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Acute Ligament Tear - Repair Technique
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Blood Supply to the Wrist
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Carpal Instability
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Differential Diagnosis:
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Kienbock's disease:
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Luno-Triquetral Coalition:
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Perilunate Dislocations
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Scapholunate Instability
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Vascularity of the Lunate
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X-ray findings
- Discussion:
- lunate articulates proximally w/ radius and distally w/
capitate;
- it has large volar surface, & is displaced volarward w/ forced
dorsiflexion of the wrist;
- most frequently dislocated carpal bone;
- w/ flexion
capitate slides out from under lunate to
create fullness where the capitate depression has been;
- Radiographs:
- lunate, capitate, and the base of the 3rd metacarpal are in line w/
each other & is covered by base of
ECRB;
- colinear alignment of: radius, lunate, capitate, & 3rd metacarpal;
- deviation of more than 15 deg either way between the links of chain may be
viewed as lax, diseased, or damaged;
- Exam:
- it is palpable just distal to radial tubercle;
- w/ flexion and extension lunate/capitate articulation may be felt;
- tenderness of dorsal lunate may suggest
Keinbock's dz, while more
ulnar tenderness suggests tears of
TFC or lunotriquetral ligament;
- knowing position of
ECU & ulnar styloid helds to differentiate ECU tendinitis
from distal radioulnar problems;
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Limited open reduction of the lunate facet in comminuted intra-articular
fractures of the distal radius.
Difficult wrist fractures. Perilunate fracture-dislocations of the wrist.
Late treatment of a dorsal transscaphoid, transtriquetral perilunate wrist dislocation
with avascular changes of the lunate.
