Five cases of perilunate fracture-dislocation are presented in which the radiological appearances were typical but the diagnoses were initially missed. A simple systematic method of x ray analysis is described.

THE PATIENT A 37-year-old man injured his right wrist in a motor vehicle collision. In the emergency department he had severe wrist pain and median nerve paresthesia. Wrist radiographs identified a dorsal perilunate dislocation (PLD) with the carpus dislocated dorsally and the lunate tilted volar but still located in the lunate fossa. Post-reduction computed tomography scan confirmed no fractures.

Figure 1. Radiograph demonstration of a perilunate dislocation: The lunate maintains its normal articulation with the radius, whereas the capitated articular surface is dislocated from the lunate dorsally. Figure 2. Diagrammatic representation of the 3 carpal arcs of Gilula's lines. The first arc is a smooth curve outlining the proximal convexities of the scaphoid, lunate, and triquetrum. The s...

AbsractAll perilunate fracture-dislocations combine bone avulsions, ligament disruptionand fractures in different forms. The most frequent pattern is the dorsal transscaphoidperilunate fracture-dislocation. The reported risk of missed initial diagnosisin perilunate dislocations is as high as 20%. Concerning pathomechanics of theperilunate fracture-dislocation, it should be noted that most dorsa...

Isolated injury of the lunotriquetral interosseous ligament complex and associated structures is less common and is poorly understood compared with the other proximal-row ligament injury, scapholunate dissociation. The spectrum of injuries ranges from isolated partial tears to frank dislocation, and from dynamic to static carpal instability. The diagnosis may be difficult to establish because o...

According to Melsom and Leslie, the earliest description of perilunate dislocation was by Malgaigne in 1855, before the advent of radiography [7]. It later was described by Cousins, Destot, de Quervain, and others [7]. According to Melsom and Leslie [7] Tavernier reported the first series in 1906. Many years later, in 1968, the concept of the proximal row as an intercalated segment was describe...

absractall perilunate fracture-dislocations combine bone avulsions, ligament disruptionand fractures in different forms. the most frequent pattern is the dorsal transscaphoidperilunate fracture-dislocation. the reported risk of missed initial diagnosisin perilunate dislocations is as high as 20%. concerning pathomechanics of theperilunate fracture-dislocation, it should be noted that most dorsa...