EMERGENCY – Long case 2

47-year-old male, fall on outstretched hand.

What do you see?
Pain. Fracture?

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Findings:

* The lunate is displaced and rotated volarly and there is no normal alignment with the radius, consistent with lunate dislocation (stage IV carpal dislocation).

* Lunate dislocations are relatively uncommon and typically occur in young adults with high energy trauma resulting in loading of a dorsiflexed wrist. 

* There is injury of all of the perilunate ligaments, most significantly the dorsal radiolunate ligament. 

Teaching point:
Be sure it is a lunate dislocation, and not a perilunate dislocation (stage II carpal dislocation)! In this case, the lunate remains in normal alignment with the distal radius, but the carpus is dislocated dorsally relative to the lunate. This injury has 60% association with scaphoid fractures.

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