Reference article, Radiopaedia.org (Accessed on 04 Mar 2023) https://doi.org/10.53347/rID-80825, see full revision history and disclosures, Mayfield classification of carpal instability, dorsal intercalated segment instability (DISI), volar intercalated segment instability (VISI), scaphoid nonunion advanced collapse (SNAC), triangular fibrocartilaginous complex (TFCC) injuries, ulnar-sided wrist impaction and impingement syndromes, calcium pyrophosphate dihydrate deposition disease. (SBQ17SE.13) toe phalanx fracture orthobulletsdaniel casey ellie casey. Copyright 2023 Lineage Medical, Inc. All rights reserved. The lunate is a central bone in the wrist that is important for proper movement and support of the joint (Figure 1). 2023 Lineage Medical, Inc. All rights reserved. Treatment is nonoperative for non-displaced fractures but displaced or intra-articular fractures require ORIF. Wrist with Kienbock's disease and ulna that is short compared to radius, Using this search tool means you agree to the, 2023 American Society for Surgery of the Hand, from the American Society for Surgery of the Hand, Decreased motion or stiffness of the wrist. Current radiographs are shown in Figure D and a clinical photograph of the affected wrist is shown in Figure E. Which of the following is the most likely cause for failure of fixation in this patient? The patient shows you the lateral film in Figure A. Diagnosis is made with PA wrist radiographs showing widening of the SL joint. (OBQ04.38) Read 14. (OBQ06.102) The scaphoid accounts for 95% of de-generative/traumatic arthritis in the wrist, with 55% involving the radioscaphoid joint (SLAC pattern). Thieme Medical Pub. Perilunate instability represents about 7 percent of all injuries to the carpus [ 5 ]. Distal radius fractures are themost common orthopaedic injury and generally result from fall on an outstretched hand. A 51-year-old female presents with an acute inability to extend her thumb, four months after she was treated with cast immobilization for a minimally-displaced distal radius fracture. It is the second most common carpal bone injury in children 1. Which plating option provides the most appropriate treatment of this fracture? - it is palpable just distal to radial tubercle; It works closely with the two forearm bones (the radius and ulna) to help the wrist move. Diagnosis requires careful evaluation of plain radiographs. Perilunate fracture-dislocations of the wrist, Late treatment of a dorsal transscaphoid, transtriquetral perilunate wrist dislocation with avascular changes of the lunate, Orthopaedic Specialists of North Carolina. The other types are perilunate, trans-radial styloid and . At the time of the index operation, there was no distal radioulnar joint instability after plating of the radius. The next best step in management would be: (OBQ12.163) Epidemiology. He reports paresthesias in his thumb and index finger. Philadelphia : Lippincott Williams & Wilkins, c2005. dorsal fractures commonly axial fracture healing. Chronic DISI deformities may be indicated for fusion procedures depending on degree of arthritis and patient symptoms. Hand therapy does not change the course of the disease; however, it can help to minimize loss of motion from the disease. Thank you. Lunate fracturesare a carpal injury that if left untreated, can result in significant carpal instability. Reference article, Radiopaedia.org (Accessed on 04 Mar 2023) https://doi.org/10.53347/rID-10010, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":10010,"questionManager":null,"mcqUrl":"https://radiopaedia.org/articles/lunate-dislocation/questions/1703?lang=us"}, Figure 1: Stage 4 of progressive perilunate, see full revision history and disclosures, Gustilo Anderson classification (compound fracture), Anderson and Montesano classification of occipital condyle fractures, Traynelis classification of atlanto-occipital dissociation, longitudinal versus transverse petrous temporal bone fracture, naso-orbitoethmoid (NOE) complex fracture, cervical spine fracture classification systems, AO classification of upper cervical injuries, subaxial cervical spine injury classification (SLIC), thoracolumbar spinal fracture classification systems, AO classification of thoracolumbar injuries, thoracolumbar injury classification and severity score (TLICS), Rockwood classification (acromioclavicular joint injury), Neer classification (proximal humeral fracture), AO classification (proximal humeral