My Orthopaedic Surgeon

Perilunate dislocations and perilunate fracture dislocations are the most devastating closed injuries of the wrist.1, 2, 3 They are often missed on initial evaluation, leading to devastating complications. These injuries occur as the final stage of a spectrum of injuries progressing around the wrist in a radial-to-ulnar direction. In the setting of a high-energy wrist injury, radiographs must be carefully scrutinized for the presence of the perilunate dislocation or one of its variants. Prompt open reduction with ligamentous repair or reconstruction is necessary to achieve favorable results. Posttraumatic arthrosis may result following these injuries irrespective of treatment, requiring a late salvage operation.
Synonyms and related keywords: perilunate dislocations, de Quervain fracture, de Quervain's fracture, retro-lunate dislocation, retrolunate dislocation, carpal instability complex, wrist injury, wrist pain, carpal instability dissociative, CID, dorsal intercalated segment instability, DISI, volar intercalated segment instability, VISI, carpal instability nondissociative, CIND
Author: Peter M Murray, MD, 2008

Carpal dislocations represent a continuum of wrist injury that can lead to lunate or perilunate dislocation. The lunate cup commonly is directed in a volar direction in dislocation because of the mechanism of the injury. Perilunate dislocations result from dislocation of the distal carpal row. The capitate normally rests within the lunate cup, as seen on a lateral view. With perilunate dislocations, the capitate is seen most commonly as dorsal, but it also may be volar to the lunate on lateral x-ray evaluation. As a result of the stresses involved, scaphoid fractures often accompany perilunate dislocation. Carpal instability may take many forms and represents a spectrum of injury including scapholunate dissociation, lunate and perilunate dislocations, scaphoid fracture, and other intercarpal instabilities.
Author: Michael S Beeson, MD 2004

Wrist injuries are common among athletes. Emergency physicians or family practitioners frequently perform the initial evaluation of wrist injuries and determine the initial treatment. Recognizing wrist dislocations early and properly referring patients with wrist dislocations can prevent complications, including prolonged pain and discomfort, surgery, and lost time from sports participation.
Synonyms and related keywords: lunate dislocation, perilunate dislocation, scapholunate dislocation, hyperextension injury of the wrist, carpal injury
Halimi, Jones & Lichota 2006