(OBQ12.244) Classification. Perilunate dislocations and fracture-dislocations are relatively uncommon injury patterns in acute wrist trauma. On physical exam she has no sensation of the volar thumb, index, and middle fingers. Hip fractures are strongly associated with BMD in the proximal femur, but there are also many clinical predictors of hip fracture risk that are independent of bone density. Difficult wrist fractures. Diagnosis requires careful evaluation of plain radiographs. A 56-year-old woman sustains the closed injury depicted in Figures A-B. Chronic DISI deformities may be indicated for fusion procedures depending on degree of arthritis and patient symptoms. The patient undergoes open reduction internal fixation (ORIF). immobilization in a short arm thumb spica cast. A 65-year-old female sustains a fall onto her outstretched right hand. Deciding whether a fracture needs reducing. 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. The lunate bone articulates with the scaphoid, the distal radius, and the TFCC. It is essentially the same sequela of . Hamate Body Fractures are rare carpal fractures that can be associated with 4th or 5th metacarpal fractures. Summary. (OBQ06.60) Wheeless' Textbook of Orthopaedics. Lunate Dislocation (Perilunate dissociation), Gymnast's Wrist (Distal Radial Physeal Stress Syndrome), Scaphoid Nonunion Advanced Collapse (SNAC), Carpal Instability Nondissociative (CIND), Constrictive Ring Syndrome (Streeter's Dysplasia), Thromboangiitis Obliterans (Buerger's disease). 2023 Lineage Medical, Inc. All rights reserved. Philadelphia : Lippincott Williams & Wilkins, c2005. A 58-year-old man underwent distal radius ORIF with a volar locking plate yesterday. CT and bone scans may also be used.This is a slow-progressing disease, and patients often have the condition for months or even years before they seek treatment. The lunate is displaced and rotated volarly. Revista dedicada a la medicina Estetica Rejuvenecimiento y AntiEdad. Distal Radius Fracture Non-Spanning External Fixator . Inability to flex the index finger proximal interphalangeal joint. {"url":"/signup-modal-props.json?lang=us"}, Murphy A, Lunate fracture. Perilunate fracture-dislocations of the wrist. (OBQ04.38) Radiographs obtained at the time of injury are shown in Figure A. He founded Orthopaedic Specialists of North Carolina in 2001 and practices at Franklin Regional Medical Center and Duke Raleigh Hospital. AP and lateral radiographs of the wrist are shown in figures A and B respectively. Medical Information Search - knowing position of ECU & ulnar styloid helds to differentiate ECU tendinitisfrom distal radioulnar problems. 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. Towson, MD 21204 Treatment requires urgent closed versus open reduction and stabilization. Type in at least one full word to see suggestions list, Orthopaedic Summit Evolving Techniques 2021, 23-Year-Old Skateboarder Falls On An Outstretched Arm With A Scapholunate Full-Thickness Tear: All Those Procedures To Repair Don't Work, I Have The Answer: 'RASL' Dazzle: I Am Not Dead Yet, Look At My Long-Term Results - Melvin P. Rosenwasser, MD, Modified Brunelli for Scapholunate Reconstruction, Cleveland Combined Hand Fellowship Lecture Series 2020-2021, Wrist Scapholunate (SL) Ligament Injury in 52M. During postoperative recovery from this injury, what benefit does formal physical therapy have as compared to a patient-guided home exercise program? Diagnosis is made with PA wrist radiographs showing widening of the SL joint. A 25-year-old female falls from her horse and injures her left wrist. (SLAC) - Hand - Orthobullets Scapholunate Advanced Collapse Article - StatPearls Scapholunate advanced collapse (SLAC) of the wrist is a very common case of degenerative arthritis . A variety of operative procedures may be indicated depending on severity of disease and patient's symptoms. Three months after the fracture she reports an acute loss of her ability to extend her thumb. The rest of the carpal bones are in a normal anatomic position in relation to the radius. - deviation of more than 15 deg either way between the links of chain may be viewed as lax, diseased, or damaged; - Exam: Lunate Dislocation (Perilunate dissociation) . Lunate fractures and associated radiocarpal and midcarpal instabilities: a systematic review:. (SBQ17SE.64) dorsal fractures commonly axial fracture healing. Unable to process the form. They often are not diagnosed initially and present delayed as lunate osteonecrosis, which is also known as Kienbock disease. Which of the following radiographic views shown in Figures A to E would be most helpful in establishing the diagnosis? Copyright 2023 Lineage Medical, Inc. All rights reserved. A 54-year-old male falls from a ladder and sustains the fracture shown in Figure A. Management should consist of. You can rate this topic again in 12 months. 