fracture), AO/OTA classification of distal humeral fractures, Milch classification (lateral humeral condyle fracture), Weiss classification (lateral humeral condyle fracture), Bado classification of Monteggia fracture-dislocations (radius-ulna), Mason classification (radial head fracture), Frykman classification (distal radial fracture), Hintermann classification (gamekeeper's thumb), Eaton classification (volar plate avulsion injury), Keifhaber-Stern classification (volar plate avulsion injury), Judet and Letournel classification (acetabular fracture), Harris classification (acetebular fracture), Young and Burgess classification of pelvic ring fractures, Pipkin classification (femoral head fracture), American Academy of Orthopedic Surgeons classification (periprosthetic hip fracture), Cooke and Newman classification (periprosthetic hip fracture), Johansson classification (periprosthetic hip fracture), Vancouver classification (periprosthetic hip fracture), Winquist classification (femoral shaft fracture), Schatzker classification (tibial plateau fracture), AO classification of distal femur fractures, Lauge-Hansen classification (ankle injury), Danis-Weber classification (ankle fracture), Berndt and Harty classification (osteochondral lesions of the talus), Sanders CT classification (calcaneal fracture), Hawkins classification (talar neck fracture), anterior superior iliac spine (ASIS) avulsion, anterior cruciate ligament avulsion fracture, posterior cruciate ligament avulsion fracture, avulsion fracture of the proximal 5th metatarsal, Mayfield classification of carpal instability, dorsal intercalated segment instability (DISI), volar intercalated segment instability (VISI), scaphoid nonunion advanced collapse (SNAC), triangular fibrocartilaginous complex (TFCC) injuries, ulnar-sided wrist impaction and impingement syndromes, calcium pyrophosphate dihydrate deposition disease, Philips Australia, Paid speaker at Philips Spectral CT events (ongoing). Copyright 2023 Lineage Medical, Inc. All rights reserved. Diagnosis is confirmed with either a radiographic carpal tunnel view or CT scan. Lunate dislocations are far less common than the less severe perilunate dislocation. A 64-year-old female sustains a nondisplaced distal radius fracture and undergoes closed treatment using a cast. Indications. Hamate Body Fractures are rare carpal fractures that can be associated with 4th or 5th metacarpal fractures. (OBQ12.168) Toe fractures of this type are rare unless there is an open injury or a high-force crushing or shearing injury. 2.Meenalochani Shunmugam, Joideep Phadnis, Amy Watts, Gregory I. Bain. Which of the regions on the patient's injury AP radiograph in Figure A, if not addressed properly during surgery, represents a risk for radiocarpal instability? ADVERTISEMENT: Supporters see fewer/no ads. A 65-year-old female sustains a fall onto her outstretched right hand. Incidence. Inability to extend the thumb interphalangeal joint. How do you counsel him about his post-operative period? He reports having undergone open reduction and internal fixation of a distal radius fracture 1 year prior that healed uneventfully. Diagnosis is generally made with radiographs of the wrist but may require CT for confirmation. Radiographic features If time has passed since injury, it can also lead to wrist arthritis. He is not able to see a physician for 4 months. - lunate articulates proximally w/ radius and distally w/ capitate; The lunate is one of the eight small bones in the wrist. There is no single cause of Kienbocks disease. A 68-year-old male falls onto his outstretched hand and suffers the injury shown in Figures A and B. Lunate fracture. You can rate this topic again in 12 months. (OBQ12.38) What additional data is most necessary to obtain before a reduction is attempted? 2020 American Society for Surgery of the Hand. Management should consist of. Post-operatively she is given a prescription with the goal of mitigating a potential adverse outcome. 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. Unable to process the form. Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. The patient now reports increasing pain and inability to use his wrist. A 57-year-old woman underwent open reduction internal fixation from a volar approach for a displaced distal radius fracture. (2008) ISBN:1588904539. fractures involving a single facial buttress, Meyers and McKeevers classification (anterior cruciate ligament avulsion fracture), Watson-Jones classification (tibial tuberosity avulsion fracture), Nunley-Vertullo classification (Lisfranc injury), pelvis and lower limb fractures by region. A 58-year-old man underwent distal radius ORIF with a volar locking plate yesterday. After completing instrumentation, radiocarpal screw penetration is best assessed on which fluoroscopic view? The mechanism of injury is typically a fall onto an outstretched hand with a hyperextended wrist or during a . Towson, MD 21204 He undergoes operative treatment of his fracture, and immediate post-op radiographs are shown in Figure C. Two weeks later he presents with significantly increased pain and deformity. A 70-year-old woman with known osteoporosis sustains a distal radius fracture of her dominant arm with some metaphyseal comminution. He founded Orthopaedic Specialists of North Carolina in 2001 and practices at Franklin Regional Medical Center and Duke Raleigh Hospital. There are no open wounds and the hand is neurovascularly intact. Radiographs are shown in Figures A and B. Around 20% of patients possess a single-vessel supply to their lunate hence there is an increased possibility of avascular necrosis, the remaining cohort typically has a two-vessel supply and intraosseous anastomosis 2. Rathachai Kaewlai, Laura L. Avery, Ashwin V. Asrani, Hani H. Abujudeh, Richard Sacknoff, Robert A. Novelline. It can be caused by multiple factors such as: Damage to the lunate can lead to pain and stiffness. It can be difficult to diagnose in its earlier stages. When the lunate is severely fracture, collapsed, or arthritic, salvage treatments such as lunate and other wrist bone removal may be necessary. (SBQ07SM.38) Displaced impaction fracture of the lunate fossa. A 24-year-old stagehand fell 12 feet off of a ladder while preparing a set. A 63-year-old female sustained a distal radius and associated ulnar styloid fracture 3 months ago after being involved in a motor vehicle collision. The black dot in the photo is the capitate. Treatment is nonoperative for non-displaced fractures but displaced or intra-articular fractures require ORIF. Inability to extend the index finger proximal interphalangeal joint. (OBQ09.227) . Clifford R. Wheeless, III, M.D. Lunate fractures account for around 4% of all carpal fractures 1. The patient undergoes closed reduction and splinting; however, her paresthesias worsen significantly in the next 12 hours. Barton's fracture: Dorsal intraarticular fracture which is often associated with dislocation at the radiocarpal joint. The injury is closed and she is neurovascularly intact. Diagnosis is generally made with radiographs of the wrist but may require CT for confirmation. 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. SLAC (scaphoid lunate advanced collapse) and SNAC (scaphoid nonunion advanced collapse) are the most common patterns seen. This content is written, edited and updated by hand surgeon members of the American Society for Surgery of the Hand. (OBQ17.87) Despite treatment, there remains a high risk of future degenerative arthritis and wrist instability. (2005) ISBN:0781745861. The rest of the carpal bones are in a normal anatomic position in relation to the radius. Lunate fracture. Depressed fracture of the lunate fossa (articular surface) Smith's. A 32-year-old ballet dancer sustains a distal radius fracture, and is subsequently closed reduced and casted. He presents to your clinic and given his age and the fracture characteristics, he is taken for open reduction with volar locking plate fixation. Worse outcomes on the Mayo wrist score are expected without fixation, Chronic distal radioulnar joint instability can be expected to occur without fixation, Wrist function depends on the level of ulnar styloid fracture and initial displacement, Grip strength and wrist range of motion are improved with fixation, There is no adverse effect on wrist function or stability without fixation. A 40-year-old right-handed professional football player reports persistent right wrist pain after falling during a game 5 days ago. Lunate. His radiograph is shown in Figure A. The lunate bone articulates with the scaphoid, the distal radius, and the TFCC. In very early stages, the treatment can be as simple as observation, activity changes, and/or immobilization. Scapholunate Ligament Injury is a source of dorsoradial wrist pain with chronic injuries leading to a form of wrist instability (DISI deformity). Hook of hamate fractures are rare, often missed, injuries generally as a result of a direct blow to the hamate bone most commonly seen in athletes. Data Trace specializes in Legal and Medical Publishing, Risk Management Programs, Continuing Education and Association Management. 