Diagnosis is confirmed with either a radiographic carpal tunnel view or CT scan. A 40-year-old slips on the ice on a wintery Michigan day and sustains a comminuted intra-articular distal radius fracture. Rathachai Kaewlai, Laura L. Avery, Ashwin V. Asrani, Hani H. Abujudeh, Richard Sacknoff, Robert A. Novelline. Phalanx Fractures - Hand - Orthobullets A 45-year-old male sustained a fall onto his right wrist 2 weeks ago. Twelve months after open reduction and internal fixation of a comminuted distal radius fracture as seen in Figure A and B, which of the following tendons is at greatest risk of rupture? This content is written, edited and updated by hand surgeon members of the American Society for Surgery of the Hand. In lunate dislocations, disruption of Gilula's arcs can be appreciated with disruption of spaces between the proximal and distal carpal bones. The patient undergoes open reduction and internal fixation of the fracture. Fractures of the normal lunate--isolated or associated with fractures of the scaphoid or radius--are very rare. The lunate is an important stabilizer of the wrist, fractures can lead to ligamentous injury and overall volar intercalated segment instability. A 35-year-old professional football player complains of severe wrist pain after making a tackle. Diagnosis is made clinically with progressive wrist pain and wrist instability with radiographs showing advanced arthritis of the radiocarpal and midcarpal joints (radiolunate joint . 4. The lunate is made up of the volar pole, body, and dorsal pole. The patient undergoes open reduction internal fixation (ORIF). Lunate fracture | Radiology Reference Article | Radiopaedia.org This is an AAOS Self Assessment Exam (SAE) question. arthroscopic repair and percutaneous pinning. Scaphoid Lunate Advanced Collapse (SLAC) - Hand - Orthobullets The injury is closed and she is neurovascularly intact. Lunate dislocations are far less common than the less severe perilunate dislocation. 1980;5 (3): 226-41. His physical exam shows dorsal wrist tenderness and is positive for the provocative test shown in Figure V. Standard PA radiograph of the wrist is normal. The force of injury in this syndrome can propagate leading to perilunate dislocation as . Lunate Dislocation (Perilunate dissociation) . Die-Punch: Depressed fracture of lunate fossa of distal radius due to an axial loading injury. Distal Radius Intraarticular Fracture ORIF with Dorsal Approach, Distal Radius Extra-articular Fracture ORIF with Volar Appr, Distal Radius Fracture Non-Spanning External Fixator, Distal Radius Fracture Spanning External Fixator, Type in at least one full word to see suggestions list, 7th Annual Frontiers in Upper Extremity Surgery, Nonoperative Treatment of Distal Radius Fractures - Michael Bednar, MD, Dorsal Plating of Radius Fractures - Nader Paksima, DO, MPH, Fragment Specific Fixation Distal Radius Fractures - Mark Rekant, MD, 12th Annual Orthopaedic Trauma: Pushing The Envelope. Terry Thomas sign: This is seen on an AP wrist film and is indicated by a gap >3mm between the scaphoid and lunate bones Cortical Ring sign: occurs when the scaphoid is in a flexed position, making the scaphoid tubercle more prominent.A measure distance less than 7mm between the end of the cortical ring and the proximal end of the scaphoid suggests scapholunate dissociation and instability. Lunate dislocationsare an uncommon traumatic wrist injury that require prompt management and surgical repair. Lunate : Wheeless' Textbook of Orthopaedics The combination of a capitate fracture and a scaphoid waist fractureis known as "scaphocapitate syndrome" . Four months post-injury, he presents to the office with an inability to extend his thumb. (SAE07SM.38) Lunate fractures and perilunate injuries - UpToDate The lunate is a central bone in the wrist that is important for proper movement and support of the joint (Figure 1). Colles'. dorsal fractures commonly axial fracture healing. Which of the regions on the patient's injury AP radiograph in Figure A, if not addressed properly during surgery, represents a risk for radiocarpal instability? Which of the following radiographic views shown in Figures A to E would be most helpful in establishing the diagnosis? immobilization in a short arm thumb spica cast. Frequent questions. Deciding whether a fracture needs reducing. (OBQ12.244) Treatment of acute SL ligament injuries may