  Case of the Week - Patient Summary 7067Peer Reviewed and Certified - | |
| Demographics: 23 y.o. man | |
| History & Chief complaint: | |
| 23-year-old male with left wrist pain following fall on outstretched hand (FOOSH). | |
| Physical exam and Laboratory: | |
| TTP left wrist with decreased ROM. | |
| Summary of Findings: | |
| Frontal radiograph of the wrist shows a "pie shaped" lunate. Lateral radiograph shows the lunate to be tilted and dislocated volarly, with the capitate remaining nearly collinear with the radius. There is an associated ulnar styloid fracture visible on both images. | |
| Differential Diagnosis: | |
| Lunate dislocation (stage IV injury)
Midcarpal dislocation (stage III injury) (There is often overlap of radiographic appearance of these two entities.) | |
| Diagnosis: | |
 Lunate dislocation | |
| Confirmed by: Radiographic Diagnosis | |
| Treatment and Followup: | |
| Surgical repair (K-wire fixation). | |
| Dislocations of bones in the wrist usually occur following a fall on an outstretched hand (FOOSH), accounting for 10% of carpal injuries. Dislocation of any of the bones can occur but the lunate is most commonly dislocated. These dislocations are divided into lunate, perilunate, and midcarpal dislocations. These designations are based on the position of the lunate or adjacent carpals in reference to the radius. Disruption of the ligaments attached to the lunate leads to these different types of dislocation. Severity of a dislocation is staged on a scale of I-IV with I being the least severe and IV corresponding to the worst.
Staging of Wrist Dislocations: Although this case presented as a lunate dislocation it should be pointed out that perilunate dislocations are 2-3 times more likely than a lunate dislocation and are usually associated with a transverse fracture of the scaphoid. | |
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