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Trentadue TP, Thoreson AR, Lopez C, Breighner RE, An KN, Holmes DR, Moran SL, Kakar S, Murthy NS, Leng S, Zhao KD. Detection of scapholunate interosseous ligament injury using dynamic computed tomography-derived arthrokinematics: A prospective clinical trial. Med Eng Phys 2024; 128:104172. [PMID: 38789217 DOI: 10.1016/j.medengphy.2024.104172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 03/22/2024] [Accepted: 04/24/2024] [Indexed: 05/26/2024]
Abstract
Scapholunate interosseous ligament injuries are a major cause of wrist instability and can be difficult to diagnose radiographically. To improve early diagnosis of scapholunate ligament injuries, we compared injury detection between bilateral routine clinical radiographs, static CT, and dynamic four-dimensional CT (4DCT) during wrist flexion-extension and radioulnar deviation. Participants with unilateral scapholunate ligament injuries were recruited to a prospective clinical trial investigating the diagnostic utility of 4DCT imaging for ligamentous wrist injury. Twenty-one participants underwent arthroscopic surgery to confirm scapholunate ligament injury. Arthrokinematics, defined as distributions of interosseous proximities across radioscaphoid and scapholunate articular surfaces at different positions within the motion cycle, were used as CT-derived biomarkers. Preoperative radiographs, static CT, and extrema of 4DCT were compared between uninjured and injured wrists using Wilcoxon signed rank or Kolmogorov-Smirnov tests. Median interosseous proximities at the scapholunate interval were significantly greater in the injured versus the uninjured wrists at static-neutral and maximum flexion, extension, radial deviation, and ulnar deviation. Mean cumulative distribution functions at the radioscaphoid joint were not significantly different between wrists but were significantly shifted at the scapholunate interval towards increased interosseous proximities in injured versus uninjured wrists in all positions. Median and cumulative distribution scapholunate proximities from static-neutral and 4DCT-derived extrema reflect injury status.
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Affiliation(s)
- Taylor P Trentadue
- Assistive and Restorative Technology Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Medical Scientist Training Program, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Graduate Program in Biomedical Engineering and Physiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew R Thoreson
- Assistive and Restorative Technology Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Cesar Lopez
- Assistive and Restorative Technology Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan E Breighner
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - Kai-Nan An
- Assistive and Restorative Technology Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - David R Holmes
- Biomedical Imaging Resource Core Facility, Mayo Clinic, Rochester, Minnesota, USA
| | - Steven L Moran
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Sanjeev Kakar
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Naveen S Murthy
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Shuai Leng
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA; Computed Tomography Clinical Innovation Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Kristin D Zhao
- Assistive and Restorative Technology Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA.
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Liechti R, Merky DN, Grobbelaar AO, van de Wall BJM, Vögelin E, Hirsiger S. Outcomes of acute perilunate injuries-a systematic review. Eur J Trauma Emerg Surg 2023; 49:2071-2084. [PMID: 36750472 DOI: 10.1007/s00068-023-02222-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/07/2023] [Indexed: 02/09/2023]
Abstract
PURPOSE The objective of this systematic review was to perform epidemiological as well as clinical, radiological and patient-reported outcome analysis of surgically treated perilunate dislocations and fracture dislocations (PLDs and PLFDs) based on the so far largest pooled patient population to date. MATERIAL AND METHODS This systematic review was written according to the updated guideline for reporting systematic reviews by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. A comprehensive literature search of Pubmed, Embase, CENTRAL, and CINAHL databases was performed. All studies reporting on complications, radiological, functional and/or patient-reported outcomes of surgically treated acute PLDs and PLFDs with a minimum follow-up of 12 months were included. RESULTS Twenty-six studies encompassing 550 patients with 553 operatively treated acute perilunate injuries (106 PLDs and 447 PLFDs) were included. The overall postoperative complication rate was 15.0% with secondary reduction loss representing the main contributing factor (10.1%). The overall reoperation rate was 10.4% and the incidence of salvage procedures was 2.8%. The risk for secondary reduction loss was higher for PLD than for PLFD injuries (24.2% vs. 7.0%, relative risk [RR] 3.5, 95% confidence interval [CI] 1.6-7.5). There was a higher overall complication rate for the combined dorsopalmar approach when compared to the isolated dorsal approach (17.4% vs. 8.4%, RR 0.5, 95% CI 0.2-1.0, number needed to treat [NNT] 11.2) and for open surgery versus arthroscopic surgery (17.4% vs. 4.8%, RR 0.3, 95% CI 0.1-0.9, NNT 8.0). A significant correlation was found between radiological osteoarthritis (rOA) and follow-up duration of the individual studies, while functional and patient-rated outcomes were comparable. CONCLUSIONS Regardless of surgical technique, PLFDs appear to be less susceptible to secondary reduction loss than PLDs. Whenever possible, less invasive (e.g. arthroscopic) surgery should be performed to minimize postoperative complications. The rate of rOA is high and increases significantly with follow-up duration. Interestingly, rOA does not seem to correlate with reduced wrist function nor patient dissatisfaction and the need for salvage surgery is surprisingly rare. LEVEL OF EVIDENCE Systematic review of level IV studies.
