Perilunate and Axial Carpal Dislocations and Fracture–Dislocations

Abstract

Perilunate dislocations and perilunate fracture–dislocations (PLD-PLFDs) and axial carpal dislocations and axial carpal fracture–dislocations (ACD-ACFDs) belong to the carpal instability complex type of wrist instabilities. 1 Dobyns J.H. Cooney W.P. Classification of carpal instability. in: Cooney W.P. Linscheid R.L. Dobyns J.H. The wrist: diagnosis and operative treatment. Mosby, St Louis1998: 490-500 Google Scholar Both occur infrequently, with PLD-PLFDs accounting for 7% of all carpal injuries that we treat in our hand emergency unit. Both are high-energy carpal injuries, which usually occur in young males in their 20s or 30s. Most PLDs are the result of a fall from a height, whereas ACDs usually result from a blast accident, creating a dorsopalmar compressive load to the wrist. Motor vehicle accidents may produce either PLD-PLFDs or ACD-ACFDs. It is worthwhile to study these 2 types of injuries together because both display dissociative intercarpal and/or intracarpal patterns of carpal trauma. A PLD-PLFD essentially disrupts the proximal row, whereas an ACD-ACFD basically disrupts the distal row and the metacarpal arch (Fig. 1). Both PLD-PLFDs and ACD-ACFDs have many variant patterns, which should be recognized and diagnosed. In some rare cases, these 2 types of carpal injuries may occur in combination or share a part of their injury pattern. In PLD-PLFDs and ACD-ACFDs, the determination of the injury path is of paramount importance because surgical repair should address each component of that injury pathway that propagates through the carpus. During the past 5 years, there has been a large contribution to the literature describing new aspects of diagnosis and treatment of these injuries. The purpose of this article is to provide an update about these complex injuries.