Procedure 71 Open Reduction and Acute Repair of Perilunate Fracture-Dislocations
Examination/Imaging
Clinical Examination
Imaging
Lunate and perilunate dislocations are occasionally missed in the emergency room and dismissed as a severe wrist sprain despite having adequate imaging. Therefore, it is essential to obtain a thorough radiographic examination and scrutinize the images to prevent missing an acute injury.
A standard radiographic series of the wrist must be obtained to evaluate for dislocation. Assess for disruption of Gilula arc lines on the posteroanterior image. On a lateral radiograph, the radial shaft, lunate, capitate, and metacarpal shafts should be collinear (Fig. 71-1).
Radiographs should also be inspected to rule out associated radial styloid, scaphoid, capitate, or triquetral fractures (Fig. 71-2).
Computed tomography can help better define any questionable fractures of the carpal bones.
Surgical Anatomy
The dorsal radiocarpal and intercarpal ligaments are frequently ruptured in these severe injuries (Fig 71-3A).
The strong volar ligaments have a characteristic transverse rent that is repaired through the volar approach (Fig. 71-3B).
The lunate dislocates through the space of Poirier, a relatively weak region of the volar capsule just below the arc of the radioscaphocapitate and ulnocapitate ligaments (see Fig. 71-3B).
The dorsal portion of the scapholunate ligament is the thickest and strongest portion of the C-shaped ligament and should be repaired if adequate ligament tissue is present (Fig. 71-3C).
