ORTHOPAEDICS - ADULT
PERILUNATE DISLOCATION
Know this. 25% are missed. You will get sued.
Prompt
Response
PromptXray findings
Response(trans-scaphoid) Periluante dislocation (radio-lunate articulation maintained with carpus dislocated posteriorly ie: dorsal displacement of capitate at capitate/lunate junction)
Scaphoid fracture - unstable given perilunate dislocation if displacement >1mm (They ALL seem to have scaphoid fractures - just say it if need marks)
Ulna styoid # and radial styloid # (present on one film)
Scaphoid fracture - unstable given perilunate dislocation if displacement >1mm (They ALL seem to have scaphoid fractures - just say it if need marks)
Ulna styoid # and radial styloid # (present on one film)
PromptComplications of perilunate dislocation
ResponseAcute:
Median nerve injury
Vascular compromise
Pressure necrosis of skin
Compartment syndrome of hand
Pain
Loss of function
Chronic
Carpal instability (DISI/VISI - Dorsal/Volar Intercalated segment instability)
AVN of proximal fragment of scaphoid, Non union
Chronic pain
Complex regional pain syndrome
Osteoarthritis
Median nerve injury
Vascular compromise
Pressure necrosis of skin
Compartment syndrome of hand
Pain
Loss of function
Chronic
Carpal instability (DISI/VISI - Dorsal/Volar Intercalated segment instability)
AVN of proximal fragment of scaphoid, Non union
Chronic pain
Complex regional pain syndrome
Osteoarthritis
PromptManagement of perilunate dislocation
ResponseAnalgesia - IV narcotic “Morphine 2.5mg aliquots titrated to pain”. Elevate limb whilst awaiting rest of plan
Keep NBM
Reduction under procedural sedation/Biers block (ED reduction may fail needing ORIF)
Short arm backslab
orthopaedic referral
Keep NBM
Reduction under procedural sedation/Biers block (ED reduction may fail needing ORIF)
Short arm backslab
orthopaedic referral