Delayed Post-Traumatic Midcarpal Dislocation

Author(s): Hawken RM, Fullilove SM

Source: J Hand Surg 32E:554-555, 2007.

Summary:

The authors reporte a case of delayed, static, palmar mid-carpal instability in a healthy 39 year-old woman who fell and landed heavily on the dorsum of her flexed wrist.  Initial radiographs showed normal carpal bone alignment.  A thumb-spica cast was applied for treatment of a suspected scaphoid fracture: a volar lip avulsion fracture of the lunate was eventually diagnosed.  Radiographs 6 weeks post-injury demonstrated VISI, and radiographs 6 months later showed volar dislocation of the lunate with degenerative changes.  Surgery was eventually undertaken, involving a scaphoid excision and four-corner arthrodesis.

Palmar midcarpal instability has been associated with injury to the following wrist ligaments: radioscaphocapitate, triquetrohamate, triquetrocapitate, and dorsal radiocarpal.  The lunate fracture in this case was assumed to represent a destabilizing soft-tissue injury.  Other instability patterns may be recognized in a delayed fashion following wrist sprains and fractures (Doig et al, Injury 1991; Forward et al, JBJS Am 2007).  These instability patterns are not always obvious, the incidence rates are not known, and proposed treatments are varied.

 

Wrist, Instability, Midcarpal, Dislocation


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