Cleveland Combined Hand Fellowship Lecture Series 2019-2020, Fractures of the Other Carpal Bones - Austin Pitcher, MD. According to meta-analysis and systematic reviews, which of the following statements is most accurate regarding her injury? The lunate is one of the eight small bones in the wrist. A 24-year-old stagehand fell 12 feet off of a ladder while preparing a set. Which of the following radiographic views shown in Figures A to E would be most helpful in establishing the diagnosis? (SAE07SM.38) Difficult wrist fractures. (SBQ17SE.12) Radiographs are shown in Figures A and B. Pearls/pitfalls. whilst on the lateral the capitate no longer sits in the lunate. J Hand Surg Am. Following fixation, a "shuck" test is performed and shows persistent instability of the distal radioulnar joint. Lunate dislocations typically occur due to a fall on an outstretched hand (or during a motor vehicle injury) where there is forceful dorsiflexion of the wrist 3. (2005) ISBN:0781745861. The rest of the carpal bones are in a normal anatomic position in relation to the radius. 14% (259/1911) 2. The black dot in the photo is the capitate. Isolated capitate fractures are rare (scaphoid is most common associated fracture) Occurs via forceful dorsiflexion of hand (FOOSH injury) with impact on radial side; Proximal fracture fragment at risk for avascular necrosis; Clinical Features. 73% (1391/1911) 3. A 17-year-old male falls from a retaining wall onto his left arm. Inability to extend the thumb interphalangeal joint. Inability to extend the index finger proximal interphalangeal joint. Chronic DISI deformities may be indicated for fusion procedures depending on degree of arthritis and patient symptoms. {"url":"/signup-modal-props.json?lang=us"}, Murphy A, Lunate fracture. (SBQ17SE.13) Overall, carpal dislocations comprise less than 10% of all wrist injuries. Displaced impaction fracture of the lunate fossa, Displaced intra-articular fracture with a fragment consisting of the volar-ulnar corner, Displaced extra-articular fracture with apex volar, Displaced extra-articular fracture with apex dorsal. Diagnosis requires careful evaluation of plain radiographs. 1. What complication is most likely to occur in this patient? . A fracture to the lunate may also be associated with injury to the TFCC. These should not be confused with perilunate dislocations in which the radiolunate articulation is preserved and the rest of the carpus is displaced dorsally. (SBQ17SE.47) Towson, MD 21204 Diagnosis can be confirmed with orthogonal radiographs of the involve digit. Diagnosis is made clinically and radiographically with orthogonal radiographs of the wrist, Treatment can be nonoperative or operative depending on fracture stability and fracture displacement as well as patient age and activity demands, accounts for 17.5% of all fractures in adults, younger patients due to high energy mechanisms, older patients due to low energy mechanisms (i.e. Around 20% of patients possess a single-vessel supply to their lunate hence there is an increased possibility of avascular necrosis, the remaining cohort typically has a two-vessel supply and intraosseous anastomosis 2. She was seen in the emergency department at the time of injury and was told she had a sprain. There is no single cause of Kienbocks disease. Nerve compression; open reduction internal fixation with open carpal tunnel release, Nerve laceration; open reduction internal fixation with primary nerve repair or grafting, Decreased arterial inflow; fasciotomy with open reduction internal fixation, Nerve compression; repeat closed reduction. Capitate fractures are classified by the anatomic location of the fracture, along with what other concomitant injuries may be present. When performed on 18 children with distal radius-ulna fractures, P . Phalanx Fractures are common hand injuries that involve the proximal, middle or distal phalanx. In the Traumatological Hospital Meidling/Vienna, 12 patients with acute fractures of the lunate bone were treated between 1983 and 1993. Diagnosis is made with PA wrist radiographs showing widening of the SL joint. For more advanced stages, surgery is usually considered. Diagnosis is confirmed with either a radiographic carpal tunnel view or CT scan. A 35-year-old professional football player complains of severe wrist pain after making a tackle. Lunate. Scaphoid Lunate Advanced Collapse (SLAC) d escribes the specific pattern of degenerative arthritis seen in chronic dissociation between the scaphoid and lunate. He is not able to see a physician for 4 months. Copyright 2023 Lineage Medical, Inc. All rights reserved. A 45-year-old construction worker sustains a fall and presents with an isolated injury to his upper extremity. Figures A and B depict the closed injury radiograph of a 79-year-old right-hand-dominant woman who fell on her left wrist. He was taken to the local teaching hospital where radiographs were taken, shown in Figures A and B. The proximal 2 Cs indicates the articulation between the lunate and . Volar pole fractures are more commonly observed as the lunate is compressed by the capitate. - colinear alignment of: radius, lunate, capitate, & 