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 . Find a hand surgeon near you. Dependent on the fracture-line and the intraosseous vascularity, partial or total avascular . Treatment involves immobilization or surgical fixation depending on location, severity and alignment of injury. Data Trace Publishing Company (OBQ13.140) Figures A and B depict the closed injury radiograph of a 79-year-old right-hand-dominant woman who fell on her left wrist. Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. The lunate is an important stabilizer of the wrist . What joint is first affected if left untreated with subsequent development of a SLAC (scapholunate advanced collapse) wrist? Check for errors and try again. A radiograph is shown in figure A. A 45-year-old male sustained a fall onto his right wrist 2 weeks ago. educational laws affecting teachers. Lunate dislocationsare an uncommon traumatic wrist injury that require prompt management and surgical repair. Capitate fractures are most commonly due to high-energy, hyperextension forces 2. Pearls/pitfalls. Die-Punch: Depressed fracture of lunate fossa of distal radius due to an axial loading injury. Extensor carpi radialis longus transfer to extensor pollicus longus, Extensor pollicis brevis transfer to extensor pollicus longus, Extensor indicis proprius transfer to extensor pollicus longus, Primary repair of extensor pollicus longus. Diagnosis is made clinically with progressive wrist pain and wrist instability with radiographs showing advanced arthritis of the radiocarpal and midcarpal joints (radiolunate joint spared). (OBQ09.254) Summary. In this condition, the lunate bone loses its blood supply, leading to death of the bone. Twelve months after open reduction and internal fixation of a comminuted distal radius fracture as seen in Figure A and B, which of the following tendons is at greatest risk of rupture? At the time the article was last revised Craig Hacking had the following disclosures: These were assessed during peer review and were determined to A fracture to the lunate may also be associated with injury to the TFCC. Scaphoid Lunate Advanced Collapse (S-LAC) - Hand - Orthobullets Scapholunate ligament - Wikipedia positive test seen in patients with scaphol-unate ligament injury or patients with liga-mentous laxity, where the scaphoid is no longer constrained proximally and sublux-ates out of the scaphoid fossa resulting in pain; when pressure removed from the Isolated capitate fractures are rare (scaphoid is most common associated fracture) Occurs via forceful dorsiflexion of hand (FOOSH injury) with impact on radial side; Proximal fracture fragment at risk for avascular necrosis; Clinical Features. He underwent operative fixation by and presents to your clinic for his 2 week follow-up visit. Difficult wrist fractures. Revista dedicada a la medicina Estetica Rejuvenecimiento y AntiEdad. sudden impact force applied to the hand and wrist causing SLIL injury and scapholunate dissociation, injury occurs most commonly with wrist positioned in extension, ulnar deviation and carpal supination, SLIL tearing will position the scaphoid in flexion and lunate extension. Lunate fractures are relatively uncommon, representing about 4 percent of all carpal bone injuries [ 1-4 ]. (OBQ07.226) These should not be confused with perilunate dislocations in which the radiolunate articulation is . - w/ flexion capitate slides out from under lunate tocreate fullness where the capitate depression has been; - Radiographs: The lunate is the fourth most fractures carpal bone (following the scaphoid, triquetrum, and trapezium). A fracture to the lunate may also be associated with injury to the TFCC. The lunate is displaced and rotated volarly. Data Trace is the publisher of A variety of operative procedures may be indicated depending on severity of disease and patient's symptoms. Phalanx fractures of the hand are some of the most common fractures occurring in humans. Scaphoid Lunate Advanced Collapse (SLAC) - Hand - Orthobullets SLAC (scaphoid lunate advanced collapse) and SNAC (scaphoid nonunion advanced collapse) are the most common patterns seen. Orthobullets Team Trauma - Distal Radius Fractures Technique Guide. What