Perilunate Fracture Dislocations Clinical Presentation

Updated: Oct 29, 2018
  • Author: Peter M Murray, MD; Chief Editor: Harris Gellman, MD  more...
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Presentation

History and Physical Examination

Most patients present acutely after a fall from a height onto a dorsiflexed wrist. Patients with perilunate dislocations and perilunate fracture dislocations may demonstrate obvious clinical deformities, such as marked swelling, or they can present rather innocuously, complaining of a sprained wrist. In the dorsal perilunate dislocation or one of its transosseous variants, the carpus is dislocated dorsally, and the radius is prominent volarly; in the pure lunate dislocation, the lunate alone is prominent volarly. These injuries are diagnosed late in as many as 25% of cases.

Because of the high-energy nature of perilunate fracture dislocations, a careful, thorough trauma survey with assessment for associated injuries of the head, thorax, and extremities is imperative. Damage to the median nerve is the most common associated injury in lunate and perilunate dislocations of the wrist. In certain situations, volar skin lacerations could represent an open dislocation or fracture dislocation.

Additionally, the volar skin can become ischemic because of pressure from the volar radius (resulting from dorsal dislocation of the hand). With long-standing perilunate dislocations, patients may present with arterial compromise or established compartment syndromes.