2. Treatment involves immobilization or surgical fixation depending on location, severity and alignment of injury. tures, specically non-union of scaphoid fractures. 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 Phalanx Fractures are common hand injuries that involve the proximal, middle or distal phalanx. Which plating option provides the most appropriate treatment of this fracture? When performed on 18 children with distal radius-ulna fractures, P . The injury pattern may involve a crush injury, a FOOSH injury (Figure 18.21), or a direct blow to the dorsal aspect of the wrist. 4. - w/ flexion and extension lunate/capitate articulation may be felt; 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. Upper extremity deep vein thrombosis (DVT), Lower extremity deep vein thrombosis (DVT). There may be other associated injuries that require further investigation via cross-sectional imaging 1,2. Schmitt R, Lanz U, Buchberger W. Diagnostic Imaging of the Hand. Patients often prefer to hold their fingers in partial flexion due to pain on extension. It rarely affects both wrists. (OBQ07.226) As he tried to brace his fall, he landed directly on his extended and ulnarly deviated left hand. (OBQ12.105) Mayfield JK, Johnson RP, Kilcoyne RK. (2008) RadioGraphics. This content is written, edited and updated by hand surgeon members of the American Society for Surgery of the Hand. Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Which of the following distal radius fractures is associated with volar translation of carpus relative to the radial articulation? Two-point discrimination is now >10mm in these fingers. (SBQ17SE.67) It can be caused by multiple factors such as: Damage to the lunate can lead to pain and stiffness. There are no open wounds and the hand is neurovascularly intact. (OBQ05.195) Immediate post-operative radiographs are seen in Figure A. Pearls/pitfalls. Long arm cast above the elbow for 6 weeks, Long arm cast for 3 weeks followed by a short arm cast for 3 additional weeks, Closed reduction and percutaneous pinning. Treatment is nonoperative for non-displaced fractures but displaced or intra-articular fractures require ORIF. Surgery may be done to change forces across the lunate and wrist joint or to improve vascularity of the lunate. The most important differential is of other carpal dislocations, particularly: In addition to stating that a lunate dislocation is present, a number of features should be sought and commented upon: ensure that radiolunate alignment is disrupted, and that you are not looking at a perilunate dislocation(stage II carpal dislocation), evaluate and comment on the degree or palmar rotation of the lunate (this can be up to 270 degrees)4, ensure that the capitate remains co-linear with the long axis of the radius, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. What is the next best step in management of this patient? main cause for these lesions is a direct impact against a hard surface with a, 4th or 5th metacarpal base fractures or dislocations, usually required to delineate fracture pattern and determine operative plan, diagnosis confirmed by history, physical exam, and, may be used for extra-articular non-displaced fracture, most fractures are intra-articular and require open reduction, interfragmentary screws +/- k-wires for temporary stabilization, fixation may be obtained with K wires or screws, Lunate Dislocation (Perilunate dissociation), Gymnast's Wrist (Distal Radial Physeal Stress Syndrome), Scaphoid Nonunion Advanced Collapse (SNAC), Carpal Instability Nondissociative (CIND), Constrictive Ring Syndrome (Streeter's Dysplasia), Thromboangiitis Obliterans (Buerger's disease). 14% (259/1911) 2. 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? The lunate is a central bone in the wrist that is important for proper movement and support of the joint (Figure 1). Data Trace Publishing Company Volar wrist swelling is usually prominent. 