is the most appropriate treatment at this time? A 28-year-old woman fell on her right wrist while rollerblading 6 days ago. Check for errors and try again. comic book publishers accepting submissions 2022 Likes ; brady list police massachusetts Followers ; nurse injector training Followers ; transfer apple health data to samsung Subscriptores ; night shift vs overnight shift Followers ; big joe's funeral questions and answers lunate fracture orthobullets It rarely affects both wrists. Greenberg's text-atlas of emergency medicine. Patients often prefer to hold their fingers in partial flexion due to pain on extension. (OBQ05.25) There is no median nerve paresthesias. Volar wrist swelling is usually prominent. The lunate is one of the eight small bones in the wrist. He initially thought it was a sprain, but presents due to continued pain worsened by push-ups. Mayfield JK, Johnson RP, Kilcoyne RK. Radiographs of the affected wrist are shown in Figure A. (OBQ11.273) A 45-year-old construction worker sustains a fall and presents with an isolated injury to his upper extremity. - Discussion: Limited open reduction of the lunate facet in comminuted intra-articular fractures of the distal radius. whilst on the lateral the capitate no longer sits in the lunate. Scaphoid Lunate Advanced Collapse (SLAC) d escribes the specific pattern of degenerative arthritis seen in chronic dissociation between the scaphoid and lunate. Most patients with Kienbocks disease have the following symptoms: The diagnosis of Kienbocks disease can often be made by reviewing your history, performing a physical examination, and taking x-rays. Spontaneous rupture of the extensor pollicis longus tendon is most frequently associated with which of the following scenarios? lunate fracture orthobullets In this condition, the lunate bone loses its blood supply, leading to death of the bone. Radiographs are provided in Figure A. Due to a fall onto a flexed wrist or a blow to the back of hand. (SLAC) - Hand - Orthobullets Scapholunate Advanced Collapse Article - StatPearls Scapholunate advanced collapse (SLAC) of the wrist is a very common case of degenerative arthritis . What is the most appropriate treatment at this time? As he tried to brace his fall, he landed directly on his extended and ulnarly deviated left hand. A 35-year-old professional football player complains of severe wrist pain after making a tackle. At the time the article was created Andrew Murphy had no recorded disclosures. (SBQ17SE.47) She presents 11 months later with the radiograph seen in Figure A, complaining of significant wrist pain. Epidemiology. Kienbocks disease is most common in men between the ages of 20 and 40. (OBQ16.228) (OBQ18.223) Which of the following factors has been associated with redisplacement of the fracture after closed manipulation? immobilization in a long arm thumb spica cast. 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. Most displaced fractures of the lesser toes can be managed by family physicians if there are no indications for referral. What is the next best step in management of this patient? DISI (dorsal intercalated segmental instability), scapholunate dissociation causes the scaphoid to flex palmar and the lunate to dorsiflex, if left untreated the DISI deformity can progress into a, DISI deformity may also develop secondary to distal pole of the scaphoid excision for treatment of STT arthritis, DISI is a form of carpal instability dissociative, c-shaped structure connecting the dorsal, proximal and volar surfaces of the scaphoid and lunate bones, dorsal fiber thickened (2-3mm) compared to volar fibers, dorsal component provides the greatest constraint to translation between the scaphoid and lunate bones, proximal fibers have minimal mechanical strength, Overview of wrist ligaments and biomechanics, acute FOOSH injury vs. degenerative rupture, age, nature of injury, duration since injury, degree of underlying arthritis, level of activity, pain increased with loading across the wrist (e.g. Orthopaedic Specialists of North Carolina. Diagnosis requires careful evaluation of plain radiographs. Two-point discrimination is now >10mm in these fingers. You remove his splint, he has no difficulty moving any fingers, very minimal pain, and is not taking any narcotic medication. Perilunate dislocations and fracture-dislocations are relatively uncommon injury patterns in acute wrist trauma.

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