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Carpal Dislocation
Carol L. Andrews, MD; Kambiz Motamedi, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Definitions

              • Dislocation: complete dissociation of articular surfaces
              • Subluxation: partial disarticulation of joint
              • Complex fracture-dislocation terminology
                • Name fractured carpal bones, inserting "trans" before each fractured bone
                • Name fractures in order (radial to ulnar)
                • Name direction of dislocation
                • Name type of dislocation
                • State fracture-dislocation
                  • e.g., transradius, transscaphoid dorsal perilunate fracture-dislocation
              • Carpal (Gilula) arcs: smoothly curved lines paralleling
                • Arc 1: proximal cortices of proximal carpal row
                • Arc 2: distal cortices of proximal carpal row
                • Arc 3: proximal cortices of capitate and hamate
              • Zone of vulnerability
                • Curved band of bones most at risk for injury with perilunate dislocation
                  • Radial styloid, scaphoid waist, capitate waist, triquetrum, ulnar styloid

            IMAGING

            • General Features

              • Radiographic Findings

                • Imaging Recommendations

                  • CT Findings

                    • MR Findings

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Staging, Grading, & Classification

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Natural History & Prognosis

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Consider

                                      • Image Interpretation Pearls

                                        • Reporting Tips

                                          Selected References

                                          1. Goodman AD et al: Evaluation, management, and outcomes of lunate and perilunate dislocations. Orthopedics. 42(1):e1-6, 2019
                                          2. Kara A et al: Surgical treatment of dorsal perilunate fracture-dislocations and prognostic factors. Int J Surg. 24(Pt A):57-63, 2015
                                          3. Muppavarapu RC et al: Perilunate dislocations and fracture dislocations. Hand Clin. 31(3):399-408, 2015
                                          4. Reinsmith LE et al: Traumatic axial dislocation injuries of the wrist. Radiology. 267(3):680-9, 2013
                                          5. Sawardeker PJ et al: Fracture-dislocations of the carpus: perilunate injury. Orthop Clin North Am. 44(1):93-106, 2013
                                          6. Jones DB Jr et al: Perilunate dislocations and fracture dislocations. J Hand Surg Am. 37(10):2168-73; quiz 2174, 2012
                                          7. Navaratnam AV et al: Perilunate dislocation. BMJ. 345:e7026, 2012
                                          8. Kaewlai R et al: Multidetector CT of carpal injuries: anatomy, fractures, and fracture-dislocations. Radiographics. 28(6):1771-84, 2008
                                          9. Givissis P et al: Neglected trans-scaphoid trans-styloid volar dislocation of the lunate. Late result following open reduction and K-wire fixation. J Bone Joint Surg Br. 88(5):676-80, 2006
                                          10. Osti M et al: Scaphoid and capitate fracture with concurrent scapholunate dissociation. J Hand Surg [Br]. 31(1):76-8, 2006
                                          11. Weil WM et al: Open and arthroscopic treatment of perilunate injuries. Clin Orthop Relat Res. 445:120-32, 2006
                                          12. Park MJ et al: Arthroscopically assisted reduction and percutaneous fixation of dorsal perilunate dislocations and fracture-dislocations. Arthroscopy. 21(9):1153, 2005
                                          13. Herzberg G et al: Acute dorsal trans-scaphoid perilunate fracture-dislocations: medium-term results. J Hand Surg [Br]. 27(6):498-502, 2002
                                          14. Gilula LA: Carpal injuries: analytic approach and case exercises. AJR Am J Roentgenol. 133(3):503-17, 1979
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Pathology

                                                • Clinical Issues

                                                  • Diagnostic Checklist

                                                    TERMINOLOGY

                                                    • Definitions

                                                      • Dislocation: complete dissociation of articular surfaces
                                                      • Subluxation: partial disarticulation of joint
                                                      • Complex fracture-dislocation terminology
                                                        • Name fractured carpal bones, inserting "trans" before each fractured bone
                                                        • Name fractures in order (radial to ulnar)
                                                        • Name direction of dislocation
                                                        • Name type of dislocation
                                                        • State fracture-dislocation
                                                          • e.g., transradius, transscaphoid dorsal perilunate fracture-dislocation
                                                      • Carpal (Gilula) arcs: smoothly curved lines paralleling
                                                        • Arc 1: proximal cortices of proximal carpal row
                                                        • Arc 2: distal cortices of proximal carpal row
                                                        • Arc 3: proximal cortices of capitate and hamate
                                                      • Zone of vulnerability
                                                        • Curved band of bones most at risk for injury with perilunate dislocation
                                                          • Radial styloid, scaphoid waist, capitate waist, triquetrum, ulnar styloid

                                                    IMAGING

                                                    • General Features

                                                      • Radiographic Findings

                                                        • Imaging Recommendations

                                                          • CT Findings

                                                            • MR Findings

                                                              DIFFERENTIAL DIAGNOSIS

                                                                PATHOLOGY

                                                                • General Features

                                                                  • Staging, Grading, & Classification

                                                                    CLINICAL ISSUES

                                                                    • Presentation

                                                                      • Demographics

                                                                        • Natural History & Prognosis

                                                                          • Treatment

                                                                            DIAGNOSTIC CHECKLIST

                                                                            • Consider

                                                                              • Image Interpretation Pearls

                                                                                • Reporting Tips

                                                                                  Selected References

                                                                                  1. Goodman AD et al: Evaluation, management, and outcomes of lunate and perilunate dislocations. Orthopedics. 42(1):e1-6, 2019
                                                                                  2. Kara A et al: Surgical treatment of dorsal perilunate fracture-dislocations and prognostic factors. Int J Surg. 24(Pt A):57-63, 2015
                                                                                  3. Muppavarapu RC et al: Perilunate dislocations and fracture dislocations. Hand Clin. 31(3):399-408, 2015
                                                                                  4. Reinsmith LE et al: Traumatic axial dislocation injuries of the wrist. Radiology. 267(3):680-9, 2013
                                                                                  5. Sawardeker PJ et al: Fracture-dislocations of the carpus: perilunate injury. Orthop Clin North Am. 44(1):93-106, 2013
                                                                                  6. Jones DB Jr et al: Perilunate dislocations and fracture dislocations. J Hand Surg Am. 37(10):2168-73; quiz 2174, 2012
                                                                                  7. Navaratnam AV et al: Perilunate dislocation. BMJ. 345:e7026, 2012
                                                                                  8. Kaewlai R et al: Multidetector CT of carpal injuries: anatomy, fractures, and fracture-dislocations. Radiographics. 28(6):1771-84, 2008
                                                                                  9. Givissis P et al: Neglected trans-scaphoid trans-styloid volar dislocation of the lunate. Late result following open reduction and K-wire fixation. J Bone Joint Surg Br. 88(5):676-80, 2006
                                                                                  10. Osti M et al: Scaphoid and capitate fracture with concurrent scapholunate dissociation. J Hand Surg [Br]. 31(1):76-8, 2006
                                                                                  11. Weil WM et al: Open and arthroscopic treatment of perilunate injuries. Clin Orthop Relat Res. 445:120-32, 2006
                                                                                  12. Park MJ et al: Arthroscopically assisted reduction and percutaneous fixation of dorsal perilunate dislocations and fracture-dislocations. Arthroscopy. 21(9):1153, 2005
                                                                                  13. Herzberg G et al: Acute dorsal trans-scaphoid perilunate fracture-dislocations: medium-term results. J Hand Surg [Br]. 27(6):498-502, 2002
                                                                                  14. Gilula LA: Carpal injuries: analytic approach and case exercises. AJR Am J Roentgenol. 133(3):503-17, 1979