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. (OBQ18.223) Find a hand surgeon near you. He underwent operative fixation by and presents to your clinic for his 2 week follow-up visit. A 65-year-old man fell and injured his right wrist. - lunate articulates proximally w/ radius and distally w/ capitate; The plate may need to removed once the fracture is healed to reduce the chance of flexor pollicis longus injury, The plate may need to removed once the fracture is healed to reduce the chance of flexor carpi radialis injury, The plate may need to removed once the fracture is healed to reduce the chance of flexor digitorum superficialis index finger injury, The patient should undergo revision fixation as soon as possible, The plate is in appropriate position and will likely never need to be removed. Displaced intra-articular fracture with a fragment consisting of the volar-ulnar corner. At the time of the index operation, there was no distal radioulnar joint instability after plating of the radius. Treatment involves observation, NSAIDs and splinting in early stages of disease. Pathology. (OBQ06.136) Treatment options depend upon the severity and stage of the disease. Diagnosis is made clinically with progressive wrist pain and wrist instability with radiographs showing advanced arthritis of the radiocarpal and midcarpal joints (radiolunate joint . Type in at least one full word to see suggestions list, Hand Scaphoid Lunate Advanced Collapse (SLAC). Diagnosis is made with PA wrist radiographs showing widening of the SL joint. 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? Telephone: 410.494.4994, Limited open reduction of the lunate facet in comminuted intra-articular fractures of the distal radius, Difficult wrist fractures. 2.Meenalochani Shunmugam, Joideep Phadnis, Amy Watts, Gregory I. Bain. Follow-up/referral. - tenderness of dorsal lunate may suggest Keinbock's dz, while moreulnar tenderness suggests tears of TFC or lunotriquetral ligament; Stage III involves disruption of the the lunotriquetral ligament or triquetral fractures. Read 14. Capitate fractures are classified by the anatomic location of the fracture, along with what other concomitant injuries may be present. What is the next most appropriate step in management? educational laws affecting teachers. Radiographs of the affected wrist are shown in Figure A. A 24-year-old stagehand fell 12 feet off of a ladder while preparing a set. Diagnosis can be confirmed with orthogonal radiographs of the involve digit. A 76-year-old male sustains a minimally displaced distal radius fracture and undergoes closed treatment with a cast. What complication is most likely to occur in this patient? The next best step in management would be: (OBQ12.163) Other common causes include: car . 1. What additional data is most necessary to obtain before a reduction is attempted? Lunate dislocationsare an uncommon traumatic wrist injury that require prompt management and surgical repair. Displaced impaction fracture of the lunate fossa, Displaced intra-articular fracture with a fragment consisting of the volar-ulnar corner, Displaced extra-articular fracture with apex volar, Displaced extra-articular fracture with apex dorsal. After soft tissue swelling subsides, open reduction and internal fixation of the distal radius is performed. Thank you. The lunate is displaced and rotated volarly. The instrument touches a structure that prevents ulnar translocation of the carpus after a PRC. Adequate maintenance of reduction by non-operative treatment is unsuccesful. Dr. Wheeless enjoys and performs all types of orthopaedic surgery but is renowned for his expertise in total joint arthroplasty (Hip and Knee replacement) as well as complex joint infections. 2023 Lineage Medical, Inc. All rights reserved. The patient undergoes open reduction and internal fixation of the fracture. (OBQ13.140) Which of the following will best achieve anatomic reduction, restore function, and prevent future degenerative changes of the wrist? 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. (2017) Journal of Hand Surgery (European Volume). Lunate/perilunate dislocations are high energy injuries to the wrist associated with neurological injury and poor functional outcomes. A 52-year-old farmers periodic wrist pain has been managed with non-operative modalities to include two injections in the last 8 months. Diagnosis is generally made with radiographs of the wrist but may require CT for confirmation. The patient undergoes closed reduction and splinting; however, her paresthesias worsen significantly in the next 12 hours. Perilunate dislocations typically occur in young adults with high energy trauma resulting in the loading of a hyperextended, ulnarly deviated hand. 