An Extraordinary case report: Bilateral pure perilunate dislocation

Abstract

Introduction: Perilunate dislocation of the carpus is an unusual injury, requiring high-energy trauma. The simultaneous bilateral form is so rare that is worthy of report, with only a few cases mentioned in the literature. We present the case of a patient with an open volar dislocation of the right wrist associated with a closed dorsal dislocation of the left wrist and distal radioulnar subluxation. Case report: A 30-year-old, right hand dominant male, suffered injuries to both wrists after being involved in a high-speed car accident. Examination of the patient revealed diffuse swelling and tenderness to both wrists with a lacerated wound over the dorsum of right wrist. Anteroposterior and lateral X-rays of both wrists were obtained, which showed bilateral perilunate pure dislocations: volar in the right side and dorsal the left side combined with a dorsal subluxation of the distal radioulnar joint. Discussion: Perilunate dislocations are relatively rare injuries involving approximately only 7% of all injuries of the carpus. It is often overlooked in primary evaluations, approximately 25% of perilunate injuries were missed. A better comprehension of the injury's mechanism and its full extent has led to better management strategies. It is recommended in the literature, that the best treatment of these injuries is open reduction, restoration of carpal bones relationship, repair of the ligaments and a proper rehabilitation and physiotherapy program.