Wrist Dislocation in Emergency Medicine Treatment & Management

  • Author: Michael S Beeson, MD, MBA, FACEP; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Apr 18, 2011
 

Prehospital Care

  • Prehospital care includes assessment for other injuries that may accompany the wrist injury.
  • If no other injuries are identified, splint the wrist.
  • Patients may be transported in their private vehicles, but the prehospital provider must emphasize the potential seriousness of the injury.
  • Under no circumstances should a prehospital provider attempt a reduction of a suspected wrist dislocation. It may be a distal radius fracture, which requires significant care to reduce.
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Emergency Department Care

  • Patients with wrist injuries have an entire spectrum of possible injuries that represent potential disability.
  • Although no specific fracture or dislocation may be seen on x-ray, carpal instability still may be present.
  • Therefore, splint with plaster even if no injury is found on x-ray.
  • Carefully splint with AP splints to the fingers until a hand specialist can evaluate the injury.
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Consultations

  • Patients in whom a wrist dislocation has been identified require referral to a hand specialist who is either an orthopedic or plastic surgeon, depending on local custom.
  • Wrist dislocations may be reduced by emergency physicians, but only after consulting with the hand specialist.
  • The patient's own primary care physician may follow up, but it is important to stress to the primary care physician the need for hand specialist referral.
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Contributor Information and Disclosures
Author

Michael S Beeson, MD, MBA, FACEP  Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine and Pharmacy; Attending Faculty, Akron General Medical Center

Michael S Beeson, MD, MBA, FACEP is a member of the following medical societies: American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, National Association of EMS Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

James E Keany, MD, FACEP  Medical Director, TravelMDAssist; Staff Physician, Department of Emergency Services, Mission Hospital Regional Medical Center

James E Keany, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American College of Sports Medicine, and California Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

David B Levy, DO, FACEP, FAAEM  Chairman, Department of Emergency Medicine, St Elizabeth Health Center; Associate Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine

David B Levy, DO, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Medical Informatics Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

References

  1. Hayden SR. A case of peri-lunate dislocation. J Emerg Med. Mar-Apr 1995;13(2):241. [Medline].

  2. Carter PR. Fractures and dislocations of the wrist. In: Common Hand Injuries and Infections. 1983:123-141.

  3. Mital RC, Beeson M. The Wrist and Forearm. Emergency Radiology. 1999;47- 75.

  4. Rockwood CA, Jr, Green DP, Bucholz RW. Fractures and dislocations of the wrist. In: Fractures in Adults. Lippincott Williams & Wilkins Publishers; 1996:745-867.

  5. Sochart DH, Birdsall PD, Paul AS. Perilunate fracture-dislocation: a continually missed injury. J Accid Emerg Med. May 1996;13(3):213-6. [Medline].

  6. Perron AD, Brady WJ, Keats TE, Hersh RE. Orthopedic pitfalls in the ED: lunate and perilunate injuries. Am J Emerg Med. Mar 2001;19(2):157-62. [Medline].

  7. Kannikeswaran N, Sethuraman U. Lunate and perilunate dislocations. Pediatr Emerg Care. Dec 2010;26(12):921-4. [Medline].

 
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Dislocations, wrist. Lateral view of a lunate dislocation, with the classic teacup sign.
Dislocations, wrist. Anteroposterior (AP) view of a lunate dislocation.
 
 
 
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