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Affiliation(s)
- Rémy Liechti
- Department of Plastic and Hand Surgery, Inselspital, University Hospital of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland.
| | - Dominique Nellie Merky
- Department of Plastic and Hand Surgery, Inselspital, University Hospital of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland
| | - Adriaan Ockert Grobbelaar
- Department of Plastic and Hand Surgery, Inselspital, University Hospital of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland
| | - Bryan J M van de Wall
- Department of Orthopedic and Trauma Surgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Esther Vögelin
- Department of Plastic and Hand Surgery, Inselspital, University Hospital of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland
| | - Stefanie Hirsiger
- Department of Plastic and Hand Surgery, Inselspital, University Hospital of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland
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Moein SA, Fereidooni R, Kousari A. Simultaneous quadruple dislocations of the hand in a motorcyclist: A case report. Trauma Case Rep 2023; 47:100900. [PMID: 37663377 PMCID: PMC10474604 DOI: 10.1016/j.tcr.2023.100900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2023] [Indexed: 09/05/2023] Open
Abstract
Herein we present a case of four simultaneous dislocations of the hand resulting from a motorcycle accident in a young man. In this case, the 1st CMC, MCP, and IP joints of the right hand were dislocated along with right perilunate dislocation. Perilunate dislocation was treated with open reduction and internal fixation. Close reduction of IP and CMC was done and CMC was fixed by pins. MCP dislocation was treated by open reduction and pinning in addition to collateral ligament and capsular repair. In follow-up excellent functional activity and range of motion were observed.
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Affiliation(s)
- Seyed Arman Moein
- Bone and Joint Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Fereidooni
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Aliasghar Kousari
- Bone and Joint Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Abstract
Carpal dislocations result from sequential disruption of the complex relationship between the bones and ligaments of the wrist. Injuries to the carpus occur via predictable mechanisms, an understanding of which is critical to identify and treat these frequently missed patterns of injury and to avoid the sequela of chronic instability. Lunate dislocations are by far the most common, but isolated dislocation of other carpal bones can also occur. Open reduction and internal fixation still remains the gold standard for treatment regardless of the debate around the specific approaches. These high-energy injuries are associated with significant long-term morbidity even when identified promptly and appropriately treated. This review will focus on the evaluation and management of common forms of carpal dislocations.
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Affiliation(s)
- Nathan Heineman
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Dang-Huy Do
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ann Golden
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Alshehri D, Mousa A, Al Ahmadi B. Trans-scaphoid Lunate Dislocation Rare Injury: A Case Report. Cureus 2023; 15:e44072. [PMID: 37750144 PMCID: PMC10517882 DOI: 10.7759/cureus.44072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2023] [Indexed: 09/27/2023] Open
Abstract
Lunate dislocations are complex and uncommon wrist injuries, often resulting from high-energy trauma like road traffic accidents, falls, and industrial mishaps. Timely diagnosis and appropriate surgical management are critical to achieving favorable outcomes and minimizing long-term disability. Here, we present a case of a 22-year-old male who sustained a trans-scaphoid lunate fracture dislocation due to a motorcycle accident. Prompt wrist x-ray evaluation and subsequent surgical interventions led to the successful restoration of wrist function and stability. This case report highlights the importance of early recognition and discusses the accurate diagnosis and timely management of lunate fracture dislocations to avoid long-term complications and disability.
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Affiliation(s)
- Dhafer Alshehri
- Orthopaedic Surgery, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, SAU
| | | | - Basim Al Ahmadi
- Orthopaedic Surgery, King Fahad General Hospital, Jeddah, SAU
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Okoro CK, Skalski MR, Patel DB, White EA, Matcuk GR. Imaging Diagnosis and Management of Carpal Trauma and Instability-An Illustrated Guide. Life (Basel) 2023; 13:1426. [PMID: 37511801 PMCID: PMC10381215 DOI: 10.3390/life13071426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/12/2023] [Accepted: 06/16/2023] [Indexed: 07/30/2023] Open
Abstract
Understanding the subtle signs of carpal instability and other unique injury patterns in the wrist is a critical skill for radiologists. Proper patient management and outcomes are directly dependent on the accurate interpretation of wrist imaging studies. This review will provide a detailed overview of typical imaging features of carpal trauma and instability, management, and complications, using multimodality imaging and original medical illustrations. A detailed overview of the osseous, ligamentous, arterial anatomy of the wrist, arcs of Gilula, and zones of vulnerability will be provided. Carpal fractures, dislocations, special radiographic views, and imaging pearls will be discussed. Instability patterns and the myriad of associate abbreviations (CID, CIND, CIC, CIA, VISI, DISI, SLD, LTD, MCI, SLAC, SNAC) will be clarified. Expected outcomes, potential complications, and management will be reviewed.
