dislocation without Fracture: A Case Report

Akinleye

Makani

Dalinka

et al. 2012

Hand (New York, N,Y.)

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“…Associated injury with the scaphoid or other carpal bones is also uncommon (Meyers et al, 1971;Vance et al, 1980), usually resulting from severe trauma. This injury is complex, with rotation of the proximal part of the capitate, often requiring open reduction and internal fixation (Vance et al, 1980;Yeager and Dalinka, 1985). In isolated fractures, immobilization in a plaster cast for six to eight weeks is the treatment of choice (Adler and Shaftan, 1962;Young, 1986).…”

Section: Discussionmentioning

confidence: 99%

Isolated Fractures of the Capitate: Use of Nuclear Medicine as an Aid to Diagnosis

Hopkins

Ammann²

1990

Int J Sports Med

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Fractures of the capitate are considered to be uncommon injuries of the wrist, however, delay in diagnosis may result in prolonged disability and avascular necrosis. Two cases are reported in which an isolated fracture of the capitate was diagnosed with a 99mTc-MDP nuclear medicine bone scan and confirmed with CT scan or repeated conventional x-rays. These two cases illustrate that an isolated fracture of the capitate should be considered in an individual presenting with persistent wrist pain of traumatic origin, even when conventional x-ray views are negative. The nuclear medicine bone scan can be a useful investigative tool and serve to guide further radiological investigations.

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“…A mention of products or services does not constitute endorsement. 6 Familiarity with injury patterns of the wrist can prompt a search for associated injuries, which are often subtle, can be missed easily, and are clinically important to prevent progressive instability of the wrist. Indexed by Bio-Science Information Services.…”

Section: Radiographic Anatomy Of the Wristmentioning

confidence: 99%

Systematic Checklist Approach to the Radiographic Interpretation of the Injured Wrist to Avoid Common Diagnostic Errors

Minor

Bui-Mansfield

Carra

2015

Contemporary Diagnostic Radiology

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Radiography is the fi rst-line imaging modality for the evaluation of traumatic wrist injury, which is encountered commonly in the daily practice of a diagnostic radiologist. Because of the complex anatomy and overlapping structures of the wrist on standard radiographic projections, abnormalities of the wrist can be subtle and easily overlooked. Therefore, it is essential for radiologists to be profi cient at the interpretation of wrist radiographs. The use of a checklist approach, and recognition of common injury patterns, potentially can increase radiologists' accuracy when interpreting standard wrist radiographs. The objective of this article is to present a simple but thorough method for accurate radiographic evaluation of the wrist and to review some common injury patterns of the wrist. Radiographic Evaluation of the WristCommon views of the wrist include posteroanterior (PA), lateral, and oblique projections. With the PA view, the wrist V o l u m e 3 8 • N u m b e r 2 0 S e p t e m b e r 3 0 , 2 0 1 5 This issue of CDR will qualify for 2 ABR Self-Assessment Module SAM (SA-CME) credits. See page 8 for more information. This module meets the American Board of Radiology's (ABR's) criteria for self-assessment toward the purpose of fulfi lling requirements in the ABR Maintenance of Certifi cation (MOC) program.Please note that in addition to the SA-CME credits, subscribers completing the activity will receive the usual ACCME credits. After participating in this activity, the diagnostic radiologist should be better able to identify the anatomic landmarks of the wrist on radiography and become familiar with a systematic checklist approach to the radiographic interpretation of the injured wrist.

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Radiology of trauma to the wrist: Dislocations, fracture dislocations, and instability patterns

Abstract: Radiologic changes from trauma to the carpus are described. Emphasis is placed upon pathomechanics and characterization of greater and lesser arc injury patterns. Finally, the various posttraumatic instability patterns of the wrist are discussed.

Cited by 32 publications

References 21 publications

Unusual Proximal Dislocation without Fracture: A Case Report

Unusual Proximal Dislocation without Fracture: A Case Report

Isolated Fractures of the Capitate: Use of Nuclear Medicine as an Aid to Diagnosis

Systematic Checklist Approach to the Radiographic Interpretation of the Injured Wrist to Avoid Common Diagnostic Errors

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