Wrist Dislocation in Emergency Medicine Follow-up

Updated: Feb 13, 2015
  • Author: Michael S Beeson, MD, MBA, FACEP; Chief Editor: Trevor John Mills, MD, MPH  more...
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Follow-up

Further Outpatient Care

Patients with lunate or perilunate dislocations, if reduced in the ED, may safely be discharged home with careful warnings of the potential for compartment syndrome, pain, and other postinjury conditions.

Close follow-up must be arranged with a hand specialist.

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Further Inpatient Care

Admission is not indicated for isolated wrist dislocation.

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Inpatient & Outpatient Medications

Because of the severity of pain, narcotic pain medication often is required for the first 3 days.

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Transfer

Transfer is required if the emergency physician is unable to achieve reduction and a hand specialist is not available to evaluate the injury.

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Complications

Vascular complications are unusual but may occur if an associated fracture is present, particularly of the distal radius.

Soft-tissue complications include carpal ligamentous disruption, which results in carpal instability.

Kienbock disease, avascular necrosis of the lunate, may occur following lunate dislocations, even if there is successful reduction in the ED.

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Prognosis

Many patients who sustain lunate or perilunate dislocation develop chronic wrist pain or wrist instability.

Remember that lunate and perilunate dislocations are part of a continuum of injury that arises from significant carpal ligamentous injury. This often results in chronic carpal instability.

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Patient Education

For excellent patient education resources, visit eMedicine's Breaks, Fractures, and Dislocations Center. Also, see eMedicine's patient education article, Wrist Injury.

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