Abstract
Background Reverse perilunate injuries (REPLI) are rare variants of the classic radial-sided
perilunate injuries (PLI) whose mechanism was described by Mayfield in 1980. Classic
radial-sided nontranscaphoid dorsal PLI invariably display a flexed, foreshortened
position of the scaphoid on their initial posteroanterior (PA) and lateral radiographs.
We observed that some dorsal perilunate dislocations displayed an extended position of the scaphoid on their initial radiographs. Our hypothesis is that this
extended position of the scaphoid was associated with a REPLI pattern.
Methods The PA and lateral initial emergency radiographs of our specialized wrist surgery
series of 114 dorsal pure ligamentous PLI (within a 186 cases series of PLI treated
between 2004 and 2020) were reviewed as well as the available figures of the current
REPLI literature.
Results A total of seven cases of cases within our dorsal PLI series displayed an extended
position of the scaphoid on their initial PA and lateral radiographs, while 107 cases
displayed a flexed, foreshortened position. The PA and lateral radiographs available
in the REPLI literature displayed an extended position of the scaphoid, a lunotriquetral
dissociation, and a dorsal dislocation of the capitate with respect to the lunate.
Discussion This study confirms our hypothesis. By contrast to the dorsal classic radial-sided
pure ligamentous PLI pattern of scaphoid displacement (scaphoid flexed and foreshortened
with scapholunate gap), the dorsal REPLI pattern displays an extended position of
the scaphoid with scapholunate step-off and overlap rather than a gap. The combination
of a lunotriquetral dissociation with a dorsal dislocation of the capitate from the
lunate yet an extended position of the scaphoid with almost normal radioscaphoid relationships
should raise a high suspicion for REPLI.
Keywords
reverse perilunate dislocation - wrist - carpus - perilunate injuries
