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

Murray, Peter M.; Palmer, Christopher G.; Shin, Alexander Y.

doi:10.1016/j.jhsa.2012.01.015

Cited by 31 publications

(22 citation statements)

References 17 publications

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“…With additional division of the dorsal radiotriquetral and scaphotriquetral ligaments, the authors noted a consistent pattern of static carpal collapse into a VISI orientation. These findings are in agreement with previous studies that have demonstrated the palmar lunotriquetral ligament to be the major stabilizer of the lunotriquetral joint as well as the role of the dorsal radiotriquetral and scaphotriquetral ligaments as important secondary restraints [20,21]. …”

Section: Classificationsupporting

confidence: 93%

Carpal Ligament Injuries, Pathomechanics, and Classification

Lee

Elfar

2015

Hand Clinics

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SYNOPSIS Carpal instability is a complex array of maladaptive and post-traumatic conditions that leads to the inability of the wrist to maintain anatomic relationships under normal loads. Many different classification schemes have evolved to explain the mechanistic evolution and pathophysiology of carpal instability, including two of the most common malalignment patterns of volar intercalated segment instability (VISI) and the more common dorsal intercalated segment instability (DISI). Recent classifications emphasize the relationships within and between the rows of carpal bones. Future research will likely unify the disparate paradigms used to describe wrist instability.

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Section: Classificationsupporting

confidence: 93%

Carpal Ligament Injuries, Pathomechanics, and Classification

Lee

Elfar

2015

Hand Clinics

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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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“…The concept of a PLIND lesion enables to expand an existing PLD-PLFD classification 8,17 by including nondislocated equivalents of PLDs-PLFDs whether they follow a radialto-ulnar mechanism 18 or a so-called reverse ulnar-to-radial mechanism. 19 This modified classification of acute perilunate injuries could aid in the recognition of a more global but nondislocated type of perilunate injury that might otherwise be missed when one is faced with an apparently isolated proximal row bony fracture(s) or interosseous ligamentous dissociation(s).…”

Section: Discussionmentioning

confidence: 99%

Perilunate Injuries, Not Dislocated (PLIND)

Herzberg

2013

Jnl Wrist Surg

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Purpose We reviewed a series of equivalents of perilunate dislocations and fracture-dislocations (PLDs-PLFDs) in which there was no dislocation of the capitate from the lunate on the initial radiographs. We propose to include these injuries as a variant of perilunate dislocations that we have termed a perilunate injury, not dislocated (PLIND) lesion in a modified classification of perilunate injuries. Methods A review of the records of all acute perilunate injuries and displaced carpal fractures was done in a single-center university hospital wrist surgery unit over a 5-year period. All cases presenting at the acute stage with displaced fractures of scaphoid, lunate, triquetrum, or capitate along with scapholunate and/or lunotriquetral dissociation but no dislocation of the capitate from the lunate in the sagittal or coronal plane were reviewed and considered as PLIND lesions. Results We identified 11 patients with PLIND lesions. Three cases with clinical and radiological follow-up are presented. Discussion Equivalents of PLDs-PLFDs presenting without dislocation of the capitate from the lunate do exist. These injuries may be overlooked despite their severity. They require both osseous and ligamentous repair. Including them into an existing perilunate injuries classification highlights their recognition and enables a better understanding and treatment of both acute and chronic nondislocated perilunate injuries. Level of Evidence Level IV, retrospective case series.

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

Cited by 31 publications

References 17 publications

Carpal Ligament Injuries, Pathomechanics, and Classification

Carpal Ligament Injuries, Pathomechanics, and Classification

Reduction and Association of the Lunotriquetral Ligament for Reverse Perilunate Dislocation

Perilunate Injuries, Not Dislocated (PLIND)

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