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 . Spontaneous rupture of the extensor pollicis longus tendon is most frequently associated with which of the following scenarios? Diagnosis is generally made with radiographs of the wrist but may require CT for confirmation. You review his operative note in which the surgeon reports having to apply a volar locking plate in a distal position to secure the difficult intra-articular fracture. The rest of the carpal bones are in a normal anatomic position in relation to the radius. Diagnosis of DISI deformity can be made with lateral wrist radiographs showing a scapholunate angle. Both images from . Diagnosis requires careful evaluation of plain radiographs. Cleveland Combined Hand Fellowship Lecture Series 2019-2020, Fractures of the Other Carpal Bones - Austin Pitcher, MD. After completing instrumentation, radiocarpal screw penetration is best assessed on which fluoroscopic view? Epidemiology. The lunate is made up of the volar pole, body, and dorsal pole. Capitate fractures are most commonly due to high-energy, hyperextension forces 2. Failure to support the lunate facet with fragment specific fixation, Use of only three bicortical screws in the intact radial shaft proximally. (OBQ18.216) 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. Diffuse swelling and tenderness over capitate (just proximal to 3rd metacarpal) Differential Diagnosis Flashcards. main cause for these lesions is a direct impact against a hard surface with a, 4th or 5th metacarpal base fractures or dislocations, usually required to delineate fracture pattern and determine operative plan, diagnosis confirmed by history, physical exam, and, may be used for extra-articular non-displaced fracture, most fractures are intra-articular and require open reduction, interfragmentary screws +/- k-wires for temporary stabilization, fixation may be obtained with K wires or screws, Lunate Dislocation (Perilunate dissociation), Gymnast's Wrist (Distal Radial Physeal Stress Syndrome), Scaphoid Nonunion Advanced Collapse (SNAC), Carpal Instability Nondissociative (CIND), Constrictive Ring Syndrome (Streeter's Dysplasia), Thromboangiitis Obliterans (Buerger's disease). . 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. Copyright 2023 Lineage Medical, Inc. All rights reserved. It works closely with the two forearm bones (the radius and ulna) to help the wrist move. Rathachai Kaewlai, Laura L. Avery, Ashwin V. Asrani, Hani H. Abujudeh, Richard Sacknoff, Robert A. Novelline. There is no median nerve paresthesias. The table below lists normal and acceptable ranges for these measurements (from orthobullets), but it is impossible to be proscriptive. Lunate Dislocation (Perilunate dissociation). How do you counsel him about his post-operative period? Copyright 2023 Lineage Medical, Inc. All rights reserved. (OBQ07.8) Diagnosis is generally made with radiographs of the wrist but may require CT for confirmation. You remove his splint, he has no difficulty moving any fingers, very minimal pain, and is not taking any narcotic medication. Which of the following interventions should be taken? Inability to extend the thumb interphalangeal joint. At the time the article was created Andrew Dixon had no recorded disclosures. Which of the following fluoroscopic views is used to assess intra-articular screw penetration during volar fixation of a distal radius fracture? Following fixation, a "shuck" test is performed and shows persistent instability of the distal radioulnar joint. Lunate/perilunate dislocations are high energy injuries to the wrist associated with neurological injury and poor functional outcomes. Die-punch. The lunate is an important stabilizer of the wrist . Orthopaedic Specialists of North Carolina. A 68-year-old male falls onto his outstretched hand and suffers the injury shown in Figures A and B. 43 (1): 84-92. A 28-year-old woman fell on her right wrist while rollerblading 6 days ago. The scaphoid accounts for 95% of degenerative/traumatic arthri- . lunate fracture orthobullets Volar pole fractures are more commonly observed as the lunate is compressed by the capitate. 