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Affiliation(s)
- Chukwuemeka K Okoro
- Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Matthew R Skalski
- Department of Radiology, Palmer College of Chiropractic-West Campus, San Jose, CA 95134, USA
| | - Dakshesh B Patel
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Eric A White
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - George R Matcuk
- Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA 90048, USA
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Trentadue TP, Lopez C, Breighner RE, Fautsch K, Leng S, Holmes III DR, Moran SL, Thoreson AR, Kakar S, Zhao KD. Evaluation of Scapholunate Injury and Repair with Dynamic (4D) CT: A Preliminary Report of Two Cases. J Wrist Surg 2023; 12:248-260. [PMID: 37223378 PMCID: PMC10202581 DOI: 10.1055/s-0042-1758159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 09/15/2022] [Indexed: 02/11/2023]
Abstract
Background In predynamic or dynamic scapholunate (SL) instability, standard diagnostic imaging may not identify SL interosseous ligament (SLIL) injury, leading to delayed detection and intervention. This study describes the use of four-dimensional computed tomography (4DCT) in identifying early SLIL injury and following injured wrists to 1-year postoperatively. Description of Technique 4DCT acquires a series of three-dimensional volume data with high temporal resolution (66 ms). 4DCT-derived arthrokinematic data can be used as biomarkers of ligament integrity. Patients and Methods This study presents the use of 4DCT in a two-participant case series to assess changes in arthrokinematics following unilateral SLIL injury preoperatively and 1-year postoperatively. Patients were treated with volar ligament repair with volar capsulodesis and arthroscopic dorsal capsulodesis. Arthrokinematics were compared between uninjured, preoperative injured, and postoperative injured (repaired) wrists. Results 4DCT detected changes in interosseous distances during flexion-extension and radioulnar deviation. Generally, radioscaphoid joint distances were greatest in the uninjured wrist during flexion-extension and radioulnar deviation, and SL interval distances were smallest in the uninjured wrist during flexion-extension and radioulnar deviation. Conclusion 4DCT provides insight into carpal arthrokinematics during motion. Distances between the radioscaphoid joint and SL interval can be displayed as proximity maps or as simplified descriptive statistics to facilitate comparisons between wrists and time points. These data offer insight into areas of concern for decreased interosseous distance and increased intercarpal diastasis. This method may allow surgeons to assess whether (1) injury can be visualized during motion, (2) surgery repaired the injury, and (3) surgery restored normal carpal motion. Level of Evidence Level IV, Case series.
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Affiliation(s)
- Taylor P. Trentadue
- Mayo Clinic Medical Scientist Training Program and Mayo Clinic Graduate Program in Biomedical Engineering and Physiology, Assistive and Restorative Technology Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Cesar Lopez
- Assistive and Restorative Technology Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Ryan E. Breighner
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - Kalli Fautsch
- Assistive and Restorative Technology Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Shuai Leng
- Computed Tomography Clinical Innovation Center, Mayo Clinic, Rochester, Minnesota
| | - David R. Holmes III
- Biomedical Imaging Resource Division, Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
| | - Steven L. Moran
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Andrew R. Thoreson
- Assistive and Restorative Technology Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Sanjeev Kakar
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Kristin D. Zhao
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota
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Sivagurunathan G, Shirodkar K, Hegde G, Shamshuddin S, Proctor R, Naqvi J, Knowles D, Ali I. Musculoskeletal Computed Tomography: How to Add Value When Reporting Adult Upper Limb Trauma. J Comput Assist Tomogr 2023; 47:264-276. [PMID: 36877776 DOI: 10.1097/rct.0000000000001417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
ABSTRACT There is increasing reliance on computed tomography to evaluate fractures and dislocations following routine evaluation with plain radiography, critical in preoperative planning; computed tomography can provide multiplanar reformats and 3-dimensional volume-rendered imaging, providing a better global assessment for the orthopedic surgeon. The radiologist plays a critical role in appropriately reformatting the raw axial images to illustrate best the findings that will help determine further management. In addition, the radiologist must succinctly report the pertinent findings that will have the most significant bearing on treatment, assisting the surgeon in deciding between nonoperative and operative management. The radiologist should also carefully review imaging to look for ancillary findings in the setting of trauma beyond the bones and joints, including the lungs and rib cage when visualized.In this review article, we will systematically describe key features for fractures of the scapula, proximal humerus, distal humerus, radial head and neck, olecranon, coronoid process through a case-based approach, and distal radius. Although there are numerous detailed classification systems for each of these fractures, we aim to focus on the core descriptors that underpin these classification systems. The goal is to provide the radiologist with a checklist of critical structures they must assess and findings that they should mention in their report, emphasizing those descriptors that influence patient management.
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9
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Fisher ND, Bi AS, De Tolla JE. Perilunate Dislocations: Current Treatment Options. JBJS Rev 2022; 10:01874474-202209000-00003. [PMID: 36413343 DOI: 10.2106/jbjs.rvw.22.00106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
➢ Approximately 25% of all patients who sustain perilunate dislocations present in a delayed fashion. ➢ While management of acute injuries is relatively well-described, treatment of chronic injuries can be complex and there is a paucity of scientific evidence to guide management. ➢ Treatment options include open reduction internal fixation, proximal row carpectomy, scaphoid or lunate excision with or without arthrodesis, and total wrist arthrodesis, although indications vary based on chronicity of injury and patient factors. ➢ The purpose of this article was to determine the quality of evidence supporting surgical options for the treatment of these injuries.
