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| IMAGE QUIZ ARCHIVE | ||||||
| Image Quiz | ||
| Pain, Swelling, and Deformity of the Wrist After Falling on an Outstretched Hand1 (continued) | ||
| Answer: Periscaphoid perilunate dislocation of the wrist | ||
| For larger view, click on image | ||
 Fig. 1-A |
 Fig. 1-B |
 Fig. 1-C |
| Fig. 1-A Posteroanterior radiograph of the left wrist, demonstrating complete disruption of the scaphotrapezium-trapezoid joints, with overlapping shadows of the scaphoid and lunate on the capitate. There is no increase in the scapholunate interval. Fig. 1-B Lateral radiograph depicting the volarly tilted and displaced lunate in the same projection as the scaphoid, while the capitate is not aligned with the lunate fossa. There is subluxation of the radiolunate articulation. Fig. 1-C Oblique radiograph depicting complete disruption of the scaphotrapezium-trapezoid joints. |
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| The patient was taken to the operating room on the day of admission. Through an initial volar Russe approach, the scaphoid was found to be flexed, supinated, and tethered to the lunate with an intact scapholunate ligament. There was a gap between the scaphoid and capitate and a complete disruption of the scaphotrapezial joint capsule. The scaphotrapezial joint capsule was avulsed distally but was still firmly attached to the volar aspect of the scaphoid. Anatomic reduction was not possible until a second dorsal longitudinal incision was made between the extensor digitorum communis and the extensor digiti minimi to allow for reduction of the dislocated lunotriquetral joint. The lunotriquetral joint was reduced and stabilized with a Kirschner wire; no direct ligament repair was done. The scaphocapitate and scaphotrapezium-trapezoid joints were easily reduced and stabilized with Kirschner wires. A capsular repair of the scaphotrapezium was performed with use of a bone anchor (Mitek 2.0-mm Tacit; Ethicon-Johnson and Johnson, Westwood, Massachusetts) that was placed into the trapezium and was reinforced with use of a radial slip of the flexor carpi radialis. This slip of flexor carpi radialis crossed obliquely over the scaphotrapezial joint in a distal ulnar to proximal radial direction and was anchored into the distal volar aspect of the scaphoid. Once anatomic reduction was confirmed on radiographs, the volar and dorsal extrinsic ligaments were repaired. These extrinsic ligaments were not grossly disrupted as a result of the trauma. Postoperative radiographs were made (Figs. 2-A and 2-B), and the patient wore a thumb spica cast for eight weeks. | ||
| For larger view, click on image | ||
 Fig. 2-A |
 Fig. 2-B |
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| Fig. 2-A Posteroanterior radiograph demonstrating lunotriquetral transfixion, scaphocapitate and scaphotrapezial transfixion, and bone-suture anchors. Fig. 2-B Lateral radiograph showing an anatomic reduction, normal scapholunate angle, and congruency of the scaphotrapezium-trapezoid and capitolunate articulations. |
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| Discussion | ||
| We are unaware of any report on an isolated periscaphoid perilunate dislocation in the recent literature. Because falls from heights are relatively common, it is intriguing that this injury pattern has not been previously reported. On the basis of the findings in a limited number of reports in the literature and the anatomic reduction and favorable outcome in our patient, we recommend open reduction and Kirschner-wire fixation of the scaphotrapezial joint, the scaphocapitate joint, and the lunotriquetral joint, and ligamentous repair-reconstruction of the scaphotrapezial joint for the treatment of a periscaphoid perilunate dislocation. | ||
| Reference | ||
| 1. Healey DC, Giachino AA, Conway AF. Periscaphoid perilunate dislocation of the wrist: a case report. J Bone Joint Surg Am. 2002;84:1201-4. | ||
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