Trans-scaphoid perilunate fracture dislocation: 'notjust a scaphoid fracture

Description

Perilunate dislocations are uncommon high-energy injuries which are missed in approximately 25% of cases on initial presentation.1 We present the X-rays of a 25-year-old man who fell from a height of approximately 2 metres onto an extended wrist. Plain radiographs (figure 1) show classical signs of a trans-scaphoid perilunate fracture dislocation. Pre-reduction, he had median nerve symptoms which settled with reduction and elevation. Reduction was performed in the emergency department with analgesia/sedation.

Figure 1

Posteroanterior and lateral pre-reduction radiographs of the wrist.

The sequence of events in this injury is well described: (1) the force begins radially and passes through the scaphoid causing it to fracture; (2) the force is transmitted ulnarly through the lunocapitate interval, and the lunate projects through the space of Poirier (between the intercarpal ligaments volar to the bones); (3) the distal portion...

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