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10
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Taljanovic MS, Omar IM, Weaver JS, Becker JL, Mercer DM, Becker GW. Posttreatment Imaging of the Wrist and Hand: Update 2022. Semin Musculoskelet Radiol 2022; 26:295-313. [PMID: 35654096 DOI: 10.1055/s-0042-1743538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Common indications for surgical procedures of the wrist and hand include acute fractures or fracture-dislocations; nonunited fractures; posttraumatic, degenerative, and inflammatory arthritides and tendinopathies; injuries to tendons, ligaments, and the triangular fibrocartilage complex; and entrapment neuropathies. Soft tissue or osseous infections or masses may also need surgical treatment. Several of these procedures require surgical hardware placement, and most entail clinical follow-up with periodic imaging. Radiography should be the first imaging modality in the evaluation of the postoperative wrist and hand. Computed tomography, magnetic resonance imaging, diagnostic ultrasonography, and occasionally nuclear medicine studies may be performed to diagnose or better characterize suspected postoperative complications. To provide adequate evaluation of postoperative imaging of the wrist and hand, the interpreting radiologist must be familiar with the basic principles of these surgical procedures and both the imaging appearance of normal postoperative findings as well as the potential complications.
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Affiliation(s)
- Mihra S Taljanovic
- Department of Medical Imaging, The University of Arizona, College of Medicine, Tucson, Arizona.,Department of Radiology, University of New Mexico, Albuquerque, New Mexico
| | - Imran M Omar
- Department of Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Jennifer S Weaver
- Department of Radiology, University of New Mexico, Albuquerque, New Mexico
| | - Jennifer L Becker
- Department of Medical Imaging, The University of Arizona, College of Medicine, Tucson, Arizona
| | - Deana M Mercer
- Department of Orthopaedics and Rehabilitation, University of New Mexico, Albuquerque, New Mexico
| | - Giles W Becker
- Department of Orthopaedic Surgery, University of Arizona, Tucson, Arizona
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Li LY, Lin CJ, Ko CY. Lunate dislocation with avulsed triquetral fracture: A case report. World J Clin Cases 2022; 10:331-337. [PMID: 35071536 PMCID: PMC8727270 DOI: 10.12998/wjcc.v10.i1.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 10/25/2021] [Accepted: 11/28/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Lunate dislocation is an uncommon traumatic wrist injury that require prompt surgical management. Misdiagnosis or delayed treatment often leads to a poor outcome. Open reduction and surgical repair of disrupted ligaments are done in most cases to prevent long-term joint dysfunction. However, this method has certain limitations that include partial functional improvement, which poses a high risk for degenerative arthritis and wrist instability.
CASE SUMMARY A 37-year-old man presented to the Emergency Department of our hospital following a motorcycle accident. Physical examination revealed swelling and tenderness of the right hand and wrist. The patient was initially misdiagnosed with a wrist contusion by an emergency physician, but was eventually diagnosed with lunate dislocation associated with a triquetral avulsed fracture, indicated for open reduction and ligament repair. We performed closed reduction and two Kirschner wire fixations following Tavernier’s method. The injured hand was protected with a standard short-arm orthosis for one month. The patient returned to normal daily work without discomfort at five months postoperatively. Encouragingly, there was no lunate necrosis or arthritis in the latest radiologic examinations.
CONCLUSION This case provides evidence that the closed reduction technique for addressing such cases can reduce soft tissue destruction.
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Affiliation(s)
- Ling-Yi Li
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung City 40402, Taiwan
| | - Cheng-Jyh Lin
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung City 40402, Taiwan
| | - Chih-Yuan Ko
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung City 40402, Taiwan
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Kang SH, Chae S, Kim J, Lee J, Park IJ. Scapholunate and lunotriquetral interosseous ligament augmentation with internal bracing in perilunate dislocation: Case reports. Medicine (Baltimore) 2021; 100:e26827. [PMID: 34559095 PMCID: PMC8462623 DOI: 10.1097/md.0000000000026827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/19/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE The goals of surgical treatment of the perilunate dislocation (PLD) are confirmation of reduction, ligament repair, and supplemental fixation of the bony architecture. Open reduction and direct repair of the torn ligament are recommended for acute PLD. However, repair of the scapholunate interosseous ligament (SLIL) and lunotriquetral interosseous ligament (LTIL) is often unreliable, and secure repair is challenging. Internal bracing (IB) is an augmentation method that uses high-strength non-absorbable tape and enhances strength and support during the critical period of ligamentous healing. However, there is a paucity of data on the application of IB for PLD in the wrist. We report 3 cases of PLD that were augmented with IB after SLIL and LTIL repair. PATIENT CONCERNS All 3 cases were men who visited our emergency department with wrist after falling off a ladder. DIAGNOSES Initial radiographs revealed a dorsal PLD. INTERVENTIONS Surgically, complete rupture of the SLIL and LTIL were confirmed. K-wires were placed into the scaphoid and lunate and used as joysticks to correct the intercalated segment instability pattern. This usually requires correcting scaphoid flexion and lunate extension and closing the scapholunate interval. Prior to SLIL and LTIL repair, temporary intercarpal fixation was performed with K-wires to maintain the carpal relationship. The dorsal SLIL and LTIL were carefully repaired using suture anchors. However, ligament repair was unreliable, and insecure. In view of the likelihood of insufficient repair, we performed IB augmentation using synthetic tape. OUTCOMES At the last follow-up, all cases were pain-free and had returned to all activities. The last follow-up radiographs showed good alignment of the carpal bones and no arthritic changes. LESSONS IB augmentation can reduce the period of K-wire fixation and cast immobilization and can enable early joint motion. We believe that interosseous ligament augmentation using IB is a reasonable treatment option for PLD.
