Weekly Case

Title : Case 618

Age / Sex : 20 / M


Chief complaint : Right wrist pain after falling off a horse.


What is your diagnosis?

Two weeks later, you can see the final diagonosis with a brief discussion of this case (Please submit only one answer).

Courtesy : Yusuhn Kang, Seoul National University Bundang Hospital



Discussion


Answer: Trans-scaphoid perilunate (fracture) dislocation.


 


Findings:


Wrist PA radiograph


- Disruption of the 1st and 2nd carpal arcs of Gilula


- Fracture of the scaphoid bone at waist  


Proximal pole fragment maintains articulation with lunate.


Distal pole fragment maintains articulation with the distal carpal row.


Wrist lateral radiograph


Capitolunate joint disruptued with capitate dislocated dorsal to the lunate


Radiolunate articulation preserved


 


Differential Diagnosis: none.


 


 


Discussion:


 


Trans-scaphoid perilunate fracture-dislocation.


- Relatively uncommon but potentially serious wrist injury that is easily missed.


- Mainly seen in youths due to high energy trauma


(fall from a height onto an outstretched hand with wrist in hyperextended and ulnar deviated position)


 


Mayfield classification of carpal instability



  • stage I: scapholunate dissociation


-  the scapholunate ligament is disrupted resulting in increased scapholunate interval.


2)  stage II: perilunate dislocation


- lunate normally aligned with the distal radius


the remaining carpal bones are dislocated (usually dorsally)


- the capitolunate joint disrupted, and the lunate projects through the space of Poirier


- 60% associated with scaphoid fractures(Trans-scaphoid perilunate dislocation)


3) stage III: midcarpal dislocation


- lunotriquetral interosseous ligament disruption or triquetral fracture


- both capitate and lunate do not align with the distal radius


4) stage IV: lunate dislocation


- dorsal radiolunate ligament injury


- dislocation of the lunate in a palmar direction


 


 


References:



  1. Kloss BT, Patierno SR, Sullivan AM. Transscaphoid perilunate dislocation. Int J Emerg Med. 2010 Dec; 3(4): 501–502.

  2. Mayfield JK, Johnson RP, Kilcoyne RK. Carpal dislocations: pathomechanics and progressive perilunar instability. J Hand Surg Am. 1980;5 (3): 226-41

  3. Scalcione LR, Gimber LH, Ho AM et-al. Spectrum of carpal dislocations and fracture-dislocations: imaging and management. AJR Am J Roentgenol. 2014;203 (3): 541-50. doi:10.2214/AJR.13.11680


To submit your answer, login first (for Korean radiologists) or send e-mail to balgundol@gmail.com (for non-Korean radiologists)

Correct Answer
Total applicants 30 Correct answers 23
Name Institution
권소이 전문의
김기욱 국군대전병원, 전문의
김지은 서울대학교병원, 전문의
노근탁 전문의
손상욱 군의관, 전문의
김창현 전문의
최형인 국군의무학교, 전문의
신재환 국군춘천병원, 전문의
윤유성 순천향대 부천병원, 전문의
장성원 중앙보훈병원, 전공의
강지희 서울대학교병원, 전문의
이혜란 전문의
박선영 한림대학교 성심병원, 전문의
전인환 전문의
이홍선 세브란스병원, 전공의
한유비 병무청, 전문의
정보미 전문의
최희석 전병원, 전문의
안준형 공중보건의, 전공의
김동수 전공의
박서영 전문의
김형민 전문의
한진우 전공의
Semi-Correct Answer
Total applicants 30 Semi-Correct answers 7
고아라 전공의
이규정 고대안암병원, 전문의
이진영 전문의
이승은 전문의
서현주 전문의
임윤진 전공의
송윤아 전문의


  • 관리자 ( 2019-04-29 14:51:15 )
    trans-scaphoid perilunate dislocation만 정답으로 처리하였습니다. 이 중 일부만 있는 경우 semicorrect로 하였습니다.

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