be immobilization versus operative repair/reconstruction depending on degree of displacement. Lunate/perilunate dislocations are high energy injuries to the wrist associated with neurological injury and poor functional outcomes. Most hand and wrist fractures (the latter of which is basically an ulnar styloid fracture) are caused by trying to break a fall with your arm outstretched. Displaced intra-articular fracture with a fragment consisting of the volar-ulnar corner. Inability to flex the thumb interphalangeal joint. Displaced impaction fracture of the lunate fossa. The mechanism of injury is typically a fall onto an outstretched hand with a hyperextended wrist or during a . Lunate fractures are often secondary to axial loading of the head capitate bone,this is seen in forceful hyperextension with ulnar deviation 2. Perilunate dislocations and fracture-dislocations are relatively uncommon injury patterns in acute wrist trauma. Orthopaedic Specialists of North Carolina. Multidetector CT of Carpal Injuries: Anatomy, Fractures, and Fracture-Dislocations1. The scaphoid accounts for 95% of de-generative/traumatic arthritis in the wrist, with 55% involving the radioscaphoid joint (SLAC pattern). (OBQ12.38) Hamate Body Fracture - Hand - Orthobullets (OBQ05.25) Patients present with wrist pain following a fall. A fracture to the lunate may also be associated with injury to the TFCC. The instrument touches a structure that prevents ulnar translocation of the carpus after a PRC. There may be other associated injuries that require further investigation via cross-sectional imaging 1,2. Scaphoid Lunate Advanced Collapse (SLAC) - Hand - Orthobullets SLAC (scaphoid lunate advanced collapse) and SNAC (scaphoid nonunion advanced collapse) are the most common patterns seen. (OBQ06.136) There are no open wounds and the hand is neurovascularly intact. The patient shows you the lateral film in Figure A. A 56-year-old woman sustains the closed injury depicted in Figures A-B. Check for errors and try again. Kienbocks disease is most common in men between the ages of 20 and 40. (SBQ17SE.67) Radiographic features A 67-year-old woman slips on the ice while retrieving her mail and lands on her outstretched left hand. - it has large volar surface, & is displaced volarward w/ forceddorsiflexion of the wrist; Hamate Body Fractures are rare carpal fractures that can be associated with 4th or 5th metacarpal fractures. Scaphoid Lunate Advanced Collapse (S-LAC) - Hand - Orthobullets Scapholunate ligament - Wikipedia positive test seen in patients with scaphol-unate ligament injury or patients with liga-mentous laxity, where the scaphoid is no longer constrained proximally and sublux-ates out of the scaphoid fossa resulting in pain; when pressure removed from the What is the most appropriate treatment at this time? Distal radius (wrist) fractures - OrthoSHO Greenberg's text-atlas of emergency medicine. Perilunate dislocations typically occur in young adults with high energy trauma resulting in the loading of a hyperextended, ulnarly deviated hand. Improved functional outcomes with open reduction internal fixation (ORIF) through FCR approach vs. closed treatment, No difference in radiographic outcomes after ORIF vs. closed treatment, No difference in functional outcomes after ORIF vs. closed treatment, Improved functional outcomes with closed treatment vs. ORIF, Improved functional outcomes with external fixation and K wire fixation vs. ORIF. most common injuries to the skeletal system, distal phalanx > middle phalanx > proximal phalanx, 40-69 years old - machinery is most common, assess for numbness indicating digital nerve injury, assess for digital artery injury via doppler, proximal fragment pulled into flexion by interossei, distal fragment pulled into extension by central slip, apex volar angulation if distal to FDS insertion, apex dorsal angulation if proximal to FDS insertion, diagnosis confirmed by history, physical exam, and radiographs, type III - unstable bicondylar or comminuted, proximal fragment in flexion (due to interossei), distal fragment in extension (due to central slip), extraarticular fractures with < 10 angulation or < 2mm shortening and no rotational deformity, 3 weeks of immobilization followed by aggressive motion, extraarticular fractures with > 10 angulation or > 2mm shortening or rotational deformity, Unstable patterns include