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Affiliation(s)
- Soo-Hwan Kang
- Department of Orthopaedic Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seungbum Chae
- Department of Orthopaedic Surgery, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, Deagu, Republic of Korea
| | - Jongmin Kim
- Department of Orthopaedic Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jiwon Lee
- Department of Orthopaedic Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Il-Jung Park
- Department of Orthopaedic Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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13
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Wrist and Hand Trauma Imaging. Clin Sports Med 2021; 40:625-639. [PMID: 34509202 DOI: 10.1016/j.csm.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Injuries to the wrist and hands occur frequently in athletes from the high forces applied during sporting events. The examples presented illustrate the important role imaging has in the diagnosis of wrist and hand injuries. In addition, different imaging modalities are complementary and various examinations may be needed to help guide the management of wrist and hand traumatic pathology.
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14
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Rubin G, Eliyahu A, Grinbaum E, Rozen N. Perilunate Dislocation Above the Age of 65 Years: Case Series and Review of Literature. Geriatr Orthop Surg Rehabil 2021; 12:21514593211036230. [PMID: 34422437 PMCID: PMC8377302 DOI: 10.1177/21514593211036230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/18/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Perilunate and fracture dislocations predominantly follow a high-energy mechanism. Perilunate dislocations have an incidence of 0.5/105 individuals/year, occurring at a mean age of 26 years and are frequently seen in men. This study aimed to describe the characteristics of this injury in elderly population of patients using literature review and our experience with four cases aged >65 years. Materials and Methods We treated four patients with perilunate dislocation aged >65 years. All the patients’ medical records were reviewed retrospectively. A literature review for case studies of perilunate dislocation was conducted with the purpose of finding cases including patients aged >65 years. Results Three of our patients had injuries that were missed in the first visit in the emergency department. The mechanism of injury was high energy in only two patients. Two patients had posterior perilunate dislocation, while the other two had transradial perilunate dislocation. Three patients were available for follow-up. The overall outcome was satisfaction according the Mayo wrist score and minimal disability according to the Disabilities of the Arm, Shoulder and Hand score. All patients reported that pain was absent and they were able to return to their regular activities. The literature review found only seven papers documenting treatment of patients aged >65 years. Discussion Perilunate dislocation is extremely rare in the population aged >65 years. Although the rate of missed diagnosis in our cohort was extremely high, the overall satisfaction and return to function was high. Conclusions This case series and literature review highlight the unique characteristics of this injury in the age group of patients aged >65 years. Although perilunate dislocation in patients aged >65 years is rare, clinicians should be aware of the presentation of this condition in the elderly.
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Affiliation(s)
- Guy Rubin
- Orthopedic Department, Emek Medical Center, Afula, Israel.,Technion Israel Institute of Technology Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Amir Eliyahu
- Orthopedic Department, Emek Medical Center, Afula, Israel
| | - Erez Grinbaum
- Orthopedic Department, Emek Medical Center, Afula, Israel
| | - Nimrod Rozen
- Orthopedic Department, Emek Medical Center, Afula, Israel.,Technion Israel Institute of Technology Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
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15
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De Jonge MC, Assink J, Vanhoenacker FM. Acute Bony Injuries of Hand and Wrist. Semin Musculoskelet Radiol 2021; 25:277-293. [PMID: 34374063 DOI: 10.1055/s-0041-1729151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Acute bony injuries to the hand and wrist are very common after a fall on an outstretched hand. In the wrist, distal radius fractures are the most common; isolated distal ulna fractures are uncommon. More serious injuries to the wrist include complicated fracture-dislocation injuries such as perilunate dislocations. At the carpal level, scaphoid fractures are the most common followed by fractures of the dorsal side of the triquetrum. The metacarpals often fracture, most commonly the base of the thumb and the subcapital region of the fifth metacarpal. In the fingers, we encounter many different types of fractures, often avulsions reflecting underlying soft tissue pathology (e.g., mallet finger). Dislocations are common in the fingers, predominantly in the distal interphalangeal joints. From an imaging standpoint, conventional radiography is always the initial examination. Complex (intra-articular) fractures, fracture-dislocation injuries, and a strong clinical suspicion of radiographically occult fractures need to be further evaluated for decision making regarding treatment. Computed tomography is the primary imaging modality of choice for the first two. In the latter, magnetic resonance imaging can be preferable, depending on clinical suspicion and the local situation in the associated hospital.
