Download PDF
J Hand Microsurg
DOI: 10.1055/s-0043-1768481
Case Report

Open Dislocation of the Lunate and Triquetrum: A Case Report

Gavrielle Hui-Ying Kang 
1   Department of Hand and Reconstructive Microsurgery, Tan Tock Seng Hospital, Singapore, Singapore
,
Lam Chuan Teoh
1   Department of Hand and Reconstructive Microsurgery, Tan Tock Seng Hospital, Singapore, Singapore
› Author Affiliations Funding None.
› Further Information
    Permissions and Reprints

Abstract

The Mayfield sequence of progressive perilunar instability is commonly encountered. A reverse-perilunate sequence has also been described, where forces are transmitted from the ulnar wrist, resulting in progressive disruption of the ulnocarpal and lunotriquetral intervals. A concomitant dislocation of both the lunate and triquetrum together is a rare injury and has not been reproduced in cadaver models nor widely encountered in clinical cases. We report a rare case of an open volar dislocation of the lunate and triquetrum, and outline the management principles and outcomes in our patient. This case highlights that not all perilunar injuries occur in the conventional sequence. Differing paths of force transmission may result in atypical patterns of carpal disruption. Nonetheless, the broad management principles are similar. Achieving carpal reduction and stabilization, soft-tissue coverage, and early rehabilitation results in reasonable patient outcomes.

Keywords

perilunate dislocation - carpal dislocation - wrist dislocation

Ethical Approval

Tan Tock Seng Hospital does not require ethical approval for reporting individual cases or case series.


Informed Consent

Written informed consent was obtained from the patient(s) for their anonymized information to be published in this article.




Publication History

Article published online:
22 May 2023

© 2023. Society of Indian Hand Surgery & Microsurgeons. All rights reserved.

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Mayfield JK, Johnson RP, Kilcoyne RK. Carpal dislocations: pathomechanics and progressive perilunar instability. J Hand Surg Am 1980; 5 (03) 226-241
    CrossrefPubMedGoogle Scholar
  • 2 Murray PM, Palmer CG, Shin AY. The mechanism of ulnar-sided perilunate instability of the wrist: a cadaveric study and 6 clinical cases. J Hand Surg Am 2012; 37 (04) 721-728
    CrossrefPubMedGoogle Scholar
  • 3 Fowler JL. Dislocation of the triquetrum and lunate: brief report. J Bone Joint Surg Br 1988; 70 (04) 665-665
    CrossrefPubMedGoogle Scholar
  • 4 Nowalk MD, Logan SE. Distinguishing biomechanical properties of intrinsic and extrinsic human wrist ligaments. J Biomech Eng 1991; 113 (01) 85-93
    CrossrefPubMedGoogle Scholar
  • 5 Berger RA. The ligaments of the wrist. A current overview of anatomy with considerations of their potential functions. Hand Clin 1997; 13 (01) 63-82
    PubMedGoogle Scholar
  • 6 Krief E, Appy-Fedida B, Rotari V, David E, Mertl P, Maes-Clavier C. Results of perilunate dislocations and perilunate fracture dislocations with a minimum 15-year follow-up. J Hand Surg Am 2015; 40 (11) 2191-2197
    CrossrefPubMedGoogle Scholar