Perilunate Dislocation

On lateral wrist XR, the capitate ("apple") should sit in the lunate ("tea cup") which should articulate with the distal radius ("saucer"). In perilunate dislocation, the capitate is dislocated dorsally and no longer sitting in the lunate. Here's quick summary:

 • Dorsal dislocation of the capitate 

 • Lunate articulates with the distal radius "saucer" but capitate "apple" does not sit in lunate "tea cup" 

 • Mechanism: Fall onto outstretched hand 

 • Exam: tenderness and swelling to dorsal wrist, pain with wrist extension 

 • Possible associated injuries: Carpal fracture (scaphoid most commonly, 60%; also trapezium, capitate, triquetrum), radial styloid fracture, median nerve injury 

 • ED Management: Pain control, sedation and emergent reduction 

 • Splint: Sugar tong 

 • Ortho consult: Yes 

 • Disposition: Pending orthopedic recommendations; ill ultimately need operative repair 



MH/CCF/CWRU EM Res @MetroHealth_EM



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