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This is an AAOS Self Assessment Exam (SAE) question. Cleveland Combined Hand Fellowship Lecture Series 2019-2020, Fractures of the Other Carpal Bones - Austin Pitcher, MD. Patients present with wrist pain following a fall. Lunate fracturesare a carpal injury that if left untreated, can result in significant carpal instability. Lunate fractures account for around 4% of all carpal fractures 1. 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. (OBQ12.38) Both images from . Revista dedicada a la medicina Estetica Rejuvenecimiento y AntiEdad. Late treatment of a dorsal transscaphoid, transtriquetral perilunate wrist dislocation with avascular changes of the lunate. Fractures of the normal lunate--isolated or associated with fractures of the scaphoid or radius--are very rare. Lunate fractures and perilunate injuries - UpToDate His radiograph is shown in Figure A. Lunate dislocations are an uncommon traumatic wrist injury that require prompt management and surgical repair. - lunate, capitate, and the base of the 3rd metacarpal are in line w/each other & is covered by base of ECRB; Scapho-lunate advanced collapse arthritis or SLAC occurs as the result of unrecognised injury to the . Carpal dislocations: pathomechanics and progressive perilunar instability. (OBQ06.102) Perilunate dislocations and fracture-dislocations are relatively uncommon injury patterns in acute wrist trauma. There may be other associated injuries that require further investigation via cross-sectional imaging 1,2. Lunate dislocations are far less common than the less severe perilunate dislocation. The patient undergoes closed reduction and splinting; however, her paresthesias worsen significantly in the next 12 hours. Rathachai Kaewlai, Laura L. Avery, Ashwin V. Asrani, Hani H. Abujudeh, Richard Sacknoff, Robert A. Novelline. Like the scaphoid bone, the lunate also has a tenuous retrograde blood supply off of an interosseus arterial branch, and it has the same inherent risk of poor healing and AVN . (SBQ17SE.28) Trans-Scaphoid Perilunate Dislocation - Handipedia On physical exam she has no sensation of the volar thumb, index, and middle fingers. Scapholunate Ligament Injury is a source of dorsoradial wrist pain with chronic injuries leading to a form of wrist instability (DISI deformity). Radiographs are provided in Figure A. The injury is closed and she is neurovascularly intact. Which of the following injuries is the most likely cause of this finding? Treatment involves immobilization or surgical fixation depending on location, severity and alignment of injury. Lunate dislocationsare an uncommon traumatic wrist injury that require prompt management and surgical repair. Adhesions within the first and third dorsal wrist compartments. In the early stages of this disease, the x-rays may be normal and other tests are needed to confirm the diagnosis. Diagnosis is confirmed with either a radiographic carpal tunnel view or CT scan. Due to a fall onto a flexed wrist or a blow to the back of hand. Two hours following closed reduction, the deformity is corrected, but the numbness and wrist pain is worsening. He denies any new trauma, and has followed all post-operative activity restrictions. A 68-year-old male falls onto his outstretched hand and suffers the injury shown in Figures A and B. A 32-year-old ballet dancer sustains a distal radius fracture, and is subsequently closed reduced and casted. Hamate Body Fracture - Hand - Orthobullets Ulnar gutter splint/cast. Scaphoid Lunate Advanced Collapse (SLAC) - Hand - Orthobullets Management should consist of. Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. Barton's fracture: Dorsal intraarticular fracture which is often associated with dislocation at the radiocarpal joint. 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. 2023 Lineage Medical, Inc. All rights reserved. (OBQ06.136) What is the next best step in management of this patient? 73% (1391/1911) 3. The combination of a capitate fracture and a scaphoid waist fractureis known as "scaphocapitate syndrome" . Acetabular Fractures Anatomic And Clinical Considerations How do you counsel him about his post-operative period? Ulnar side of hand. Lunate fractures - OrthopaedicsOne Articles - OrthopaedicsOne The latter mechanism frequently occurs . On examination, her wrist is mildly swollen and she is unable to actively oppose her thumb. The lunate is an important stabilizer of the wrist, fractures can lead to ligamentous injury and overall volar intercalated segment instability. The lunate bone articulates with the scaphoid, the distal radius, and the TFCC. Classification. The lunate is displaced and rotated volarly. (OBQ08.179) 2023 Lineage Medical, Inc. All rights reserved. AP and lateral radiographs of the wrist are shown in figures A and B respectively. Die-punch. 2.0 screw for a Scaphoid Hand Fracture How to palpate the . 4. Treatment is nonoperative for non-displaced fractures but displaced or intra-articular fractures require ORIF. Diagnosis of DISI deformity can be made with lateral wrist radiographs showing a scapholunate angle. Stage IV denotes a true lunate dislocation, involving a . Difficult wrist fractures. Lunate dislocation. Perilunate dislocations typically occur in young adults with high energy trauma resulting in the loading of a hyperextended, ulnarly deviated hand. (SBQ17SE.64) (OBQ04.233) Limited open reduction of the lunate facet in comminuted intra-articular fractures of the distal radius. - colinear alignment of: radius, lunate, capitate, & 3rd metacarpal; Capitate fractures are typically seen with associated scaphoid fractures, distal radial fractures, or lunate injuries; they are rarely seen in isolation. Lunate Fracture - an overview | ScienceDirect Topics He was treated as a sprain and no further follow-up was planned. (OBQ05.25) Which of the following radiographic views shown in Figures A to E would be most helpful in establishing the diagnosis? This medication is given in an effort to decrease the incidence of which of the following? (2005) ISBN:0781745861. (OBQ17.87) dorsal fractures commonly axial fracture healing. A variety of operative procedures may be indicated depending on severity of disease and patient's symptoms. (OBQ12.105) Download Ebook Scapholunate Advanced Collapse And Scaphoid Nonunion A normal wrist without Kienbock's disease. 