spiral, oblique, fracture with severe comminution, Eaton-Belsky pinning through metacarpal head, minifragment fixation with plate and/or lag screws, lag screws alone indicated in presence of long oblique fracture, proximal fragment in flexion (due to FDS), distal fragment in extension (due to terminal tendon), due to inherent stability provided by an intact and prolonged FDS insertion, proximal fragment in extension (due to central slip), results from hyperextension injury or axial loading, unstable if > 40% articular surface involved, represents avulsion of collateral ligaments, usually stable due to nail plate dorsally and pulp volarly, often associated with laceration of nail matrix or pulp, shearing due to axial load, leading to fracture involving > 20% of articular surface, avulsion due tensile force of terminal tendon or FDP, leading to small avulsion fracture, terminal tendon attaches to proximal epiphyseal fragment, nail matrix may be incarcerated in fracture and block reduction, distal phalanx fractures with nailbed injury, dorsal base fractures with > 25% articular involvement, displaced volar base fractures with large fragment and involvement of FDP, predisposing factors include prolonged immobilization, associated joint injury, and extensive surgical dissection, treat with rehab and surgical release as a last resort, Apex volar angulation effectively shortens extensor tendon and limits extension of PIPJ, surgery indicated when associated with functional impairment, corrective osteotomy at malunion site (preferred), metacarpal osteotomy (limited degree of correction), most are atrophic and associated with bone loss or neurovascular compromise, Lunate Dislocation (Perilunate dissociation), Gymnast's Wrist (Distal Radial Physeal Stress Syndrome), Scaphoid Nonunion Advanced Collapse (SNAC), Carpal Instability Nondissociative (CIND), Constrictive Ring Syndrome (Streeter's Dysplasia), Thromboangiitis Obliterans (Buerger's disease). Barton's fracture: Dorsal intraarticular fracture which is often associated with dislocation at the radiocarpal joint. Given the lunate's position in the wrist, there is significant overlap from other carpal bones and hence these fractures can be subtle. A 63-year-old female sustained a distal radius and associated ulnar styloid fracture 3 months ago after being involved in a motor vehicle collision. Pearls/pitfalls. Radiographs are shown in Figures A and B. Following fixation, a "shuck" test is performed and shows persistent instability of the distal radioulnar joint. The proximal 2 Cs indicates the articulation between the lunate and . Scaphoid Lunate Advanced Collapse (SLAC) - Hand - Orthobullets Data Trace is the publisher of sudden impact force applied to the hand and wrist causing SLIL injury and scapholunate dissociation, injury occurs most commonly with wrist positioned in extension, ulnar deviation and carpal supination, SLIL tearing will position the scaphoid in flexion and lunate extension. Radiographs obtained at the time of injury are shown in Figure A. Trans-Scaphoid Perilunate Dislocation - Handipedia Scapholunate Advanced Collapse Article - StatPearls Wrist osteoarthritis - Wikipedia You can rate this topic again in 12 months. 2023 Lineage Medical, Inc. All rights reserved. - knowing position of ECU & ulnar styloid helds to differentiate ECU tendinitisfrom distal radioulnar problems. Copyright 2023 Lineage Medical, Inc. All rights reserved. You can rate this topic again in 12 months. A radiograph is shown in Figure 21. Diffuse swelling and tenderness over capitate (just proximal to 3rd metacarpal) Differential Diagnosis Unable to process the form. (2017) Journal of Hand Surgery (European Volume). This medication is given in an effort to decrease the incidence of which of the following? Ulnar Styloid Fracture: Symptoms, Causes, Treatment, Healing Time Long arm cast above the elbow for 6 weeks, Long arm cast for 3 weeks followed by a short arm cast for 3 additional weeks, Closed reduction and percutaneous pinning. The lunocapitate articulation may be disrupted resulting in a dorsal perilunate dislocation, or in the case of concomitant scaphoid fracture, the wrist may undergo a transscaphoperilunate dislocation. Hand therapy does not change the course of the disease; however, it can help to minimize loss of motion from the disease. Distal and proximal radius. Medical search. Frequent questions