1980;5 (3): 226-41. The black dot in the photo is the capitate. There is no single cause of Kienbocks disease. - it is palpable just distal to radial tubercle; She was seen in the emergency department at the time of injury and was told she had a sprain. diastasis of the scapholunate complex occurs with complete SLIL tears and capsule disruption. Hamate Body Fractures are rare carpal fractures that can be associated with 4th or 5th metacarpal fractures. Summary. Which of the following has evidence to support its utility in this clinical situation? Given the lunate's position in the wrist, there is significant overlap from other carpal bones and hence these fractures can be subtle. A 32-year-old professional baseball player presents with wrist pain after a fall on his outstretched wrist 10 days ago. Terry Thomas sign: This is seen on an AP wrist film and is indicated by a gap >3mm between the scaphoid and lunate bones Cortical Ring sign: occurs when the scaphoid is in a flexed position, making the scaphoid tubercle more prominent.A measure distance less than 7mm between the end of the cortical ring and the proximal end of the scaphoid suggests scapholunate dissociation and instability. Examination now reveals dorsal tenderness in the proximal wrist but no snuffbox or ulnar tenderness. A 40-year-old right-handed professional football player reports persistent right wrist pain after falling during a game 5 days ago. Scaphoid Lunate Advanced Collapse (SLAC) d. escribes the specific pattern of degenerative arthritis seen in chronic dissociation between the scaphoid and lunate. Improved functional outcomes with open reduction internal fixation (ORIF) through FCR approach vs. closed treatment, No difference in radiographic outcomes after ORIF vs. closed treatment, No difference in functional outcomes after ORIF vs. closed treatment, Improved functional outcomes with closed treatment vs. ORIF, Improved functional outcomes with external fixation and K wire fixation vs. ORIF. 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 17-year-old male falls from a retaining wall onto his left arm. Which of the following is true post-operatively regarding this patient's ulnar styloid fracture? Stage IV denotes a true lunate dislocation, involving a . (SBQ17SE.13) A 45-year-old male sustained a fall onto his right wrist 2 weeks ago. Lunate fractures account for around 4% of all carpal fractures 1. Diagnosis can be confirmed with orthogonal radiographs of the involve digit. These should not be confused with perilunate dislocations in which the radiolunate articulation is preserved and the rest of the carpus is displaced dorsally. (OBQ09.254) The lunate is an important stabilizer of the wrist, fractures can lead to ligamentous injury and overall volar intercalated segment instability. (OBQ13.78) Read millions of eBooks and audiobooks on the web, iPad, iPhone and Android. Lunate fracture. (OBQ17.87) This is an AAOS Self Assessment Exam (SAE) question. A fracture to the lunate may also be associated with injury to the TFCC. Hand therapy does not change the course of the disease; however, it can help to minimize loss of motion from the disease. A 45-year-old construction worker sustains a fall and presents with an isolated injury to his upper extremity. (OBQ06.102) The lunocapitate articulation may be disrupted resulting in a dorsal perilunate dislocation, or in the case of concomitant scaphoid fracture, the wrist may undergo a transscaphoperilunate dislocation. 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. A 35-year-old professional football player complains of severe wrist pain after making a tackle. Colles'. (OBQ04.233) Inability to extend the index finger proximal interphalangeal joint. Most hand and wrist fractures (the latter of which is basically an ulnar styloid fracture) are caused by trying to break a fall with your arm outstretched. He initially thought it was a sprain, but presents due to continued pain worsened by push-ups. Barton's fracture: Dorsal intraarticular fracture which is often associated with dislocation at the radiocarpal joint. He denies any new trauma, and has followed all post-operative activity restrictions. 