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. Treatment involves immobilization or surgical fixation depending on location, severity and alignment of injury. FOOSH), high incidence of distal radius fractures in women > 50 years old, DEXA scan is recommended for women with distal radius fractures, fall on outstretched hand (FOOSH) is most common in older population, higher energy mechanism more common in younger patients, includes the radial styloid and scaphoid fossa, attachment sites for the brachioradialis tendon, long radiolunate ligament, and radioscaphocapitate ligament, serves as a buttress to resist radial carpal translation, functions as a load-bearing platform for activities performed with the wrist in ulnar deviation, holds the carpus out to length radially, allowing a more uniform distribution of load across the scaphoid and lunate facets, serves as an anchor for the radioscaphocapitate ligament that prevents ulnar translation of the carpus, transmits load from the carpus to the forearm, based on joint involvement (radiocarpal and/or radioulnar) +/- ulnar styloid fracture, divides intra-articular fractures into 4 types based on displacement, Depressed fracture of the lunate fossa of the articular surface of the distal radius, Fracture-dislocation of radiocarpal joint with intra-articular fx involving the volar or dorsal lip (volar Barton or dorsal Barton fx), Low energy, dorsally displaced, extra-articular fx, Low energy, volarly displaced, extra-articular fx, usually a fall onto outstretched hand (FOOSH), Dorsal angulation < 5 or within 20 of contralateral distal radius, dorsal angulation < 5 or within 20 of contralateral distal radius, extra-articular fracture with stable volar cortex, 82-90% good results if used appropriately, radiographic findings indicating instability (pre-reduction radiographs best predictor of stability), dorsal angulation > 5 or > 20 of contralateral distal radius, displaced intra-articular fractures > 2mm, associated ulnar styloid fractures do not require fixation, articular margin fractures (dorsal and volar Barton's fractures), the volar ulnar corner (critical corner) supports the volar lunate facet with its strong radiolunate ligament attachments, failure to address this fragment can result in volar carpal subluxation, comminuted and displaced extra-articular fractures (Smith's fractures), progressive loss of volar tilt and radial length following closed reduction and casting, medically unstable patients unable to undergo a lengthy procedure, important adjunct with 80-90% good/excellent results, therefore usually combined with percutaneous pinning technique or plate fixation, apply longitudinal traction and volar/dorsal pressure to the distal fracture fragment, avoid positions of extreme flexion and ulnar deviation (Cotton-Loder Position), no significant benefit of physical therapy over home exercises for simple distal radius fractures treated with cast immobilization, radial shortening is the most predictive of instability, followed by dorsal comminution, dorsal comminution > 50%, palmar comminution, intraarticular comminution, higher loss of reduction with 3 or more of LaFontaine criteria, Meta-analyses and systematic reviews demonstrate no difference in functional outcomes between closed treatment versus operative methods in elderly patients (>65 years old), K wires are placed dorsally into the fracture and used as reduction tools until they are driven into the proximal radius, Rayhack technique with arthroscopically assisted reduction, distal radius extra-articular fracture ORIF with volar approach, distal radius intra-articular fracture ORIF with dorsal approach, associated with plate placement distal to watershed area, the most volar margin of the radius closest to the flexor tendons, can have hyperesthesia over the base of the thenar eminence due to palmar cutaneous nerve injury during retraction of the digital flexor tendons when plating the distal radius, new volar locking plates offer improved support to subchondral bone, intra-articular distal radius fractures with dorsal comminution, can combine with external fixation and percutaneous pinning, volar lunate facet fragments may require fragment-specific fixation to prevent early postoperative failure, screw penetration into the radiocarpal joint or DRUJ, assess intra-articular screws with a 23 degree elevated lateral view, assess dorsal cortex penetration with a skyline view, no benefit of therapist-directed physical therapy compared to home exercise program, distal radius fracture spanning external fixator, distal radius fracture non-spanning external fixator, place radial shaft pins under direct visualization to avoid injury to superficial radial nerve, and excessive volar flexion and ulnar deviation, pin site care comprising daily showers and dry dressings recommended, prevent by avoiding immobilization in excessive wrist flexion and ulnar deviation (Cotton-Loder position), progressive paresthesias, weakness in thumb opposition, paresthesias that do not respond to reduction and last > 24-48 hours, nondisplaced distal radial fractures have a higher rate of spontaneous rupture of the EPL tendon, extensor mechanism is thought to impinge on the tendon following a nondisplaced fracture and causes either a mechanical attrition or a local area of ischemia in the tendon, volar plating with screw fixation that penetrates the dorsal cortex and is proud dorsally, very distal volar plate placement on the radius (distal to watershed line) is associated with FPL rupture, due to physical contact of tendon on plate and subsequent tendinopathy, 90% young adults will develop symptomatic arthrosis if articular stepoff > 1-2mm, delayed procedure associated with higher need for bone grafting and a more difficult procedure, radial shortening associated with greatest loss of wrist function and degenerative changes in extra-articular fractures, AAOS 2010 clinical practice guidelines recommend, early efforts to regain motion of wrist and fingers, Proximal Humerus Fracture Nonunion and Malunion, Distal Radial Ulnar Joint (DRUJ) Injuries.