Hook of hamate fractures are rare, often missed, injuries generally as a result of a direct blow to the hamate bone most commonly seen in athletes. (OBQ05.195) Lunate/perilunate dislocations are high energy injuries to the wrist associated with neurological injury and poor functional outcomes. Copyright 2023 Lineage Medical, Inc. All rights reserved. A 57-year-old woman underwent open reduction internal fixation from a volar approach for a displaced distal radius fracture. Scapholunate Ligament Injury & DISI - Hand - Orthobullets Wheeless' Textbook of Orthopaedics. Diagnosis is generally made with radiographs of the wrist but may require CT for confirmation. 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? He underwent operative fixation by and presents to your clinic for his 2 week follow-up visit. When dislocation occurs in the wrist . The rest of the carpal bones are in a normal anatomic position in relation to the radius. (OBQ06.102) The lunate is an important stabilizer of the wrist . diastasis of the scapholunate complex occurs with complete SLIL tears and capsule disruption. Upper extremity deep vein thrombosis (DVT), Lower extremity deep vein thrombosis (DVT). - it is palpable just distal to radial tubercle; What additional data is most necessary to obtain before a reduction is attempted? - lunate, capitate, and the base of the 3rd metacarpal are in line w/each other & is covered by base of ECRB; (OBQ18.216) The mechanism of injury is typically a fall onto an outstretched hand with a hyperextended wrist or during a . Patients often prefer to hold their fingers in partial flexion due to pain on extension. Copyright 2023 Lineage Medical, Inc. All rights reserved. A lumberjack in rural Michigan falls 10 feet from an Evergreen branch onto an outstretched arm and develops immediate wrist pain. In lunate dislocations, disruption of Gilula's arcs can be appreciated with disruption of spaces between the proximal and distal carpal bones. He presents to your clinic and given his age and the fracture characteristics, he is taken for open reduction with volar locking plate fixation. A 54-year-old male falls from a ladder and sustains the fracture shown in Figure A. (OBQ07.226) Now, he complains of worsening hand pain and sensory disturbances in his volar thumb and index finger. 1. Treatment involves immobilization or surgical fixation depending on location, severity and alignment of injury. Hamate Body Fractures are rare carpal fractures that can be associated with 4th or 5th metacarpal fractures. 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. Radiographs are shown in Figures A and B. What is the most likely etiology of her new loss of function? A 67-year-old woman slips on the ice while retrieving her mail and lands on her outstretched left hand. Lunate Dislocation - Core EM (OBQ12.244) Urgent reduction and surgical repair of disrupted ligaments is required to prevent long-term joint dysfunction. Like the scaphoid bone, the lunate also has a tenuous retrograde blood supply off of an interosseus arterial branch, and it has the same inherent risk of poor healing and AVN . Like the scaphoid bone, the lunate also has a tenuous retrograde blood supply off of an interosseus arterial branch, and it has the same inherent risk of poor healing and AVN . Electromyography and nerve conduction velocity studies, AP and lateral radiographs of the forearm, (SAE07SM.78) Post-operatively she is given a prescription with the goal of mitigating a potential adverse outcome. It can be caused by multiple factors such as: Damage to the lunate can lead to pain and stiffness. There is no single cause of Kienbocks disease. Barton's fracture - WikEM A 65-year-old female sustains a fall onto her outstretched right hand. Depressed fracture of the lunate fossa (articular surface) Smith's. When he finally does, he is diagnosed with a perilunate dislocation and indicated for a Proximal Row Carpectomy (PRC). The proximal 2 Cs indicates the articulation between the lunate and . Current radiographs are shown in Figure D and a clinical photograph of the affected wrist is shown in Figure E. Which of the following is the most likely cause for failure of fixation in this patient? Thieme Medical Pub. Volar Barton's Fractures : Wheeless' Textbook of Orthopaedics Lunate fractures are often secondary to axial loading of the head capitate bone,this is seen in forceful hyperextension with ulnar deviation 2. (SBQ17SE.75) Management should consist of. The combination of a capitate fracture and a scaphoid waist fractureis known as "scaphocapitate syndrome" . - knowing position of ECU & ulnar styloid helds to differentiate ECU tendinitisfrom distal radioulnar problems. . The instrument touches a structure that prevents ulnar translocation of the carpus after a PRC. (OBQ09.227) Reference article, Radiopaedia.org (Accessed on 04 Mar 2023) https://doi.org/10.53347/rID-80825, see full revision history and disclosures, Mayfield classification of carpal instability, dorsal intercalated segment instability (DISI), volar intercalated segment instability (VISI), scaphoid nonunion advanced collapse (SNAC), triangular fibrocartilaginous complex (TFCC) injuries, ulnar-sided wrist impaction and impingement syndromes, calcium pyrophosphate dihydrate deposition disease. You can rate this topic again in 12 months. What is the appropriate surgical treatment at this time? Figure A is an intraoperative photo. Diagnosis requires careful evaluation of plain radiographs. He sustained 2 minor falls over the next 6 years and his wrist pain recurred. Lunate fractures are relatively uncommon, representing about 4 percent of all carpal bone injuries [ 1-4 ]. ADVERTISEMENT: Supporters see fewer/no ads. - w/ flexion and extension lunate/capitate articulation may be felt; There may be other associated injuries that require further investigation via cross-sectional imaging 1,2. Lunate Dislocation (Perilunate dissociation) - Hand - Orthobullets Ulnar gutter splint/cast. Dr. Wheeless enjoys and performs all types of orthopaedic surgery but is renowned for his expertise in total joint arthroplasty (Hip and Knee replacement) as well as complex joint infections. commonly missed (~25%) on initial presentation, occurs when wrist extended and ulnarly deviated, disruption of capitolunate articulation -->, disruption of lunotriquetral articulation -->, failure of dorsal radiocarpal ligament -->, ligamentous disruptions with associated fractures of the radius, ulnar, or carpal bones, lunate stays in position while carpus dislocates, lunate forced volar or dorsal while carpus remains aligned, major stabilizers of the proximal carpal row, ligaments the both originate and insert among the carpal bones, + lunotriquetral disruption, "perilunate", Lunate dislocated from lunate fossa (usually volar), median nerve symptoms may occur in ~25% of patients, most common in Mayfield stage IV where the lunate dislocates into the carpal tunnel, due to palmar rotation from dorsal force of carpus, loss of colinearity of radius, lunate, and capitate, no indications when used as definitive management, universally poor functional outcomes with non-operative management, emergent closed reduction/splinting followed by open reduction, ligament repair, fixation, possible carpal tunnel release, decreased grip strength and stiffness are common, chronic injury (defined as >8 weeks after initial injury), not uncommon, as initial diagnosis frequently missed, chronic injuries with degenerative changes, finger traps, elbow at 90 degrees of flexion, dorsal dislocations are reduced through wrist extension, traction, and flexion of wrist, longitudinal incision centered at Lister's tubercle, excellent exposure of proximal carpal row and midcarpal joints, extended carpal tunnel incision just proximal to volar wrist crease, some believe volar ligament repair not necessary, difficulty regaining digital flexion and grip, controversy of k-wire versus intraosseous cerclage wiring, repair of lunotriquetral interosseous ligament, decision to repair based on surgeon preference as no studies have shown improved results, short arm thumb spica splint converted to short arm cast at first post-op visit, duration of casting varies, but at least 6 weeks, perform via dorsal and volar incisions if median nerve compression is present, volar approach allows median nerve decompression with excision of lunate, dorsal approach facilitates excision of the scaphoid and triquetrum, radiodense appearance of the lunate on radiograph reported in up to 12.5% of cases, usually identified 1-4 months post-injury, - 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). Wrist with Kienbock's disease and ulna that is short compared to radius, Using this search tool means you agree to the, 2023 American Society for Surgery of the Hand, from the American Society for Surgery of the Hand, Decreased motion or stiffness of the wrist. Perilunate fracture-dislocations of the wrist. Surgery may be done to change forces across the lunate and wrist joint or to improve vascularity of the lunate. Scaphoid Lunate Advanced Collapse (SLAC) d escribes the specific pattern of degenerative arthritis seen in chronic dissociation between the scaphoid and lunate. The swelling often causes a decrease in 2-point discrimination in the median nerve distribution due to acute carpal tunnel syndrome. It is the second most common carpal bone injury in children 1. The lunate is an important stabilizer of the wrist, fractures can lead to ligamentous injury and overall volar intercalated segment instability. The lunate is one of the eight small bones in the wrist. The patient undergoes open reduction and internal fixation of the fracture. Lunate fractures account for around 4% of all carpal fractures 1. Indications. Capitate fractures account for 1-2% of all carpal fractures 1,2. According to meta-analysis and systematic reviews, which of the following statements is most accurate regarding her injury? Alendronate 700mg once per week for 3 months, Alendronate 70mg once per week for 3 months.