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 . whilst on the lateral the capitate no longer sits in the lunate. push up position), may be associated with wrist instability or weakness, may see swelling over the dorsal aspect of the wrist, tenderness in the anatomical snuffbox or over the, pain increased with extreme wrist extension and radial deviation, when deviating from ulnar to radial, pressure over volar aspect of scaphoid subluxates the scaphoid dorsally out of the scaphoid fossa of the distal radius, and a clunk is palpated when pressure is released as the scaphoid reduces back over the dorsal rim of the radius, a painful clunk during this maneuver may indicate insufficiency of scapholunate ligament, clenched fist (can exaggerate the diastasis), dorsal tilt of lunate leads to SL angle > 70, may be used as screening tool for arthroscopy, always assess the contralateral wrist for comparison, may demonstrate the presence of a tear but cannot determine the size of the tear, positive finding of a tear may indicate the need for wrist arthroscopy, often overused as a screening modality for SLIL tears, requires careful inspection of the SLIL by a dedicated radiologist to confirm diagnosis, Carpal instability nondissociative (CIND), splinting and close follow-up with repeat imaging and clinical response with acute injuries, most people feel casting alone is insufficient, acute scapholunate ligament injury without carpal malalignment, ligament pathoanatomy is ammenable to repair, if pathoanatomy of SL ligament injury is a scaphoid fx than repair with, small incision is made just distal to the radial styloid, care to avoid cutting the radial sensory nerve branches, often added to a ligament repair and remains a viable alternative for a chronic instability when ligament repair is not feasible, place two k-wires in parallel into the scaphoid bone, reduce the SL joint by levering the scaphoid into extension, supination and ulnar deviation and lunate into flexion and radial deviation, confirm reduction of the SL joint under fluoroscopy, FCR tendon transfer (direct SL joint reduction), ECRB tendonosis (indirect SL joint reduction), weave not recommended due to high incidence of late failure. Ulnar side of hand. The lunate is one of the eight small bones in the wrist. (OBQ18.177) commonly missed (~25%) on initial presentation, occurs when wrist extended and ulnarly deviated, disruption of capitolunate articulation -->, disruption of lunotriquetral articulation -->, failure of dorsal radiocarpal ligament -->, ligamentous disruptions with associated fractures of the radius, ulnar, or carpal bones, lunate stays in position while carpus dislocates, lunate forced volar or dorsal while carpus remains aligned, major stabilizers of the proximal carpal row, ligaments the both originate and insert among the carpal bones, + lunotriquetral disruption, "perilunate", Lunate dislocated from lunate fossa (usually volar), median nerve symptoms may occur in ~25% of patients, most common in Mayfield stage IV where the lunate dislocates into the carpal tunnel, due to palmar rotation from dorsal force of carpus, loss of colinearity of radius, lunate, and capitate, no indications when used as definitive management, universally poor functional outcomes with non-operative management, emergent closed reduction/splinting followed by open reduction, ligament repair, fixation, possible carpal tunnel release, decreased grip strength and stiffness are common, chronic injury (defined as >8 weeks after initial injury), not uncommon, as initial diagnosis frequently missed, chronic injuries with degenerative changes, finger traps, elbow at 90 degrees of flexion, dorsal dislocations are reduced through wrist extension, traction, and flexion of wrist, longitudinal incision centered at Lister's tubercle, excellent exposure of proximal carpal row and midcarpal joints, extended carpal tunnel incision just proximal to volar wrist crease, some believe volar ligament repair not necessary, difficulty regaining digital flexion and grip, controversy of k-wire versus intraosseous cerclage wiring, repair of lunotriquetral interosseous ligament, decision to repair based on surgeon preference as no studies have shown improved results, short arm thumb spica splint converted to short arm cast at first post-op visit, duration of casting varies, but at least 6 weeks, perform via dorsal and volar incisions if median nerve compression is present, volar approach allows median nerve decompression with excision of lunate, dorsal approach facilitates excision of the scaphoid and triquetrum, radiodense appearance of the lunate on radiograph reported in up to 12.5% of cases, usually identified 1-4 months post-injury, - Lunate Dislocation (Perilunate dissociation), Gymnast's Wrist (Distal Radial Physeal Stress Syndrome), Scaphoid Nonunion Advanced Collapse (SNAC), Carpal Instability Nondissociative (CIND), Constrictive Ring Syndrome (Streeter's Dysplasia), Thromboangiitis Obliterans (Buerger's disease).
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