2.  67 yo F presents after
losing control of her walker
and falling forward onto
her outstretched, extended
right hand. Pt complains of
10/10 pain in the wrist and
inability to move her wrist.
Denies any other injuries
 T 98.4 P 87 BP 156/88 O2
97%
 Gen: age approp female in
obv pain but NAD
 MSK: profound swelling of
right wrist, no laceration,
2+ distal pulses. TTP over
right wrist and prox right
metacarpals.
 Neuro- limited
flexion/extension of right
wrist, otherwise 5/5
strength, nl sensation

4. Posterior dislocation of capitate and distal carpal row with lunate in nl
position

5.  Pain Management
 Reduction of carpal dislocation with longitudinal
traction and dorsal pressure
 Ortho consultation needed as often associated carpal
fx present and significant ligamentous injury requiring
open repair

6.  Often missed due to inadequate radiographs
 Important to get good lateral view to see dislocation
 High frequency of associated carpal fractures, usually
scaphoid or radial styloid
 Must be cautious of median nerve palsy; can have an
acute carpal tunnel syndrome
 Immediate ortho consultation preferred

8.  http://www.wheelessonline.com/ortho/perilunate_dislocat
ion
 http://radiopaedia.org/articles/perilunate-dislocation
 http://www.eorif.com/WristHand/perilunatedislocation.ht
ml
 http://www.ispub.com/journal/the_internet_journal_of_or
thopedic_surgery/volume_8_number_1_8/article/concomi
tant_elbow_and_perilunate_dislocation_floating_forearm.
html
 http://www.feinberg.northwestern.edu/emergencymed/res
idency/ortho-
teaching/wrist/case67/case67background.html