3rd metacarpal; Treatment is nonoperative for non-displaced fractures but displaced or intra-articular fractures require ORIF. Diagnosis is generally made with radiographs of the wrist but may require CT for confirmation. Hip fractures are strongly associated with BMD in the proximal femur, but there are also many clinical predictors of hip fracture risk that are independent of bone density. Which of the following has evidence to support its utility in this clinical situation? Kienbocks disease is most common in men between the ages of 20 and 40. The most important differential is of other carpal dislocations, particularly: In addition to stating that a lunate dislocation is present, a number of features should be sought and commented upon: ensure that radiolunate alignment is disrupted, and that you are not looking at a perilunate dislocation(stage II carpal dislocation), evaluate and comment on the degree or palmar rotation of the lunate (this can be up to 270 degrees)4, ensure that the capitate remains co-linear with the long axis of the radius, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. A 56-year-old woman sustains the closed injury depicted in Figures A-B. Capitate fractures account for 1-2% of all carpal fractures 1,2. Mechanism of injury. If time has passed since injury, it can also lead to wrist arthritis. (OBQ06.102) He presents to your clinic and given his age and the fracture characteristics, he is taken for open reduction with volar locking plate fixation. Summary. Diagnosis is generally made with radiographs of the wrist but may require CT for confirmation. Lunate Dislocation (Perilunate dissociation), Gymnast's Wrist (Distal Radial Physeal Stress Syndrome), Scaphoid Nonunion Advanced Collapse (SNAC), Carpal Instability Nondissociative (CIND), Constrictive Ring Syndrome (Streeter's Dysplasia), Thromboangiitis Obliterans (Buerger's disease). Copyright 2023 Lineage Medical, Inc. All rights reserved. She also complains of some paresthesias in her thumb and index finger. arthroscopic repair and percutaneous pinning. DISI (dorsal intercalated segmental instability), scapholunate dissociation causes the scaphoid to flex palmar and the lunate to dorsiflex, if left untreated the DISI deformity can progress into a, DISI deformity may also develop secondary to distal pole of the scaphoid excision for treatment of STT arthritis, DISI is a form of carpal instability dissociative, c-shaped structure connecting the dorsal, proximal and volar surfaces of the scaphoid and lunate bones, dorsal fiber thickened (2-3mm) compared to volar fibers, dorsal component provides the greatest constraint to translation between the scaphoid and lunate bones, proximal fibers have minimal mechanical strength, Overview of wrist ligaments and biomechanics, acute FOOSH injury vs. degenerative rupture, age, nature of injury, duration since injury, degree of underlying arthritis, level of activity, pain increased with loading across the wrist (e.g. Diagnosis of DISI deformity can be made with lateral wrist radiographs showing a scapholunate angle > 70 degrees. (OBQ11.273) Hook of hamate fractures are rare, often missed, injuries generally as a result of a direct blow to the hamate bone most commonly seen in athletes. Copyright 2023 Lineage Medical, Inc. All rights reserved. SLAC (scaphoid lunate advanced collapse) and SNAC (scaphoid nonunion advanced collapse) are the most common patterns seen. Lunate Dislocation (Perilunate dissociation). Hamate Body Fractures are rare carpal fractures that can be associated with 4th or 5th metacarpal fractures. - it is palpable just distal to radial tubercle; Late treatment of a dorsal transscaphoid, transtriquetral perilunate wrist dislocation with avascular changes of the lunate. Epidemiology. A 67-year-old woman slips on the ice while retrieving her mail and lands on her outstretched left hand. (SBQ07SM.38) Wheeless' Textbook of Orthopaedics. Which of the following distal radius fractures is associated with volar translation of carpus relative to the radial articulation? Frequent questions. They often are not diagnosed initially and present delayed as lunate osteonecrosis, which is also known as Kienbock disease. A fracture to the lunate may also be associated with injury to the TFCC. Hip fracture A 56-year-old male presents to your clinic with a 4-month history of inability to extend the IP joint of his thumb. Type in at least one full word to see suggestions list, Hand Scaphoid Lunate Advanced Collapse (SLAC). A 40-year-old slips on the ice on a wintery Michigan day and sustains a comminuted intra-articular distal radius fracture. The patient recovered well initially but presents after 6 months with grip weakness. Improved functional outcomes with open reduction internal fixation (ORIF) through FCR approach vs. closed treatment, No difference in radiographic outcomes after ORIF vs. closed treatment, No difference in functional outcomes after ORIF vs. closed treatment, Improved functional outcomes with closed treatment vs. ORIF, Improved functional outcomes with external fixation and K wire fixation vs. ORIF. (2008) RadioGraphics. Which of the following interventions should be taken? Proper . 