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Affiliation(s)
- Milko C De Jonge
- Department of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Joeri Assink
- Department of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Filip M Vanhoenacker
- Department of Radiology, Antwerp University Hospital, Edegem, Belgium.,Department of Radiology, AZ Sint-Maarten, Mechelen, Belgium.,Department of Radiology, Ghent University Hospital, Ghent, Belgium
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16
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Garner M, Rudran B, Khan A, Tang Q, Mathew P. Lunate dislocations: anatomy, diagnosis and management. Br J Hosp Med (Lond) 2021; 82:1-10. [PMID: 34338022 DOI: 10.12968/hmed.2021.0025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Lunate dislocation is an uncommon but serious wrist injury, often resulting from a high energy mechanism of trauma. Advanced trauma life support protocols should be followed to diagnose and treat concomitant life-threatening pathology. Thorough neurovascular and soft tissue examination is required to identify open wounds and median nerve dysfunction, including acute onset carpal tunnel syndrome. Imaging is undertaken to appreciate injury severity, which is graded by the Mayfield classification. Closed reduction in the emergency department is the initial management, which alleviates pressure on neurovascular structures. Definitive management is surgical, most commonly via open reduction and direct ligamentous stabilisation. The aims of surgery are to restore anatomical carpal alignment and maintain stability, allowing repair and healing of the important wrist ligaments. Medium-to long-term functional outcomes are adequate, with most patients returning to work within 6 months. However, progressive radiographic midcarpal arthrosis is common, as well as permanent loss of grip strength, range of motion and chronic pain. This article considers the anatomy, diagnosis and management of acute lunate and perilunate dislocations.
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Affiliation(s)
- Madeleine Garner
- Department of Trauma and Orthopaedics, Chelsea & Westminster Hospital, London, UK
| | - Branavan Rudran
- Department of Trauma and Orthopaedics, Royal National Orthopaedic Hospital, London, UK
| | - Amir Khan
- Department of Trauma and Orthopaedics, Royal National Orthopaedic Hospital, London, UK
| | - Quen Tang
- Department of Trauma and Orthopaedics, Chelsea & Westminster Hospital, London, UK
| | - Philip Mathew
- Department of Trauma and Orthopaedics, Chelsea & Westminster Hospital, London, UK
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17
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Franssen NT, Carpenter RJ, Stuart SM. Wrist Injury in Deployed U.S. Marine-How to Maintain the Mission. Mil Med 2021; 185:e1290-e1293. [PMID: 31665415 DOI: 10.1093/milmed/usz365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Wrist pain commonly affects military members and while most instances are benign, some require urgent orthopedic attention to prevent permanent loss of function. A 27-year-old male Marine while deployed presented with wrist pain after a seemingly benign fall during recreation. Radiographs were initially read as unremarkable and treated as a sprain. Though when reviewed by the Shock Trauma Platoon physicians, a perilunate dislocation was noted. After unsuccessful closed attempts to reduce injury, the Marine was sent to orthopedic surgery and underwent open reduction internal fixation and required a subsequent closed reduction and percutaneous pinning. Perilunate dislocations are uncommon but are among the most severe types of wrist injuries. This case is a reminder that proper evaluation of all injuries is critical. Proper evaluation of wrist injuries includes an attentive physical exam and careful examination of the radiographs; paying close attention to Gilula arcs and collinearity of the radius, lunate, and capitate. Prompt recognition and referral to specialty care for definitive treatment are important to maximize functional outcomes.
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Affiliation(s)
- Nathan T Franssen
- VMFA 211 Flight Surgeon, Marine Center Medical Home, Marine Corps Air Station, Yuma, AZ 85639-9180
| | | | - Sean M Stuart
- Surgeon-13th Marine Expeditionary Unit, Combat Trauma Research Group, Oceanside, CA 92058
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18
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Abstract
Imaging plays a key role in the evaluation and treatment planning of hand and wrist injuries in athletes. Depending on the suspected injury, a combination of conventional radiographs, computed tomography, magnetic resonance imaging, magnetic resonance arthrography, and/or ultrasound may be indicated. This article reviews the strengths and limitations of these imaging modalities and how they can be utilized in commonly encountered clinical questions.
