A 26 year old engineering student presented to the emergency with pain in the wrist after a fall on an outstretched hand from the motorcycle travelling at a very high speed. Examination shows swelling, diffuse tenderness, deformity, and limited wrist movement. 'Spilled teacup' sign is seen on a PA view X-ray wrist. What is the likely diagnosis?
Perilunate dislocations usually result from high energy hyperextension injuries to the wrist. In perilunate dislocations, the capitate and other carpal bones are displaced dorsal to the lunate, which remains located in the lunate fossa of the distal radius. Lunate dislocation is the final stage in the continuum of perilunate dislocation and refers to the volar displacement of lunate from the lunate fossa of the distal radius. Impoant Dx : Suspect perilunate dislocation in patients who sustain high energy hyperextension wrist injuries with or without carpal bone fractures Complication : Delay in diagnosis can result in injury to the median nerve in the acute setting and post-traumatic ahritis Inv : Confirm the diagnosis with posteroanterior and lateral plain wrist radiography, which would show the "spilled teacup" sign (lunate angulated volarly) and disruption of the smooth borders of the carpal rows (Gilula's lines) Rx : Immediate management involves closed reduction, followed by early surgical repair (stabilisation and fixation) Ref: 1. Perilunate dislocation, Annakan V Navaratnam, Rupe Eckersley ; BMJ 2012;345:e7026 2. Witvoet J, Allieu Y. . Rev Chir Ohop Reparatrice Appar Mot1973;59(suppl 1):98-125.
Scaphoid fractures
Perilunate dislocation
Post-traumatic ahritis
Fracture of radial styloid