Abstract：
:Perilunate and perilunate fracture dislocations are high-energy injuries with the wrist loaded in extension, ulnar deviation, and intercarpal supination. The force vector travels from a radial to a ulnar direction and can result in complex carpal instability. The diagnosis is often delayed, which can result in suboptimal outcomes. Nonoperative management can produce inferior results, with patients experiencing pain and weakness. Therefore, early treatment with open reduction and internal fixation is recommended to assess the osteochondral and ligamentous disruption and to achieve anatomic reduction of the carpus. Despite this, these patients can develop radiographic degenerative joint disease, which can be seen in up to 90% of cases. This can be due to difficulty in holding and maintaining carpal reduction. Increased radiodensity of the lunate following these injuries has been observed but is believed to be a transient phenomenon without risk of progression to avascular necrosis. This may be due to the blood supply of the lunate, which has varied patterns of intraosseous and extraosseous vascularity. The authors report a patient who developed avascular necrosis and delayed lunate fragmentation following a May-field Type IV perilunate dislocation. This finding highlights the importance of long-term follow-up with these patients.
journal_name
Orthopedicsjournal_title
Orthopedicsauthors
Wilke B,Kakar Sdoi
10.3928/01477447-20150603-92subject
Has Abstractpub_date
2015-06-01 00:00:00pages
e539-42issue
6eissn
0147-7447issn
1938-2367journal_volume
38pub_type
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