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Affiliation(s)
| | - B Matthew Howe
- Department of Radiology, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
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19
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Kapoor G, Heire P, Turmezei T, Chojnowski A, Toms AP. Perilunate injuries: biomechanics, imaging, and classification. Clin Radiol 2019; 75:81-87. [PMID: 31806363 DOI: 10.1016/j.crad.2019.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 10/21/2019] [Indexed: 11/17/2022]
Abstract
Perilunate injuries are uncommon injuries that are often misdiagnosed. Although conventional radiographs can underestimate the severity of the perilunate injuries, assessment with cross-sectional imaging can be complex, and terminology is inconsistent in the scientific literature. The aim of this paper is to describe the biomechanics, anatomy, and classification of perilunate trauma in order to provide a systematic approach to the description and diagnosis of these injuries.
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Affiliation(s)
- G Kapoor
- Department of Radiology, Norfolk & Norwich University Hospital, Colney Lane, Norwich, Norfolk, UK.
| | - P Heire
- Department of Radiology, Norfolk & Norwich University Hospital, Colney Lane, Norwich, Norfolk, UK
| | - T Turmezei
- Department of Radiology, Norfolk & Norwich University Hospital, Colney Lane, Norwich, Norfolk, UK
| | - A Chojnowski
- Department of Radiology, Norfolk & Norwich University Hospital, Colney Lane, Norwich, Norfolk, UK
| | - A P Toms
- Department of Radiology, Norfolk & Norwich University Hospital, Colney Lane, Norwich, Norfolk, UK
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20
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Huang C, You D, Guo W, Qu W, Hu Y, Li R, Zhu Z. First-stage scapholunate fusion for the treatment of a chronic lunate dislocation: A case report. Medicine (Baltimore) 2019; 98:e16453. [PMID: 31305477 PMCID: PMC6641798 DOI: 10.1097/md.0000000000016453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Lunate dislocation is a rare injury to the wrist caused by high-energy trauma, and poor prognosis is often associated with missed initial diagnosis. To date, there is no consensus regarding an effective treatment plan for such cases. PATIENT CONCERNS Here, we describe the case of a 36-year-old man who presented with lunate dislocation following a delay in diagnosis of over 7 weeks, and further illuminate its diagnosis and treatment. DIAGNOSIS The diagnosis of chronic lunate dislocation was rendered. INTERVENTIONS The patient was treated using reduction via the dorsal approach brachial plexus anesthesia. After the reduction, a headless compression screw fixation was performed for first-stage scapholunate fusion, and Kirschner wire fixation of the lunate-triquetrum-hamate was used to stabilize the distal and proximal carpal rows. OUTCOMES The patient was followed up for 1 year and showed wrist function recovered well; radiographic examination showed no lunate dislocation and successful scapholunate bony fusion. A satisfactory outcome was achieved. LESSONS The case study presented here provide evidence that performing an effective first-stage scapholunate fusion is recommended to achieve better therapeutic outcomes for a chronic lunate dislocation. Furthermore, this approach led to a good long-term clinical outcome in our case.
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Affiliation(s)
- Chao Huang
- Hand and Foot Surgery, The Second Hospital of Jilin University
| | - Di You
- Department of Anesthesiology, The Sino-Japanese Friendship Hospital of Jilin University, Nanguan District, Changchun City, Jilin, P. R. China
| | - Wenlai Guo
- Hand and Foot Surgery, The Second Hospital of Jilin University
| | - Wenrui Qu
- Hand and Foot Surgery, The Second Hospital of Jilin University
| | - Yuchen Hu
- Hand and Foot Surgery, The Second Hospital of Jilin University
| | - Rui Li
- Hand and Foot Surgery, The Second Hospital of Jilin University
| | - Zhe Zhu
- Hand and Foot Surgery, The Second Hospital of Jilin University
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21
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Torabi M, Lenchik L, Beaman FD, Wessell DE, Bussell JK, Cassidy RC, Czuczman GJ, Demertzis JL, Khurana B, Klitzke A, Motamedi K, Pierce JL, Sharma A, Walker EA, Kransdorf MJ. ACR Appropriateness Criteria® Acute Hand and Wrist Trauma. J Am Coll Radiol 2019; 16:S7-S17. [DOI: 10.1016/j.jacr.2019.02.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/09/2019] [Indexed: 12/28/2022]
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22
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Goodman AD, Harris AP, Gil JA, Park J, Raducha J, Got CJ. Evaluation, Management, and Outcomes of Lunate and Perilunate Dislocations. Orthopedics 2019; 42:e1-e6. [PMID: 30403823 DOI: 10.3928/01477447-20181102-05] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 03/07/2018] [Indexed: 02/03/2023]
Abstract
Lunate and perilunate dislocations are potentially devastating injuries that are often unrecognized at initial evaluation. Prompt recognition and treatment is necessary to prevent adverse sequelae, including median nerve dysfunction, carpal instability, posttraumatic arthritis, reduced functionality, and avascular necrosis. In patients who are surgical candidates, operative intervention is warranted to restore carpal kinematics and provide optimal outcomes. [Orthopedics. 2019; 42(1):e1-e6.].
