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CC BY-NC-ND 4.0 · J Wrist Surg
DOI: 10.1055/s-0044-1786160
Case Report

Traumatic Ulnar Carpal Translocation, Distal Radioulnar Joint Subluxation with Occult Perilunate Injury

Timothy Visser 
1   Department of Orthopaedics and Rehabilitation, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
,
Mikayla Borusiewicz
2   Division of Plastic Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
,
Alexander Payatakes 
1   Department of Orthopaedics and Rehabilitation, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
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Abstract

Background Perilunate injuries pose a significant treatment challenge, particularly when initially missed or underestimated. These injuries have a multitude of variations as propagation of the injury may be through ligaments and/or bone, with more recent appreciation given to nondislocated perilunate injuries.

Case Description We present a new variant of perilunate injuries, not dislocated (PLIND). This occult ligamentous perilunate injury was associated with ulnar carpal translocation, radiocarpal subluxation, and distal radioulnar subluxation. The extent of injury was fully appreciated intraoperatively, with only subtle clues present on preoperative exam and imaging, emphasizing the high index of suspicion required to identify these injuries. Clinical outcome at 1-year follow-up was very satisfactory.

Literature Review PLIND consist a distinct subset within the spectrum of perilunate injuries in which there is no observed disruption of the capitolunate relationship. Based on few cases reported in the literature (attributable to their rare occurrence and likely additional lack of awareness surrounding the injury pattern), current recommendations for surgical management include arthroscopic or open approach to appropriately address osseous and ligamentous injuries.

Clinical Relevance Recognition of PLIND injuries is challenging given the lack of frank dislocation of the capitate head on the lunate, as observed in classic perilunate injuries. Heightened clinical suspicion in patients with consistent mechanism and presentation, followed by timely surgical management, may limit sequelae of persistent instability and arthritis. Our case contributed to relevant literature by presenting a previously undescribed PLIND variant combined with radiocarpal instability, ulnar carpal translocation, and distal radioulnar subluxation.

Keywords

perilunate injuries - radiocarpal instability - carpal instability - PLIND


Publication History

Received: 29 November 2023

Accepted: 27 March 2024

Article published online:
24 April 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Herzberg G, Comtet JJ, Linscheid RL, Amadio PC, Cooney WP, Stalder J. Perilunate dislocations and fracture-dislocations: a multicenter study. J Hand Surg Am 1993; 18 (05) 768-779
    CrossrefPubMedGoogle Scholar
  • 2 Herzberg G. Perilunate injuries, not dislocated (PLIND). J Wrist Surg 2013; 2 (04) 337-345
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Kozin SH. Perilunate injuries: diagnosis and treatment. J Am Acad Orthop Surg 1998; 6 (02) 114-120
    CrossrefPubMedGoogle Scholar
  • 4 Fisher ND, Bi AS, De Tolla JE. Perilunate dislocations: current treatment options. JBJS Rev 2022;10(09):
    PubMedGoogle Scholar
  • 5 Johnson RP. The acutely injured wrist and its residuals. Clin Orthop Relat Res 1980; 149 (149) 33-44
    CrossrefPubMedGoogle Scholar
  • 6 Kailu L, Zhou X, Fuguo H. Chronic perilunate dislocations treated with open reduction and internal fixation: results of medium-term follow-up. Int Orthop 2010; 34 (08) 1315-1320
    CrossrefPubMedGoogle Scholar
  • 7 Herzberg G. Perilunate and axial carpal dislocations and fracture-dislocations. J Hand Surg Am 2008; 33 (09) 1659-1668
    CrossrefPubMedGoogle Scholar