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| IMAGE QUIZ ARCHIVE | ||||||
| Image Quiz | ||
| Pain and Swelling in the Wrist After Falling on the Outstretched Hand from a Height of Fifteen Feet1 (continued) | ||
| Answer: Trans-scaphoid volar lunate dislocation. | ||
 Fig. 1 |
Fig. 1 Posteroanterior (A) and oblique (B) radiographs showing the transscaphoid volar lunate dislocation. For larger view, click on image |
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| The proximal fragment of the scaphoid was displaced along with the lunate in a volar direction, approximately 4 cm proximal to the radiocarpal joint. | ||
| Discussion | ||
| The treatment options for carpal dislocations and fracture-dislocations vary according to the pattern and configuration of the injury. Although different patterns of carpal dislocation may be found depending on the direction and amplitude of the deforming force, volar lunate dislocations are uncommon. In a multicenter study involving 166 cases of perilunate dislocations and fracture-dislocations, the lunate was dislocated volarly along with the proximal pole of the scaphoid in only thirteen cases (8%). Dislocation of the lunate and proximal pole of the scaphoid with the fragments displaced proximal to the radiocarpal joint, characterized as a total dislocation by Ekerot, is exceptionally rare, with only six cases reported in the literature to our knowledge. The factors that have a negative influence on the clinical and radiographic results include delay in reduction, severe soft-tissue lesions, open wounds, inadequate reduction, and fracture malunion. Carpal instability, degenerative changes of the radiocarpal and midcarpal joints, and osteonecrosis of the lunate and scaphoid often complicate the injury. | ||
| Early reduction has been associated with an improved outcome of treatment of these injuries. Closed reduction is very difficult and may even be impossible to achieve and maintain when a scaphoid fracture accompanies the lunate dislocation. A double-incision technique is useful in such cases because it provides good exposure of the carpal bones, thus permitting optimal restoration of alignment. | ||
| In our patient, neither the scaphoid nor the lunate demonstrated any evidence of osteonecrosis. | ||
| A satisfactory outcome can be achieved after a transscaphoid lunate dislocation even in the presence of substantial displacement. Immediate management of these injuries with open reduction and internal fixation can result in optimal functional recovery when the injury is not accompanied by damage to the articular surface of the carpal bones or by a neurologic deficit. | ||
| Reference | ||
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