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23
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24
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Morin M, DeSilva G. Lunate Dislocation in a Division 1 Football Player. Curr Sports Med Rep 2017; 16:312-313. [PMID: 28902751 DOI: 10.1249/jsr.0000000000000395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Matthew Morin
- The University of Arizona Orthopedic Residency Program, Tucson, AZ
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25
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Wrist Pain after a Fall. Ann Emerg Med 2017; 69:e5-e6. [DOI: 10.1016/j.annemergmed.2016.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Indexed: 11/17/2022]
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26
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Kim K, Kim MW. Ultrasonography Detected Missed Lunate Volar Dislocation Associated With Median Neuropathy: A Case Report. Ann Rehabil Med 2017; 41:709-714. [PMID: 28971058 PMCID: PMC5608681 DOI: 10.5535/arm.2017.41.4.709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 10/10/2016] [Indexed: 11/05/2022] Open
Abstract
Lunate and perilunate dislocations are uncommon, but they have clinical importance because complications, such as median neuropathy and avascular necrosis of the lunate, can occur. Although early diagnosis enabling early surgical treatment is crucial for preventing long-term sequelae, these dislocations are frequently missed in the initial assessment. Imaging tools, such as plain radiography, magnetic resonance imaging, ultrasonography, and electrodiagnostic studies, have been used for diagnosis. The proper choice of initial evaluation tools is important for making an accurate early diagnosis. Here we present a case of lunate dislocation associated with median neuropathy in which ultrasonography, along with the electrodiagnostic study and plain radiography, played an important diagnostic role in detecting structural abnormalities. This case report reveals the complementary diagnostic role of ultrasonography in initial assessment and provides ultrasonographic images of lunate dislocation as a cause of median neuropathy.
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Affiliation(s)
- Kyeongwon Kim
- Department of Rehabilitation Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Min-Wook Kim
- Department of Rehabilitation Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
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27
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Gómez-Suárez F, Yañez-Calvo J, Castro-Menéndez M. Luxación aislada del piramidal. REVISTA IBEROAMERICANA DE CIRUGÍA DE LA MANO 2016. [DOI: 10.1016/j.ricma.2016.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Aunque las luxaciones carpianas son lesiones relativamente frecuentes, la luxación aislada del piramidal es excepcional. Presentamos un caso aislado de luxación volar del hueso piramidal, revisando los casos similares publicados en la literatura y analizando los aspectos más importantes en relación con su diagnóstico y tratamiento.Varón de 38 años de edad, con caída sobre su mano derecha en hiperextensión. Inicialmente el diagnóstico pasó desapercibido. Al mes se realizó reducción abierta y estabilización con agujas de Kirchner.A los 4 años de la cirugía el paciente se encuentra asintomático y con la misma fuerza de agarre que la mano contralateral. Las radiografías postoperatorias muestran una buena reducción del carpo sin signos de inestabilidad.La falta de un diagnóstico inicial y en consecuencia un retraso en el tratamiento hacen más difícil el manejo de las lesiones, pero es una reducción inadecuada del carpo el factor pronóstico más negativo.
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Affiliation(s)
- F. Gómez-Suárez
- Departamento de Cirugía Ortopédica y Traumatología, Mutua Gallega, Ourense, España
| | - J. Yañez-Calvo
- Unidad de Cirugía de la Mano, Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, España
| | - M. Castro-Menéndez
- Departamento de Cirugía Ortopédica y Traumatología, Hospital de Monforte de Lemos, Monforte de Lemos, Lugo, España
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28
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Morin ML, Becker GW. An unusual variant of perilunate fracture dislocations. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2016; 3:7-10. [PMID: 27583261 PMCID: PMC4996057 DOI: 10.3109/23320885.2016.1152902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 02/07/2016] [Indexed: 11/13/2022]
Abstract
Trans-scaphoid, trans-radial styloid, trans-triquetral perilunate fracture dislocations are rare. We describe a 19-year-old male who suffered this injury after crashing his bicycle. He underwent open reduction internal fixation and percutaneous pinning. Scaphoid union was achieved at 8 weeks. Near complete range of painless motion was achieved by 4 months.
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Affiliation(s)
- Matthew L Morin
- Department of Orthopedic Surgery, University of Arizona , Tucson , AZ , USA
| | - Giles W Becker
- Department of Orthopedic Surgery, University of Arizona , Tucson , AZ , USA
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29
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Abstract
Radiographs remain the mainstay for initial imaging of suspected fracture in the emergency setting. Missed fractures potentially have significant negative consequences for patients, referring physicians, and radiologists. Most missed fractures are owing to perceptual errors. In this review, we emphasize knowledge of 3 categories of pitfalls as they pertain to the upper extremity: the common but challenging; the out of mind, out of sight; and those related to satisfaction of search. For specific injuries, emphasis is placed on helpful radiographic signs and important additional radiographic views to obtain.
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Affiliation(s)
- Scott Tyson
- Department of Radiology, Imaging Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk A-21, Cleveland, OH 44195, USA
| | - Stephen F Hatem
- Department of Radiology, Imaging Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk A-21, Cleveland, OH 44195, USA.
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30
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Upper Extremity Trauma Radiographs. AJR Am J Roentgenol 2015; 204:W374. [DOI: 10.2214/ajr.14.13838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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