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Perilunate Dislocation, Emergency Medicine

Judson J. Merritt and Ian R. Grover Reviewed 06/2017
 


Basics

Description

  • Lunate remains located and in line with the radius but the distal carpal bones are displaced dorsally (∼95% of the time) or volarly (∼5% of the time)

  • Early surgical treatment is recom...

Diagnosis

Signs and Symptoms

  • Severe wrist pain

  • Wrist swelling

  • Diffuse wrist tenderness

  • Paresthesias in the median nerve distribution

History

  • History of a high-energy injury

  • Any concomitant injuries

  • Pain in th...

Treatment

Concern is for concomitant, more serious, injuries. 

Pre-Hospital

  • Assess for other injuries

  • Immobilize

  • Pain control

  • Elevate

Initial Stabilization/Therapy

  • Identify other, more serious, associated in...

Follow-Up

Disposition

Admission Criteria

  • Open dislocation, presence of multiple trauma, or other, more serious, injuries

  • Inability to reduce dislocation or maintain reduction

  • Neurovascular compromise

Discharge Criteria

Pearls and Pitfalls

  • Up to 25% of these injuries are missed on initial presentation.

  • In a patient with wrist pain, swelling, and limited range of motion, it is important to obtain adequate x-rays of the...

Additional Reading

  • Budoff  JE. Treatment of acute lunate and perilunate dislocations. J Hand Surg Am.  2008;33A:1424–1432.

  • Forli  A, Courvoisier  A, Wimsey  S, et al. Perilunate dislocations and t...

Codes

ICD9

  • 814.01 Closed fracture of navicular [scaphoid] bone of wrist

  • 833.09 Closed dislocation of wrist, other

ICD10

  • S62.009A Unsp fracture of navicular bone of unsp wrist, init

  • S63.095A Other dislocati...

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