2.0 screw for a Scaphoid Hand Fracture How to palpate the . Read 14. A 46-year-old woman sustains an extra-articular fracture of the distal radius and undergoes open reduction and internal fixation with a volar plate and screw construct. Other common causes include: car . {"url":"/signup-modal-props.json?lang=us"}, Dixon A, Hacking C, El-Feky M, et al. The lunocapitate articulation may be disrupted resulting in a dorsal perilunate dislocation, or in the case of concomitant scaphoid fracture, the wrist may undergo a transscaphoperilunate dislocation. Barton's fracture: Dorsal intraarticular fracture which is often associated with dislocation at the radiocarpal joint. Radiographs taken in the emergency room are seen in Figure A. A radiograph is shown in Figure 21. Clifford R. Wheeless, III, M.D. Rathachai Kaewlai, Laura L. Avery, Ashwin V. Asrani, Hani H. Abujudeh, Richard Sacknoff, Robert A. Novelline. - lunate articulates proximally w/ radius and distally w/ capitate; sudden impact force applied to the hand and wrist causing SLIL injury and scapholunate dissociation, injury occurs most commonly with wrist positioned in extension, ulnar deviation and carpal supination, SLIL tearing will position the scaphoid in flexion and lunate extension. Recent radiographs are seen in Figure B. Surgical treatment that will best address his symptoms and preserve wrist motion consists of, Anterior and posterior interosseous neurectomy. diastasis of the scapholunate complex occurs with complete SLIL tears and capsule disruption. 2. 43 (1): 84-92. Around 60% of perilunate dislocations are associated with a scaphoid fracture which is then termed a trans-scaphoid perilunate dislocation . Scaphoid Lunate Advanced Collapse (SLAC) d. escribes the specific pattern of degenerative arthritis seen in chronic dissociation between the scaphoid and lunate. Fracture geometry, particularly a jagged bone spike, can present a physical barrier in closed reduction of pediatric distal radius-ulna fractures. His physical exam shows dorsal wrist tenderness and is positive for the provocative test shown in Figure V. Standard PA radiograph of the wrist is normal. Perilunate fracture-dislocations of the wrist. Most likely, the most reliable test to assess the blood supply of the lunate is Magnetic Resonance Imaging (MRI). lunate fracture orthobullets Stage IV denotes a true lunate dislocation, involving a . Upper extremity deep vein thrombosis (DVT), Lower extremity deep vein thrombosis (DVT). 2.Meenalochani Shunmugam, Joideep Phadnis, Amy Watts, Gregory I. Bain. (OBQ07.8) Evaluation of volar compartment pressures with a needle monitor, Icing and elevation of the arm with follow-up evaluation in 8 hours, Immediate EMG evaluation of the left upper extremity, Closed reduction, carpal tunnel release, and sugar tong splinting, Emergent open reduction internal fixation with carpal tunnel release. (OBQ09.254) (SBQ17SE.28) Which of the regions on the patient's injury AP radiograph in Figure A, if not addressed properly during surgery, represents a risk for radiocarpal instability? . The lunate is made up of the volar pole, body, and dorsal pole. On examination, her wrist is mildly swollen and she is unable to actively oppose her thumb. Distal Radius Intraarticular Fracture ORIF with Dorsal Approach, Distal Radius Extra-articular Fracture ORIF with Volar Appr, Distal Radius Fracture Non-Spanning External Fixator, Distal Radius Fracture Spanning External Fixator, Type in at least one full word to see suggestions list, 7th Annual Frontiers in Upper Extremity Surgery, Nonoperative Treatment of Distal Radius Fractures - Michael Bednar, MD, Dorsal Plating of Radius Fractures - Nader Paksima, DO, MPH, Fragment Specific Fixation Distal Radius Fractures - Mark Rekant, MD, 12th Annual Orthopaedic Trauma: Pushing The Envelope. Electromyography and nerve conduction velocity studies, AP and lateral radiographs of the forearm, (SAE07SM.78) Lunate Dislocation (Perilunate dissociation) . It can be caused by multiple factors such as: Damage to the lunate can lead to pain and stiffness. In this condition, the lunate bone loses its blood supply, leading to death of the bone. - it has large volar surface, & is displaced volarward w/ forceddorsiflexion of the wrist; Radiographs are provided in Figure A. You review his operative note in which the surgeon reports having to apply a volar locking plate in a distal position to secure the difficult intra-articular fracture. The lunate bone articulates with the scaphoid, the distal radius, and the TFCC. Which of the following will best achieve anatomic reduction, restore function, and prevent future degenerative changes of the wrist? He denies any new trauma, and has followed all post-operative activity restrictions. It works closely with the two forearm bones (the radius and ulna) to help the wrist move. Thieme Medical Pub. Diagnosis is made clinically with progressive wrist pain and wrist instability with radiographs showing advanced arthritis of the radiocarpal and midcarpal joints (radiolunate joint .
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